Performance of village pharmacies and patient compliance after implementation of essential drug programme in rural Burkina Faso.
(17/1632)
After implementation of a nation-wide essential drug programme in Burkina Faso a prospective study was undertaken consisting of non-participant observation in the health centre and in the village pharmacy, and of household interviews with the patients. The study covered all general consultations in nine health centres in three districts over a two-week period as well as all client-vendor contacts in the corresponding village pharmacies; comprising 313 patients in consultations and 498 clients in eight village pharmacies with 12 vendors involved in dispensing 908 drugs. Additionally patients were interviewed in their households. Performance and utilization of the village pharmacy: 82.0% of the drugs prescribed in the health centres were actually dispensed at the village pharmacy, 5.9% of the drugs were not available at the village pharmacy. Wrong drugs were dispensed in 2.1% of cases. 41.3% of the drugs dispensed in the village pharmacy were bought without a prescription. Differences are seen between the district and are put in relation to different onset of the essential drug programme. Patient compliance: Patients could recall the correct dosage for 68.3% of the drugs. Drug taking compliance was 63.1%, derived from the pills remaining in the households. 11.5% of the drugs had obviously been taken incorrectly to such an extent that the occurrence of undesired drug effects was likely. The study demonstrates the success of the essential drug programme not only in performance but also in acceptability and utilization by the population. (+info)
Satisfaction with outpatient health care services in Manica Province, Mozambique.
(18/1632)
The objective of the study was to describe ambulatory health care services, determine the level of client satisfaction, and identify obstacles to care in a rural area of Mozambique. Exit surveys at 34 health clinics in Manica Province were completed on a sample of 879 adults representing between 1% and 2% of the average monthly visit totals at each clinic. Eighty-three per cent of interviewees were women. Just over half of the visits were for paediatric patients. Men were more likely to be at the clinic for their own health care needs than women (81% vs. 40%, p < 0.001). Of patients seen for acute illness, 45% were examined, 22% received preventive education, and 23% received prognostic information. Overall, 55% of interviewees believed that the service they received was good or very good, 32% rated it as fair, and 13% as poor. Satisfaction was positively associated with increased training level of the provider (p < 0.005), and shorter waiting times (p < 0.001). The most common complaints about the clinic visits were lack of adequate transportation, long waiting times, lack of physical examinations, and failure to receive prescribed medications. These findings suggest that the majority of Mozambicans interviewed are moderately satisfied with the available outpatient services in Manica. Provider training, provider availability and distribution of medicines were areas identified by respondents as needing improvement. (+info)
Determinants of patient choice of medical provider: a case study in rural China.
(19/1632)
This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of outpatient treatment from a household survey in Shunyi county of Beijing in 1993. This represents the first effort to identify and quantify the impact of individual factors on patient choice of provider in China. The results show that relative to self-pay patients, Government and Labour Health Insurance beneficiaries are more likely to use county hospitals, while patients covered by the rural Cooperative Medical System (CMS) are more likely to use village-level facilities. In addition, high-income patients are more likely to visit county hospitals than low-income patients. The results also reveal that disease patterns have a significant impact on patient choice of provider, implying that the ongoing process of health transition will lead people to use the higher quality services offered at the county hospitals. We discuss the implications of the results for organizing health care finance and delivery in rural China to achieve efficiency and equity. (+info)
A mobile unit: an effective service for cervical cancer screening among rural Thai women.
(20/1632)
BACKGROUND: We carried out a systematic screening programme using a mobile unit with the purpose of increasing use of Papanicolaou (Pap) smear screening among rural Thai women. The mobile unit campaign was carried out initially between January and February 1993 and then in 1996 in all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand. METHODS: To evaluate the effect of the programme on changes in knowledge and use of screening, we compared the results of three interview surveys of women, 18-65 years old, in villages selected by systematic sampling for each survey; first in 1991 (before the operation of the programme), secondly in 1994 (one year after the first screening campaign), and last in 1997 (one year after the second campaign). This report also compares data on Pap smears taken by the mobile unit with other existing screening services in the study area. RESULTS: A total of 1603, 1369, and 1576 women respectively, participated in each survey. The proportion of women reported knowing of the Pap smear test increased from 20.8% in 1991 to 57.3% in 1994 and to 75.5% in 1997. The proportion of women who had ever had a Pap smear increased from 19.9% in 1991 to 58.1% in 1994 and to 70.1% by 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers identified among the Pap smears taken by screening services in the area between 1992 and 1996. The rate of CIN III was 3.5/1000 smears in this screening programme, which was 5.2 and 2.0 times higher than the rates in the maternal and child health/family planning clinic and the annual one-week mass screening campaign respectively. CONCLUSIONS: The use of a mobile unit may be an effective screening programme in rural areas where existing screening activities cannot effectively reach the female population at risk. (+info)
Treatment costs and loss of work time to individuals with chronic lymphatic filariasis in rural communities in south India.
(21/1632)
This year-round case-control study investigated treatment costs and work time loss to people affected by chronic lymphatic filariasis in two rural communities in south India. About three-quarters of the patients sought treatment for filariasis at least once and 52% of them paid for treatment, incurring a mean annual expenditure of Rs. 72 (US $2.1; range Rs. 0-1360 (US $39.0)). Doctor's fees and medicines constituted 57% and 23% of treatment costs. The proportion of people seeking treatment was smaller and treatment costs constituted a higher proportion of household income in lower income groups. Most patients did not leave work, but spent only 4.36+/-3.41 h per day on economic activity compared to 5.25+/-3.52 h worked by controls; the mean difference of 0.89+/-4.20 h per day was highly significant (P<0.01). This loss of work time is perpetual, as chronic disease manifestations are mostly irreversible. An estimated 8% of potential male labour input is lost due to the disease. Regression analyses revealed that lymphatic filariasis has a significant effect on work time allotted to economic activity (P<0.05) but not on absenteeism from work (P>0.05). Female patients spent 0.31+/-1.42 h less on domestic activity compared to their matched controls (P<0.05). The results clearly show that the chronic form of lymphatic filariasis inflicts a considerable economic burden on affected individuals. (+info)
Confidential inquiry into malaria deaths.
(22/1632)
The results of a confidential inquiry into mortality attributed to malaria in South Africa's Mpumalanga Province are being used to guide the design of strategies for improving the management of cases and reducing the probability of deaths from the disease. (+info)
CD-ROM use by rural physicians.
(23/1632)
A survey of 131 eastern Washington rural family physicians showed that 59.5% owned a personal computer with a CD-ROM drive. There was an inverse correlation between the physicians' years in practice and computer ownership: 10 years or less (80.6%), 11 to 20 years (72.2%), 21 to 30 years (55.6%), and more than 30 years (32.4%). Those physicians who owned a computer used their CD-ROM for entertainment (52.6%), medical textbooks (44.9%), literature searching software (25.6%), drug information (17.9%), continuing medical education (15.4%), and journals on CD-ROM (11.5%). Many rural doctors who owned computers felt that CD-ROM software helped them provide better patient care (46.8%) and kept them current on new information and techniques (48.4%). Indications for medical education, libraries and CD-ROM publishers are noted. (+info)
Rural background and clinical rural rotations during medical training: effect on practice location.
(24/1632)
BACKGROUND: Providing health care services in rural communities in Canada remains a challenge. What affects a family medicine resident's decision concerning practice location? Does the resident's background or exposure to rural practice during clinical rotations affect that decision? METHODS: Cross-sectional mail survey of 159 physicians who graduated from the Family Medicine Program at Queen's University, Kingston, Ont., between 1977 and 1991. The outcome variables of interest were the size of community in which the graduate chose to practise on completion of training (rural [population less than 10,000] v. nonrural [population 10,000 or more]) and the size of community of practice when the survey was conducted (1993). The predictor or independent variables were age, sex, number of years in practice, exposure to rural practice during undergraduate and residency training, and size of hometown. RESULTS: Physicians who were raised in rural communities were 2.3 times more likely than those from nonrural communities to choose to practise in a rural community immediately after graduation (95% confidence interval 1.43-3.69, p = 0.001). They were also 2.5 times more likely to still be in rural practice at the time of the survey (95% confidence interval 1.53-4.01, p = 0.001). There was no association between exposure to rural practice during undergraduate or residency training and choosing to practise in a rural community. INTERPRETATION: Physicians who have roots in rural Canada are more likely to practise in rural Canada than those without such a background. (+info)