Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria.
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BACKGROUND: Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states. METHODS AND FINDINGS: Fifty-four percent of the health-care professionals (550/1,021) were sampled from public tertiary care facilities. Nine percent of professionals reported refusing to care for an HIV/AIDS patient, and 9% indicated that they had refused an HIV/AIDS patient admission to a hospital. Fifty-nine percent agreed that people with HIV/AIDS should be on a separate ward, and 40% believed a person's HIV status could be determined by his or her appearance. Ninety-one percent agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves. Forty percent believed that health-care professionals with HIV/AIDS should not be allowed to work in any area of health-care that requires patient contact. Twenty percent agreed that many with HIV/AIDS behaved immorally and deserve the disease. Basic materials needed for treatment and prevention of HIV were not adequately available. Twelve percent agreed that treatment of opportunistic infections in HIV/AIDS patients wastes resources, and 8% indicated that treating someone with HIV/AIDS is a waste of precious resources. Providers who reported working in facilities that did not always practice universal precautions were more likely to favor restrictive policies toward people with HIV/AIDS. Providers who reported less adequate training in HIV treatment and ethics were also more likely to report negative attitudes toward patients with HIV/AIDS. There was no consistent pattern of differences in negative attitudes and practices across the different health specialties surveyed. CONCLUSION: While most health-care professionals surveyed reported being in compliance with their ethical obligations despite the lack of resources, discriminatory behavior and attitudes toward patients with HIV/AIDS exist among a significant proportion of health-care professionals in the surveyed states. Inadequate education about HIV/AIDS and a lack of protective and treatment materials appear to contribute to these practices and attitudes. (+info)
Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients.
(74/595)
PURPOSE: Treatment access underlies quality cancer care. We hypothesize that mastectomy rates in a rural state are independently influenced by distance to radiation therapy (XRT) and by changing XRT access through opening new facilities. PATIENTS AND METHODS: Early-stage breast cancer patients diagnosed from 1996 to 2000 were identified in the Virginia state registry. Distance from patient zip code to nearest XRT facility was calculated with geographical software. Distance to XRT facility (< or = 10, > 10 to 25, > 25 to 50, and > 50 miles), American Joint Committee on Cancer tumor stage, age, race, and diagnosis year were evaluated for influencing mastectomy rate. Mastectomy use within 15 miles of five new facilities was assessed before and after opening. RESULTS: Among 20,094 patients, 43% underwent mastectomy, 53% underwent lumpectomy, and therapy of 4% of patients is unknown. Twenty-nine percent of patients lived more than 10 miles from XRT facility. Mastectomy increased with distance to XRT facility (43% at < or = 10 miles, 47% at > 10 to 25 miles, 53% at > 25 to 50 miles, and 58% at > 50 miles; P < .001). Among 11,597 patients with T1 (< 2 cm) tumors, mastectomy also varied by distance (31% at < or = 10 miles, 36% at > 10 to 25 miles, 41% at > 25 to 50 miles, and 49% at > 50 miles; P < .001). In multivariate analysis, mastectomy use was independently influenced by XRT distance after adjusting for age, race, T stage, and diagnosis year. Over the study period, mastectomy rates declined from 48% to 43% across Virginia, and there were similar declines in a 15-mile area around four new radiation facilities in urban settings. However, mastectomies decreased from 61% to 45% around a new XRT facility in a rural setting. CONCLUSION: Distance to XRT facility significantly impacts mastectomy use. Opportunities for increasing breast-conservation rates through improved XRT access exist. (+info)
Quality of care of modern health services as perceived by users and non-users in Burkina Faso.
(75/595)
OBJECTIVE: Only one-fifth of the population in rural Burkina Faso uses modern health services. This article aims to identify barriers to increased use, which may help decision makers to develop policies to remove them. DESIGN: This article compares perceived quality of care of 853 pairs of users and non-users of modern health services. Non-users were matched to users on age, sex, occupation of the head of the household and distance to health post. Questions were structured according to four dimensions of quality of care. SETTING: Nouna health care district, Burkina Faso. RESULTS: Both users and non-users were relatively favourable about health personnel practices and conduct (77% versus 70% of the maximum attainable score), and about health care delivery (77% versus 74%). They were less favourable about adequacy of resources and services (51% versus 46%), and financial and physical accessibility of care (57% versus 51%). Both groups were very negative regarding the availability of drugs (33% versus 27%). Users were more favourable than non-users overall (66% versus 61%), and especially regarding payment arrangements (51% versus 43%) and costs (50% versus 40%). Observed differences were generally significant. CONCLUSION: To remove barriers to increase utilization, policy makers may do good to target their attention to improve financial accessibility of modern health services and improve drugs availability. These factors seem most persistent in decisions of ill people to stay with home-based care and/or traditional medicine, or go to consult modern health services. (+info)
Contextual influences on the use of health facilities for childbirth in Africa.
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OBJECTIVES: Previous studies of maternal health-seeking behavior focused on individual- and household-level factors. We examined community-level influences on the decision to deliver a child in a health facility across 6 African countries. METHODS: Demographic and Health Survey data were linked with contextual data, and multilevel models were fitted to identify the determinants of childbirth in a health facility in the 6 countries. RESULTS: We found strong community-level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified. CONCLUSIONS: Community economic development, the climate of female autonomy, service provision, and fertility preferences all exert an influence on a woman's decision to seek care during labor, but significant community variation remains unexplained. (+info)
Safer injections following a new national medicine policy in the public sector, Burkina Faso 1995-2000.
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BACKGROUND: The common failure of health systems to ensure adequate and sufficient supplies of injection devices may have a negative impact on injection safety. We conducted an assessment in April 2001 to determine to which extent an increase in safe injection practices between 1995 and 2000 was related to the increased access to injection devices because of a new essential medicine policy in Burkina Faso. METHODS: We reviewed outcomes of the new medicine policy implemented in 1995. In April 2001, a retrospective programme review assessed the situation between 1995 and 2000. We visited 52 health care facilities where injections had been observed during a 2000 injection safety assessment and their adjacent operational public pharmaceutical depots. Data collection included structured observations of available injection devices and an estimation of the proportion of prescriptions including at least one injection. We interviewed wholesaler managers at national and regional levels on supply of injection devices to public health facilities. RESULTS: Fifty of 52 (96%) health care facilities were equipped with a pharmaceutical depot selling syringes and needles, 37 (74%) of which had been established between 1995 and 2000. Of 50 pharmaceutical depots, 96% had single-use 5 ml syringes available. At all facilities, patients were buying syringes and needles out of the depot for their injections prescribed at the dispensary. While injection devices were available in greater quantities, the proportion of prescriptions including at least one injection remained stable between 1995 (26.5%) and 2000 (23.8%). CONCLUSION: The implementation of pharmaceutical depots next to public health care facilities increased geographical access to essential medicines and basic supplies, among which syringes and needles, contributing substantially to safer injection practices in the absence of increased use of therapeutic injections. (+info)
No-fault compensation in New Zealand: harmonizing injury compensation, provider accountability, and patient safety.
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In 1974 New Zealand jettisoned a tort-based system for compensating medical injuries in favor of a government-funded compensation system. Although the system retained some residual fault elements, it essentially barred medical malpractice litigation. Reforms in 2005 expanded eligibility for compensation to all "treatment injuries," creating a true no-fault compensation system. Compared with a medical malpractice system, the New Zealand system offers more-timely compensation to a greater number of injured patients and more-effective processes for complaint resolution and provider accountability. The unfinished business lies in realizing its full potential for improving patient safety. (+info)
The incidence of induced abortion in Uganda.
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CONTEXT: Although Uganda's law permits induced abortion only to save a woman's life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS: A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS: Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country's most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women's health, increased access to contraceptive services is needed for all women. (+info)
Modelling distances travelled to government health services in Kenya.
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OBJECTIVE: To systematically evaluate descriptive measures of spatial access to medical treatment, as part of the millennium development goals to reduce the burden of HIV/AIDS, tuberculosis and malaria. METHODS: We obtained high-resolution spatial and epidemiological data on health services, population, transport network, topography, land cover and paediatric fever treatment in four Kenyan districts to develop access and use models for government health services in Kenya. Community survey data were used to model use of government health services by febrile children. A model based on the transport network was then implemented and adjusted for actual use patterns. We compared the predictive accuracy of this refined model to that of Euclidean distance metrics. RESULTS Higher-order facilities were more attractive to patients (54%, 58% and 60% in three scenarios) than lower-order ones. The transport network model, adjusted for competition between facilities, was most accurate and selected as the best-fit model. It estimated that 63% of the population of the study districts were within the 1 h national access benchmark, against 82% estimated by the Euclidean model. CONCLUSIONS: Extrapolating the results from the best-fit model in study districts to the national level shows that approximately six million people are currently incorrectly estimated to have access to government health services within 1 h. Simple Euclidean distance assumptions, which underpin needs assessments and against which millennium development goals are evaluated, thus require reconsideration. (+info)