Male bias in health care utilization for under-fives in a rural community in western India.

A cross-sectional survey, in 1991, of 3100 families in 45 contiguous villages in the Pune district of Maharashtra state showed that 456 under-5-year-olds had suffered an acute respiratory infection and/or diarrhoea during the previous 7 days. Significantly more boys (88.9%) than girls (76.5%) were treated by a registered private medical practitioner (odds ratio (OR) = 2.51). Referrals for further treatment were followed by parents significantly more often in the case of their sons (69.2%) than daughters (25%) (OR = 6.75). An average of Rs 35 (US$1 1.16) was spent on the treatment of a son, compared with Rs 23 (US$ 0.76) for a daughter. In general, parents were willing to travel a greater distance (> 2 km) to seek medical treatment for their sons. These differences persisted even after adjusting for severity of illness, parent''s income, occupation and education, and the birth order of the child. Intervention programmes directed at under-fives would need to correct the bias against girls if equitable access to health care is to be achieved.     

手机与健康

近年来,手机作为移动通讯工具正以不可阻挡之势在中国迅速普及,而且正在成为人们生活中的必需品,手机微波辐射对人体健康的影响越来越引起人们的关注。     

Willingness to pay for rural health insurance through community participation in India

The main objective of this article is to examine the willingness to pay for a viable rural health insurance scheme through community participation in India, and the policy concerns it engenders. The willingness to pay for a rural health insurance scheme through community participation is estimated through a contingent valuation approach (logit model), by using the rural household survey on health from Karnataka State in India. The results show that insurance/saving schemes are popular in rural areas. In fact, people have relatively good knowledge of insurance schemes (especially life insurance) rather than saving schemes. Most of the people stated they are willing to join and pay for the proposed rural health insurance scheme. However, the probability of willingness to join was found to be greater than the probability of willingness to pay. Indeed, socio-economic factors and physical accessibility to quality health services appeared to be significant determinants of willingness to join and pay for such a scheme. The main justification for the willingness to pay for a proposed rural health insurance scheme are attributed from household survey results: (a) the existing government health care provider's services is not quality oriented; (b) is not easily accessible; and, (c) is not cost effective. The discussion suggests that policy makers in India should take serious note of the growing influence of the private sector and people's willingness to pay for organizing a rural health insurance scheme to provide quality and efficient health care in India. Policy interventions in health should not ignore private sector existence and people's willingness to pay for such a scheme and these two factors should be explicitly involved in the health management process. It is also argued that regulatory and supportive policy interventions are inevitable to promote this sector's viable and appropriate development in organizing a health insurance scheme.     

Evaluation of computerized health management information system for primary health care in rural India

Background  

The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India.     

远程心电会诊网络在社区卫生服务中的应用

为进一步深化医疗卫生体制改革,促进城乡协调发展,余姚市卫生系统对所辖区域内医疗卫生资源的整合机制进行了一系列积极的探索。通过社区远程心电会诊网络的建设,优化资源配置,提升了社区卫生服务的能力和效率,取得了良好成效。     

Assessing the health care needs of a rural community

This article describes the methods used to complete a recent community health needs assessment study in a rural area. It illustrates the strategic marketing and management value of conducting this type of assessment by examining selected results from the study and discussing their implications for the local health care delivery system.     

The substitutability of outpatient primary care in rural community health centers for inpatient hospital care.

To determine whether outpatient medical care obtained at federally funded rural community health centers (CHCs) in Maine acts primarily as a substitute or as a complement to inpatient care, a study of 36 communities served by CHCs was conducted. The hospital use of CHC users (age- and sex-adjusted admissions, days, and length of stay) was compared with that of nonusers from the same communities in 1980. Statistically lower rates of hospital admissions and days were observed for all CHC patients and for selected groups based on their age, sex, and insurance status (specifically Medicaid or Medicare). Hospital use of CHC community populations was then compared with that of 24 comparison communities without access to CHCs, using multiple linear regression in a pre/post design. The model tested, which included rates of health center use, insurance penetration, poverty, and hospital availability, among other factors, did not detect any differences in hospital use between CHC community and comparison populations. These results and additional data presented on selected hospital diagnoses and insurance coverage suggest that treatment, and hospitalization incentives, of CHC providers may reduce hospitalization. Clinic providers lack the economic, professional, and institutional incentives to hospitalize. Additional study to determine the actual substitutability effect is indicated.     

农村社区卫生服务的实践与思考

该区将城市社区卫生服务与农村初级卫生保健“合二为一”,在位于城郊结合部的6个乡镇开展了农村社区卫生服务的试点工作。主要做法:①以社区卫生服务联系系统内外、区域内外、行业内外,合理配置卫生资源,将卫生服务的重心移向社区;②以预防为主,走防治结合的道路,开展集医疗、预防、保健、康复、健康教育、计划生育技术指导“六位一体”的卫生服务;③乡镇卫生院由过去的以疾病为中心转向以健康为中心,由原来发展小专科走上发展社区卫生服务的道路;④将合作医疗保险与健康保健合同“合二为一”。主要体会:①当前开展农村社区卫生服务,顺应了第二次卫生革命的潮流;②发展农村社区卫生服务,亟需政府的关心、社会的支持和群众的拥护;③发展农村社区卫生服务,需要培养一批掌握适宜技术的全科医生。     

Current health scenario in rural India

ABSTRACT: India is the second most populous country of the world and has changing socio-political-demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growth-orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 27% of the population live. Contagious, infectious and waterborne diseases such as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in an holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current 'biomedical model' to a 'sociocultural model', which should bridge the gaps and improve quality of rural life, is the current need. A revised National Health Policy addressing the prevailing inequalities, and working towards promoting a long-term perspective plan, mainly for rural health, is imperative.     

Politics of rural health in India

The setting up of the National Rural Health Mission is yet another political move by the present government of India to make yet another promise to the long suffering rural population to improve their health status. As has happened so often in the past, it is based on questionable premises. It adopts a simplistic approach to a highly complex problem. The Union Ministry of Health and Family Welfare and its advisors, either because of ignorance or otherwise, have doggedly refused to learn from the many experiences of the past, both in terms of the efforts to earlier somewhat sincere efforts to develop endogenous mechanisms to offer access to health services as well as from the devastative impact on the painstakingly built rural health services of the imposition of prefabricated, ill-conceived, ill-formulated, techno-centric vertical programmes on the people of India. The also ignore some of the basic postulates of public health practice in a country like India. That did not substantiate the bases of some of their substantive contentions with scientific data obtained from health systems research reveals that they are not serious about their promise to rural population. This is yet another instance of what Romesh Thaper had called 'Baba Log playing government government'.     

Human and porcine Taenia solium infection in rural north India

72 members of a pig farming community and 50 slaughtered pigs in Uttar Pradesh, India, were examined between November 2000 and June 2001 for Taenia solium infection. 27 of the human subjects (38%) had intestinal taeniasis and 7 (9.7%) had reported seizures. All 3 of the latter who were examined had neurocysticercosis. 13 of the pigs (26%) had cysticercosis. Such high prevalences indicate the need for detailed assessment of the disease burden in this community.     

The household management of childhood diarrhea in rural north India

An in-depth anthropological study of child diarrhea in 3 villages in rural North India investigated the variation in the household management of child diarrhea. Qualitative and quantitative methodologies were used to collect data on a series of variables, including maternal knowledge, beliefs, and practices during diarrhea, feeding and fluid intake during diarrhea, treatment choices, and knowledge and use of oral rehydration therapy (ORT). The results showed both positive and negative diarrhea management behaviors. Almost all mothers continued to breastfeed normally, and did not decrease fluids during diarrhea. A shift in the child's diet toward 'softer' and 'cooler' foods rather than the withholding of food was the norm. The use of anti-diarrheals was widespread. Acceptance and sustained use of ORT was found to be inversely related to an understanding of the function of ORT. Eighty-one percent of mothers who had previously used ORT but who do not plan to use it again were dissatisfied because it 'did not stop the diarrhea'. These mothers thought that ORT was a medicine that would cure the diarrhea. Therefore, in ORT interventions there is a need to explain that the function of ORT is to replace lost fluids, and not to stop the diarrhea. Anthropological research of household diarrhea management can provide important information that will result in improved intervention design. Messages that are meant to change behavior must be based upon the target group's perception.     

Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics

Setting: Malawi has chronic shortages of health workers, high burdens of human immunodeficiency virus (HIV) infection and malaria and a predominately rural population. Mobile health clinics (MHCs) could provide primary health care for adults and children in hard-to-reach areas.Objectives: To determine the feasibility, volume, and types of services provided by three MHCs from 2011 to 2013 in Mulanje District, Malawi.Design: Cross-sectional retrospective study.Results: The MHCs conducted 309 492 visits for primary health care, and in 2013 services operated on 99% of planned days. Despite an improvement in service provision, overall patient visits declined over the study period. Malaria and respiratory and gastro-intestinal conditions constituted 60% of visits. Females (n = 11 543) significantly outnumbered males (n = 2481) tested for HIV, yet males tested HIV-positive (27%) more often than females (14%). Malaria accounted for 26 421 (35%) visits for children aged <5 years, with a significant increase in the rainy season. Implementation of rapid diagnostic testing was associated with a decline in numbers treated for malaria. Antibiotic stockouts at government clinics were associated with increased MHC visits.Conclusion: MHCs can routinely provide primary health care for adults and children living in rural Malawi and complement fixed clinics. Moving from a complementary role to integration within the government health system remains a challenge.     

Prevalence and associated risk factors of Taenia solium taeniasis in a rural pig farming community of north India

There is a lack of information on the disease burden due to Taenia solium taeniasis and its associated risk factors in pig farming communities throughout the world. The present study was conducted in a rural pig farming community of north India to estimate the prevalence of T. solium taeniasis and associated factors. Demographic, clinical and epidemiological data were collected from 1181 subjects in 210 households in 30 villages. Stool specimens from 924 subjects were examined for eggs of Taenia and other parasites. Identification of T. solium was confirmed by morphological features of segments and species-specific DNA detection from segments and stool. The prevalence of T. solium taeniasis was 18.6% (172/924); factors associated with taeniasis on multivariate analysis were age above 15 years, history of passage of Taenia segments in stool, undercooked pork consumption and poor hand hygiene (hand-washing with clay/water after defecation). Seventy-eight subjects (6.6%) with epilepsy were identified. The study showed alarmingly high rates of epilepsy and T. solium taeniasis in the study community; it highlights the need for large-scale imaging-based surveys to identify the factors associated with epilepsy including neurocysticercosis. Health education, mass anthelminthic therapy and other preventive measures are required to control the menace of the disease.     

大力发展农村卫生事业为建设海峡西岸社会主义新农村服务

新中国成立以来，福建省农村卫生同全国一样，取得了翻天覆地的变化，全省农村婴儿死亡率从200％。下降到13．77％0，农村孕产妇死亡率从1 500／10万下降到32．88／10万；传染病发病率从2 177．14／10万下降到217．82／10万；农村人口平均期望寿命从解放初期的35岁上升到2002年的72．4岁。到目前为止，全省有县级疾病预防控制中心84个，综合性医院102所，妇幼保健机构81所，中医院65所；乡镇卫生院939所，其中中心卫生院155所，乡镇卫生技术人员20 397名。