24 CFR 91.220 - Action plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... in its strategic plan; (C) Surplus from urban renewal settlements; (D) Grant funds returned to the...) Being discharged from publicly funded institutions and systems of care, such as health-care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and...

Inputs to quality: supervision, management, and community involvement in health facilities in Egypt in 2004.

PubMed

Cherlin, Emily J; Allam, Adel A; Linnander, Erika L; Wong, Rex; El-Toukhy, Essam; Sipsma, Heather; Krumholz, Harlan M; Curry, Leslie A; Bradley, Elizabeth H

2011-10-20

As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care. We conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics. Nearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities. Although the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.

Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

PubMed

Mugasha, Christine; Kigozi, Joanita; Kiragga, Agnes; Muganzi, Alex; Sewankambo, Nelson; Coutinho, Alex; Nakanjako, Damalie

2014-01-01

Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs. A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT.

Intra-Facility Linkage of HIV-Positive Mothers and HIV-Exposed Babies into HIV Chronic Care: Rural and Urban Experience in a Resource Limited Setting

PubMed Central

Mugasha, Christine; Kigozi, Joanita; Kiragga, Agnes; Muganzi, Alex; Sewankambo, Nelson; Coutinho, Alex; Nakanjako, Damalie

2014-01-01

Introduction Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs. Methods A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. Results Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1–3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3–15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. Conclusion Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT. PMID:25546453

Health Status and Working Condition of Migrant Workers: Major Public Health Problems

PubMed Central

Bener, Abdulbari

2017-01-01

Background: Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. Methods: This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. Results: There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type (P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours (P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms (P < 0.01). Multiple logistic regression was used for predictors’ health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. Conclusions: The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services. PMID:28966757

Health Status and Working Condition of Migrant Workers: Major Public Health Problems.

PubMed

Bener, Abdulbari

2017-01-01

Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type ( P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours ( P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms ( P < 0.01). Multiple logistic regression was used for predictors' health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services.

Women's use of private and government health facilities for childbirth in Nairobi's informal settlements.

PubMed

Bazant, Eva S; Koenig, Michael A; Fotso, Jean-Christophe; Mills, Samuel

2009-03-01

The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home.

Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana’s Community-based Health Planning and Services (CHPS)

PubMed Central

2014-01-01

Background Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Conclusions Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings. PMID:24690310

Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana's Community-based Health Planning and Services (CHPS).

PubMed

Adongo, Philip Baba; Phillips, James F; Aikins, Moses; Arhin, Doris Afua; Schmitt, Margaret; Nwameme, Adanna U; Tabong, Philip Teg-Nefaah; Binka, Fred N

2014-04-01

Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.

Strategic planning and marketing research for older, inner-city health care facilities: a case study.

PubMed

Wood, V R; Robertson, K R

1992-01-01

Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.

The rising burden of chronic conditions among urban poor: a three-year follow-up survey in Bengaluru, India.

PubMed

Gowda, Mrunalini J; Bhojani, Upendra; Devadasan, Narayanan; Beerenahally, Thriveni S

2015-08-15

Chronic conditions are on rise globally and in India. Prevailing intra-urban inequities in access to healthcare services compounds the problems faced by urban poor. This paper reports the trends in self-reported prevalence of chronic conditions and health-seeking pattern among residents of a poor urban neighborhood in south India. A cross sectional survey of 1099 households (5340 individuals) was conducted using a structured questionnaire. The prevalence and health-seeking pattern for chronic conditions in general and for hypertension and diabetes in particular were assessed and compared with a survey conducted in the same community three years ago. The predictors of prevalence and health-seeking pattern were analyzed through a multivariable logistic regression analysis. The overall self-reported prevalence of chronic conditions was 12%, with hypertension (7%) and diabetes (5.8%) being the common conditions. The self-reported prevalence of chronic conditions increased by 3.8 percentage point over a period of three years (OR: 1.5). Older people, women and people living below the poverty line had greater odds of having chronic conditions across the two studies compared. Majority of patients (89.3%) sought care from private health facilities indicating a decrease by 8.7 percentage points in use of government health facility compared to the earlier study (OR: 0.5). Patients seeking care from super specialty hospitals and those living below the poverty line were more likely to seek care from government health facilities. There is need to strengthen health services with a preferential focus on government services to assure affordable care for chronic conditions to urban poor.

Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan.

PubMed

Herberholz, Chantal; Phuntsho, Sonam

2018-06-18

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan. Copyright © 2018 Elsevier Ltd. All rights reserved.

Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria.

PubMed

Campbell, P C; Ebuehi, O M

2011-01-01

Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one' efforts. Several factors affect job satisfaction. To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. A cross sectional comparative study recruited qualified health workers selected by multi stage sampling technique from rural and urban health facilities in four local government areas (LGAs) of Ogun State in Southwestern Nigeria. Data were collected and analysed using Epi info V 3.5.1 RESULTS: The response rates were 88(88%) and 91(91%) respectively in the rural and urban areas. While urban workers derived satisfaction from availability of career development opportunities, materials and equipment, in their current job, rural workers derived satisfaction from community recognition of their work and improved staff relationship. Major de-motivating factors common to both groups were lack of supportive supervision, client-provider relationship and lack of in-service training. However more rural 74(84.1%) than urban 62(68.1%) health workers would prefer to continue working in their present health facilities (p=0.04). There was a statistically significant difference between the two groups in job satisfaction with respect to tools availability and career development opportunities (p<0.05). There is dissimilarity in factors influencing job satisfaction between rural and urban healthcare workers. There is need for human resource policy to be responsive to the diverse needs of health workers particularly at the primary level.

Birth in a health facility--inequalities among the Ethiopian women: results from repeated national surveys.

PubMed

Yesuf, Elias Ali; Kerie, Mirkuzie Woldie; Calderon-Margalit, Ronit

2014-01-01

Uptake of health facilities for delivery care in Ethiopia has not been examined in the light of equality. We investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal education. This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was analyzed using logistic regressions to estimate the weighted association between birth in a health facility and study's predictors. Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain low (5.4%,2000 and 11.8%,2011). Compared with women from rural places, women from urban areas had independent OR of a health facility delivery of 4.9 (95% CI: 3.4, 7.0), 5.0 (95% CI: 3.6, 6.9), and 4.6 (95% CI: 3.5, 6.0) in 2000, 2005, and 2011, respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively). Women of the upper economic quintile had 3.0-7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile, with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a health facility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and Somali getting relatively worse over time. The disparity related to urbanity or education in the use of health facility for birth in Ethiopia is staggering. There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between economic strata except for the richest households.

Impact of the Urban Reproductive Health Initiative on family planning uptake at facilities in Kenya, Nigeria, and Senegal.

PubMed

Winston, Jennifer; Calhoun, Lisa M; Corroon, Meghan; Guilkey, David; Speizer, Ilene

2018-01-05

The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The Urban Reproductive Health Initiative (URHI) was a Bill & Melinda Gates Foundation funded program designed to help contribute to these goals in urban areas in India, Kenya, Nigeria, and Senegal. URHI implemented a range of country-specific demand and supply side interventions, with supply interventions generally focused on improved service quality, provider training, outreach to patients, and commodity stock management. This study uses data collected by the Measurement, Learning & Evaluation (MLE) Project to examine the effectiveness of these supply-side interventions by considering URHI's influence on the number of family planning clients at health facilities over a four-year period in Kenya, Nigeria, and Senegal. The analysis used facility audits and provider surveys. Principal-components analysis was used to create country-specific program exposure variables for health facilities. Fixed-effects regression was used to determine whether family planning uptake increased at facilities with higher exposure. Outcomes of interest were the number of new family planning acceptors and the total number of family planning clients per reproductive health care provider in the last year. Higher program component scores were associated with an increase in new family planning acceptors per provider in Kenya (β = 18, 95% CI = 7-29), Nigeria (β = 14, 95% CI = 8-20), and Senegal (β = 7, 95% CI = 3-12). Higher scores were also associated with more family planning clients per provider in Kenya (β = 31, 95% CI = 7-56) and Nigeria (β = 26, 95% CI = 15-38), but not in Senegal. Supply-side interventions have increased the number of new family planning acceptors at facilities in urban Nigeria, Kenya, and Senegal and the overall number of clients in urban Nigeria and Kenya. While tailoring to the local environment, programs seeking to increase family planning use should include components to improve availability and quality of family planning services, which are part of a rights-based approach to family planning programming.

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

PubMed Central

Neuman, Melissa; Alcock, Glyn; Azad, Kishwar; Kuddus, Abdul; Osrin, David; More, Neena Shah; Nair, Nirmala; Tripathy, Prasanta; Sikorski, Catherine; Saville, Naomi; Sen, Aman; Colbourn, Tim; Houweling, Tanja A J; Seward, Nadine; Manandhar, Dharma S; Shrestha, Bhim P; Costello, Anthony; Prost, Audrey

2014-01-01

Objectives To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design Cross-sectional study. Setting 81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban). Participants 45 327 births occurring in the study areas between 2005 and 2012. Outcome measures Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location. Results Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57). Conclusions Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring. PMID:25550293

Geographic disparities in patient travel for dialysis in the United States.

PubMed

Stephens, J Mark; Brotherton, Samuel; Dunning, Stephan C; Emerson, Larry C; Gilbertson, David T; Harrison, David J; Kochevar, John J; McClellan, Ann C; McClellan, William M; Wan, Shaowei; Gitlin, Matthew

2013-01-01

To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients. Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software. The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles). Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life. © 2013 National Rural Health Association.

Rapid Urban Malaria Appraisal (RUMA) III: epidemiology of urban malaria in the municipality of Yopougon (Abidjan)

PubMed Central

Wang, Shr-Jie; Lengeler, Christian; Smith, Thomas A; Vounatsou, Penelope; Cissé, Guéladio; Tanner, Marcel

2006-01-01

Background Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated. Methods A health facility-based survey and health care system evaluation was carried out in a peripheral municipality of Abidjan (Yopougon) during the rainy season of 2002, applying a standardized Rapid Urban Malaria Appraisal (RUMA) methodology. Results According to national statistics, approximately 240,000 malaria cases (both clinical cases and laboratory confirmed cases) were reported by health facilities in the whole of Abidjan in 2001. They accounted for 40% of all consultations. In the health facilities of the Yopougon municipality, the malaria infection rates in fever cases for different age groups were 22.1% (under one year-olds), 42.8% (one to five years-olds), 42.0% (> five to 15 years-olds) and 26.8% (over 15 years-olds), while those in the control group were 13.0%. 26.7%, 21.8% and 14.6%, respectively. The fractions of malaria-attributable fever were 0.12, 0.22, 0.27 and 0.13 in the same age groups. Parasitaemia was homogenously detected in different areas of Yopougon. Among all children, 10.1% used a mosquito net (treated or not) the night before the survey and this was protective (OR = 0.52, 95% CI 0.29–0.97). Travel to rural areas within the last three months was frequent (31% of all respondents) and associated with a malaria infection (OR = 1.75, 95% CI 1.25–2.45). Conclusion Rapid urbanization has changed malaria epidemiology in Abidjan and endemicity was found to be moderate in Yopougon. Routine health statistics are not fully reliable to assess the burden of disease, and the low level of the fractions of malaria-attributable fevers indicated substantial over-treatment of malaria. PMID:16584575

The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya.

PubMed

Calhoun, Lisa M; Speizer, Ilene S; Guilkey, David; Bukusi, Elizabeth

2018-03-01

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death.

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.

PubMed

Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí

2010-09-17

Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas.

Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey

PubMed Central

2014-01-01

Background Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia. Methods A population-based survey was conducted in 2007 as part of the ‘REsponse to ACcountable priority setting for Trust in health systems’ (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban–rural residence. Results There were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with health facility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi. Conclusion Strong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a health facility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery. PMID:24996456

Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study

PubMed Central

2010-01-01

Background A large proportion of the 340,000 HIV-positive children in South Africa live in rural areas, yet there is little sub-Saharan data comparing rural paediatric antiretroviral therapy (ART) programme outcomes with urban facilities. We compared clinical, immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South Africa. Methods We conducted a retrospective cohort study of routine data of children enrolled on ART between November 2003 and March 2008 in three settings, namely: urban residence and facility attendance (urban group); rural residence and facility attendance (rural group); and rural residents attending urban facilities (rural/urban group). Outcome measures were: death, loss to follow up (LTFU), virological suppression, and changes in CD4 percentage and weight-for-age-z (WAZ) scores. Kaplan-Meier estimates, logrank tests, multivariable Cox regression and generalized estimating equation models were used to compare outcomes between groups. Results In total, 2332 ART-naïve children were included, (1727, 228 and 377 children in the urban, rural and rural/urban groups, respectively). At presentation, rural group children were older (6.7 vs. 5.6 and 5.8 years), had lower CD4 cell percentages (10.0% vs. 12.8% and 12.7%), lower WAZ scores (-2.06 vs. -1.46 and -1.41) and higher proportions with severe underweight (26% vs.15% and 15%) compared with the urban and rural/urban groups, respectively. Mortality was significantly higher in the rural group and LTFU significantly increased in the rural/urban group. After 24 months of ART, mortality probabilities were 3.4% (CI: 2.4-4.8%), 7.7% (CI: 4.5-13.0%) and 3.1% (CI: 1.7-5.6%) p = 0.0137; LTFU probabilities were 11.5% (CI: 9.3-14.0%), 8.8% (CI: 4.5-16.9%) and 16.6% (CI: 12.4-22.6%), p = 0.0028 in the urban, rural and rural/urban groups, respectively. The rural group had an increased adjusted mortality probability, adjusted hazards ratio 2.41 (CI: 1.25-4.67) and the rural/urban group had an increased adjusted LTFU probability, aHR 2.85 (CI: 1.41-5.79). The rural/urban group had a decreased adjusted probability of virological suppression compared with the urban group at any timepoint on treatment, adjusted odds ratio 0.67 (CI: 0.48-0.93). Conclusions Rural HIV-positive children are a vulnerable group, exhibiting delayed access to ART and an increased risk of poor outcomes while on ART. Expansion of rural paediatric ART programmes, with future research exploring improvements to rural health system effectiveness, is required. PMID:21108804

Utilization of travel reimbursement in the Veterans Health Administration.

PubMed

Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

2014-01-01

To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the nearest VHA facility increased their travel reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kc, Vikash Kumar; Jha, Nisha; Sharma, Damodar

2016-01-01

Background Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed. PMID:27540325

Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya

PubMed Central

Noor, A. M.; Zurovac, D.; Hay, S. I.; Ochola, S. A.; Snow, R. W.

2010-01-01

Summary Distance is a crucial feature of health service use and yet its application and utility to health care planning have not been well explored, particularly in the light of large-scale international and national efforts such as Roll Back Malaria. We have developed a high-resolution map of population-to-service access in four districts of Kenya. Theoretical physical access, based upon national targets, developed as part of the Kenyan health sector reform agenda, was compared with actual health service usage data among 1668 paediatric patients attending 81 sampled government health facilities. Actual and theoretical use were highly correlated. Patients in the larger districts of Kwale and Makueni, where access to government health facilities was relatively poor, travelled greater mean distances than those in Greater Kisii and Bondo. More than 60% of the patients in the four districts attended health facilities within a 5-km range. Interpolated physical access surfaces across districts highlighted areas of poor access and large differences between urban and rural settings. Users from rural communities travelled greater distances to health facilities than those in urban communities. The implications of planning and monitoring equitable delivery of clinical services at national and international levels are discussed. PMID:14516303

Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District.

PubMed

Ng'anjo Phiri, Selia; Fylkesnes, Knut; Moland, Karen Marie; Byskov, Jens; Kiserud, Torvid

2016-01-01

Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district. A cross-sectional survey was conducted in 2011 as part of the 'Response to Accountable priority setting for Trust in health systems' (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas. A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71-75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60-2.71%) than in rural areas 0.4% (95% CI 0.27-0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55-8.76). Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths.

HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings.

PubMed

Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche

2018-06-01

HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman-infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman-infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.

Use of health care among febrile children from urban poor households in Senegal: does the neighbourhood have an impact?

PubMed

Kone, Georges Karna; Lalou, Richard; Audibert, Martine; Lafarge, Hervé; Dos Santos, Stéphanie; Ndonky, Alphousseyni; Le Hesran, Jean-Yves

2015-12-01

Urban malaria is considered a major public health problem in Africa. The malaria vector is well adapted in urban settings and autochthonous malaria has increased. Antimalarial treatments prescribed presumptively or after rapid diagnostic tests are also highly used in urban settings. Furthermore, health care strategies for urban malaria must comply with heterogeneous neighbourhood ecosystems where health-related risks and opportunities are spatially varied. This article aims to assess the capacity of the urban living environment to mitigate or increase individual or household vulnerabilities that influence the use of health services. The data are drawn from a survey on urban malaria conducted between 2008 and 2009. The study sample was selected using a two-stage randomized sampling. The questionnaire survey covered 2952 households that reported a case of fever episode in children below 10 years during the month before the survey.Self-medication is a widespread practice for children, particularly among the poorest households in Dakar. For rich households, self-medication for children is more a transitional practice enabling families to avoid opportunity costs related to visits to health facilities. For the poorest, it is a forced choice and often the only treatment option. However, the poor that live in well-equipped neighbourhoods inhabited by wealthy residents tend to behave as their rich neighbours. They grasp the opportunities provided by the area and adjust their behaviours accordingly. Though health care for children is strongly influenced by household socio-economic characteristics, neighbourhood resources (facilities and social networks) will promote health care among the poorest and reduce access inequalities. Without being a key factor, the neighbourhood of residence-when it provides resources-may be of some help to overcome the financial hurdle. Findings suggest that the neighbourhood (local setting) is a relevant scale for health programmes in African cities. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

HEALTH INSURANCE AND HEALTH CARE AMONG THE MID-AGED AND OLDER CHINESE: EVIDENCE FROM THE NATIONAL BASELINE SURVEY OF CHARLS

PubMed Central

Zhang, Chuanchuan; Lei, Xiaoyan; Strauss, John; Zhao, Yaohui

2016-01-01

SUMMARY We document the recent profile of health insurance and health care among mid-aged and older Chinese using data from the China Health and Retirement Longitudinal Study conducted in 2011. Overall health insurance coverage is about 93%. Multivariate regressions show that respondents with lower income as measured by per capita expenditure have a lower chance of being insured, as do the less-educated, older, and divorced/widowed women and rural-registered people. Premiums and reimbursement rates of health insurance vary significantly by schemes. Inpatient reimbursement rates for urban people increase with total cost to a plateau of 60%; rural people receive much less. Demographic characteristics such as age, education, marriage status, per capita expenditure, and self-reported health status are not significantly associated with share of out-of-pocket cost after controlling community effects. For health service use, we find large gaps that vary across health insurance plans, especially for inpatient service. People with access to urban health insurance plans are more likely to use health services. In general, Chinese people have easy access to median low-level medical facilities. It is also not difficult to access general hospitals or specialized hospitals, but there exists better access to healthcare facilities in urban areas. PMID:26856894

Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh

PubMed Central

Adams, Alayne M; Islam, Rubana; Ahmed, Tanvir

2015-01-01

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5–6 days/week, but close by 4–5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor. PMID:25759453

Access to Health Services Among Slum Dwellers in an Industrial Township and Surrounding Rural Areas: A Rapid Epidemiological Assessment

PubMed Central

Banerjee, Amitav; Bhawalkar, J.S.; Jadhav, S.L.; Rathod, Hetal; Khedkar, D.T.

2012-01-01

Context: The biggest challenge in implementing the primary health care principles is of equitable distribution of health care to all. The rural masses and urban slum dwellers are most vulnerable to lack of access to health care. Aim: To study access to health services among slum dwellers and rural population. Setting and Design: A cross-sectional survey in an urban slum and surrounding rural areas in field practice area of a medical college. Materials and Methods: Structured instrument along with qualitative techniques such as focus group discussions, were used to collect information on access and utilization of health services from 865 individuals of both sexes and all ages selected from urban slums, villages, and indoor and outdoor patients. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. Results: More than 50% of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases and malnutrition (especially in children), risk of lifestyle diseases as evidenced by high Body mass index in 25% of adults surveyed was found. Private medical practitioners were more accessible than government facilities. More than 60% sought treatment from private medical facilities for their own ailments (for sickness in children this proportion was 74%). People who visited government facilities were more dissatisfied with the services (30.88%) than those who visited private facilities (18.31%). This difference was significant (OR=1.99, 95% confidence interval 1.40 to 2.88; χ2 =15.95, df=1, P=0.007). The main barriers to health care identified were waiting time long, affordability, poor quality of care, distance, and attitude of health workers. Conclusion: The underprivileged in India continue to have poor access to basic determinants of good health as well as to curative services from government sources during illness. PMID:24478995

The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study.

PubMed

Panciera, Rocco; Khan, Akib; Rizvi, Syed Jafar Raza; Ahmed, Shakil; Ahmed, Tanvir; Islam, Rubana; Adams, Alayne M

2016-08-22

Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors. Increasing travel time to the nearest EmOC facility is found to act as a strong deterrent to seeking care for the urban poor in Sylhet. Logistic regression results indicate that a 5-min increase in travel time to the nearest EmOC facility is associated with a 30 % decrease (0.655 odds ratio, 95 % CI: 0.529-0.811) in the likelihood of delivery at an EmOC facility rather than at home. Moreover, the impact of travel time varies substantially between public, NGO and private facilities. A 5-min increase in travel time from a private EmOC facility is associated with a 32.9 % decrease in the likelihood of delivering at a private facility, while for public and Non-Government Organizations (NGO) EmOC facilities, the impact is lower (28.2 and 28.6 % decrease respectively). Other strong determinants of delivery at an EmOC facility are the use of antenatal care and mother's formal education, while Muslim mothers are found to be more likely to deliver at home. Geospatial evidence points to the need to strengthen referral and emergency transport systems in order to reduce urban travel time, and establish or relocate EmOC facilities closer to where the poor reside. However, female education and antenatal care coverage remain the most important determinants of facility delivery.

Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Akazili, James; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F

2015-01-01

Despite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament. This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factors that account for differences in efficiency and determine the association between quality care and efficiency levels. The study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regions in southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilities while Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation test was performed to determine the association between quality care and efficiency. Overall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the 20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilities and 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9; p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % technical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant association was found between technical efficiency scores of health facilities and many technical quality care proxies, except in overall quality score per the NHIS accreditation data (Coef. = -0.3158; p < 0.05) and SafeCare Essentials quality score on environmental safety for staff and patients (Coef. = -0.2764; p < 0.05) where the association was negative. The findings suggest some level of wastage of health resources in many healthcare facilities, especially those located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective need analysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limited resources without compromising quality care standards.

Basrah Children’s Hospital, Basrah, Iraq

DTIC Science & Technology

2009-07-28

that 97% of urban and 79% of rural populations had access to health care, which included public health programs for malaria and tuberculosis control...construct the medical logistics warehouses landscaping install kitchen and laundry equipment medical equipment (medical waste autoclave, oxygen...addition, the SOW required the construction of supporting facilities to include the following: cafeteria and associated facilities (i.e. kitchen

Prevalence of School Policies, Programs, and Facilities That Promote a Healthy Physical School Environment

PubMed Central

Everett Jones, Sherry; Brener, Nancy D.; McManus, Tim

2003-01-01

Objectives. We examined the extent to which schools in the United States have health-promoting policies, programs, and facilities. Methods. We analyzed data from the School Health Policies and Programs Study 2000. Results. We found that public schools (vs private and Catholic schools), urban schools (vs rural and suburban schools), and schools with larger enrollments (vs smaller schools) had more health-promoting policies, programs, and facilities in place. On average, middle schools had 11.0 and middle/junior and high schools had 10.4 out of a possible 18 policies, programs, and facilities. Conclusions. Although some schools had many healthy physical environment features, room for improvement exists. Resources are available to help schools improve their health-promoting policies, programs, and facilities. PMID:12948982

Health Insurance and Health Care among the Mid-Aged and Older Chinese: Evidence from the National Baseline Survey of CHARLS.

PubMed

Zhang, Chuanchuan; Lei, Xiaoyan; Strauss, John; Zhao, Yaohui

2017-04-01

We document the recent profile of health insurance and health care among mid-aged and older Chinese using data from the China Health and Retirement Longitudinal Study conducted in 2011. Overall health insurance coverage is about 93%. Multivariate regressions show that respondents with lower income as measured by per capita expenditure have a lower chance of being insured, as do the less-educated, older, and divorced/widowed women and rural-registered people. Premiums and reimbursement rates of health insurance vary significantly by schemes. Inpatient reimbursement rates for urban people increase with total cost to a plateau of 60%; rural people receive much less. Demographic characteristics such as age, education, marriage status, per capita expenditure, and self-reported health status are not significantly associated with share of out-of-pocket cost after controlling community effects. For health service use, we find large gaps that vary across health insurance plans, especially for inpatient service. People with access to urban health insurance plans are more likely to use health services. In general, Chinese people have easy access to median low-level medical facilities. It is also not difficult to access general hospitals or specialized hospitals, but there exists better access to healthcare facilities in urban areas. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India.

PubMed

Ranson, Michael Kent; Jayaswal, Rupal; Mills, Anne J

2012-07-01

In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care. A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth. Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care. In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively-with a focus, for example, on rural areas and urban slum areas-in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India

PubMed Central

Ranson, Michael Kent; Jayaswal, Rupal; Mills, Anne J

2012-01-01

Background In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care. Methods A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth. Results Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care. Conclusions In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively—with a focus, for example, on rural areas and urban slum areas—in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated. PMID:21653545

Effects of low birth weight on time to BCG vaccination in an urban poor settlement in Nairobi, Kenya: an observational cohort study.

PubMed

Mutua, Martin Kavao; Ochako, Rhoune; Ettarh, Remare; Ravn, Henrik; Echoka, Elizabeth; Mwaniki, Peter

2015-04-18

The World Health Organization recommends Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis be given at birth. However, in many developing countries, pre-term and low birth weight infants get vaccinated only after they gain the desired weight. In Kenya, the ministry of health recommends pre-term and low birth weight infants to be immunized at the time of discharge from hospital irrespective of their weight. This paper seeks to understand the effects of birth weight on timing of BCG vaccine. The study was conducted in two Nairobi urban informal settlements, Korogocho and Viwandani which hosts the Nairobi Urban Health and Demographic Surveillance system. All infants born in the study area since September 2006 were included in the study. Data on immunization history and birth weight of the infant were recorded from child's clinic card. Follow up visits were done every four months to update immunization status of the child. A total of 3,602 infants were included in this analysis. Log normal accelerated failure time parametric model was used to assess the association between low birth weight infants and time to BCG immunization. In total, 229 (6.4%) infants were low birth weight. About 16.6% of the low birth weight infants weighed less than 2000 grams and 83.4% weighed between 2000 and 2490 grams. Results showed that, 60% of the low birth weight infants received BCG vaccine after more than five weeks of life. Private health facilities were less likely to administer a BCG vaccine on time compared to public health facilities. The effects of low birth weight on females was 0.60 and 0.97-times that of males for infants weighing 2000-2499 grams and for infants weighing <2000 grams respectively. The effect of low birth weight among infants born in public health facilities was 1.52 and 3.94-times that of infants delivered in private health facilities for infants weighing 2000-2499 grams and those weighing < 2000 grams respectively. Low birth weight infants received BCG immunization late compared to normal birth weight infants. Low birth weight infants delivered in public health facilities were more likely to be immunized much later compared to private health facilities.

Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Uthman, Olalekan A; Amouzou, Agbessi

2018-01-01

Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women's access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Cross-sectional data on 37,086 community dwelling women aged between 15-49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don't trust facility/poor service, 5) No female provider, 6) Husband/family didn't allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3-57.9) in Nigeria and 45.4% (42.0-47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.

The Role of Gender Empowerment on Reproductive Health Outcomes in Urban Nigeria

PubMed Central

Speizer, Ilene S.; Fotso, Jean-Christophe; Akiode, Akinsewa; Saad, Abdulmumin; Calhoun, Lisa; Irani, Laili

2014-01-01

Objectives To date, limited evidence is available for urban populations in sub-Saharan Africa, specifically research into the association between urban women’s empowerment and reproductive health outcomes. The objective of this study is to investigate whether women’s empowerment in urban Nigerian settings is associated with family planning use and maternal health behaviors. Moreover, we examine whether different effects of empowerment exist by region of residence. Methods This study uses baseline household survey data from the Measurement, Learning & Evaluation Project (MLE) for the Nigerian Urban Reproductive Health Initiative (NURHI) being implemented in six major cities. We examine four dimensions of empowerment: economic freedom, attitudes towards domestic violence, partner prohibitions and decision-making. We determine if the empowerment dimensions have different effects on reproductive health outcomes by region of residence using multivariate analyses. Results Results indicate that more empowered women are more likely to use modern contraception, deliver in a health facility and have a skilled attendant at birth. These trends vary by empowerment dimension and by city/region in Nigeria. Conclusions We conclude by discussing the implications of these findings on future programs seeking to improve reproductive health outcomes in urban Nigeria and beyond. PMID:23576403

Prevalence and factors associated with underutilization of antenatal care services in Nigeria: A comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey

PubMed Central

Auta, Asa; Khanal, Vishnu; Bamidele, Olasunkanmi David; Akuoko, Cynthia Pomaa; Adefemi, Kazeem; Tapshak, Samson Joseph; Zhao, Yun

2018-01-01

Introduction Antenatal care (ANC) is a major public health intervention aimed at ensuring safe pregnancy outcomes. In Nigeria, the recommended minimum of four times ANC attendance is underutilized. This study investigates the prevalence and factors associated with underutilization of ANC services with a focus on the differences between rural and urban residences in Nigeria. Methods We analyzed the 2013 Nigeria Demographic and Health Survey dataset with adjustment for the sampling weight and the cluster design of the survey. The prevalence of underutilization of ANC was assessed using frequency tabulation while associated factors were examined using Chi-Square test and multivariable logistic regression analysis. Results The prevalence of underutilization of ANC was 46.5% in Nigeria, 61.1% in rural residence and 22.4% in urban residence. The North-West region had the highest prevalence of ANC underuse in Nigeria at 69.3%, 76.6% and 44.8% for the overall, rural and urban residences respectively. Factors associated with greater odds of ANC underuse in rural residence were maternal non-working status, birth interval < 24 months, single birth type, not listening to radio at all, lack of companionship to health facility and not getting money for health services. In urban residence, mothers professing Islam, those who did not read newspaper at all, and those who lacked health insurance, had greater odds of ANC underuse. In both rural and urban residence, maternal and husband’s education level, region of residence, wealth index, maternal age, frequency of watching television, distance to- and permission to visit health facility were significantly associated with ANC underuse. Conclusions Rural-urban differences exist in the use of ANC services, and to varying degrees, factors associated with underuse of ANC in Nigeria. Interventions aimed at addressing factors identified in this study may help to improve the utilization of ANC services both in rural and urban Nigeria. Such interventions need to focus more on reducing socioeconomic, geographic and regional disparities in access to ANC in Nigeria. PMID:29782511

Prevalence and factors associated with underutilization of antenatal care services in Nigeria: A comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey.

PubMed

Adewuyi, Emmanuel Olorunleke; Auta, Asa; Khanal, Vishnu; Bamidele, Olasunkanmi David; Akuoko, Cynthia Pomaa; Adefemi, Kazeem; Tapshak, Samson Joseph; Zhao, Yun

2018-01-01

Antenatal care (ANC) is a major public health intervention aimed at ensuring safe pregnancy outcomes. In Nigeria, the recommended minimum of four times ANC attendance is underutilized. This study investigates the prevalence and factors associated with underutilization of ANC services with a focus on the differences between rural and urban residences in Nigeria. We analyzed the 2013 Nigeria Demographic and Health Survey dataset with adjustment for the sampling weight and the cluster design of the survey. The prevalence of underutilization of ANC was assessed using frequency tabulation while associated factors were examined using Chi-Square test and multivariable logistic regression analysis. The prevalence of underutilization of ANC was 46.5% in Nigeria, 61.1% in rural residence and 22.4% in urban residence. The North-West region had the highest prevalence of ANC underuse in Nigeria at 69.3%, 76.6% and 44.8% for the overall, rural and urban residences respectively. Factors associated with greater odds of ANC underuse in rural residence were maternal non-working status, birth interval < 24 months, single birth type, not listening to radio at all, lack of companionship to health facility and not getting money for health services. In urban residence, mothers professing Islam, those who did not read newspaper at all, and those who lacked health insurance, had greater odds of ANC underuse. In both rural and urban residence, maternal and husband's education level, region of residence, wealth index, maternal age, frequency of watching television, distance to- and permission to visit health facility were significantly associated with ANC underuse. Rural-urban differences exist in the use of ANC services, and to varying degrees, factors associated with underuse of ANC in Nigeria. Interventions aimed at addressing factors identified in this study may help to improve the utilization of ANC services both in rural and urban Nigeria. Such interventions need to focus more on reducing socioeconomic, geographic and regional disparities in access to ANC in Nigeria.

Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso.

PubMed

Schoeps, A; Ouédraogo, N; Kagoné, M; Sié, A; Müller, O; Becher, H

2013-12-17

To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time. Copyright © 2013 Elsevier Ltd. All rights reserved.

Differences in health care seeking behaviour between rural and urban communities in South Africa

PubMed Central

2012-01-01

Objective The aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population. Design A cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. Results The results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988). Conclusion Recommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour. PMID:22691443

Improving the urban environment.

PubMed

Rotibi, A

1992-11-01

An effective environmental sanitation program should encompass key features considered necessary for a primary health care (PHC) program such as availability, accessibility, affordability, acceptability, and practicability. Poor housing conditions give rise to stress, delinquency, and crime, as well as to helminthic and other parasitic infestations. In Africa, urbanization has accelerated since the 1950s because of rural-urban migration. In Nigeria new housing construction has been poor, with inadequate provision of physical facilities and community services in residential areas. Overcrowding is rampant, with occupancy rates of 2-3 persons per room recorded for many cities including Owerri, Abba, Warri and Ontisha. In a survey of rooming-house facilities in Lagos, the average was 5-7 persons per room. 47% of households were living in just one rooms in Sokoto and 80% in the Lagos metropolitan area. An urban household survey by the Federal Office of Statistics found that 45% of households were without electricity. Similarly, 46% of households were found to be without running water, 29% obtained their water from wells, and 14% from streams. The inadequate provision of toilets poses major health risks. Many Nigerian cities lack efficient waste disposal systems: in Ibadan mounds of uncollected rubbish obstruct the roads. According to a Statistics Office survey 48% of refuse is estimated to be dumped illegally, while 23% is simply heaped in family compounds. A recently launched campaign on environmental sanitation is the start of improving the health of urban dwellers which could cut expenditure on curative health measures.

Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh.

PubMed

Adams, Alayne M; Islam, Rubana; Ahmed, Tanvir

2015-03-01

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5-6 days/week, but close by 4-5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

Management of Urban Stormwater Runoff in the Chesapeake Bay Watershed

USGS Publications Warehouse

Hogan, Dianna M.

2008-01-01

Urban and suburban development is associated with elevated nutrients, sediment, and other pollutants in stormwater runoff, impacting the physical and environmental health of area streams and downstream water bodies such as the Chesapeake Bay. Stormwater management facilities, also known as Best Management Practices (BMPs), are increasingly being used in urban areas to replace functions, such as flood protection and water quality improvement, originally performed by wetlands and riparian areas. Scientists from the U.S. Geological Survey (USGS) have partnered with local, academic, and other Federal agency scientists to better understand the effectiveness of different stormwater management systems with respect to Chesapeake Bay health. Management of stormwater runoff is necessary in urban areas to address flooding and water quality concerns. Improving our understanding of what stormwater management actions may be best suited for different types of developed areas could help protect the environmental health of downstream water bodies that ultimately receive runoff from urban landscapes.

Do slums matter? Location and early childhood preventive care choices among urban residents of Bangladesh.

PubMed

Heller, Lauren R

2013-10-01

Upward trends in the relative proportions of slum residents in developing countries have led to widespread concern regarding the impact of slum residency on health behaviors. Measurement of these impacts requires recognizing that unobservable household characteristics that affect the location decision may also affect health care choices and outcomes. To address the potential for bias, this paper models the location decision and the household's demand for maternal and child health services simultaneously using a flexible, semi-parametric approach. It uses a unique urban data set from Bangladesh that incorporates sophisticated geographical mapping techniques to carefully delineate between slum and non-slum areas at a particular point in time. The results suggest that accounting for the endogenous location decision of a family substantially reduces bias in estimated marginal effects of slum residence on preventive care demand. While community infrastructure variables appear correlated with preventive care demand, the causal effect of the availability of primary health care facilities is indistinguishable from zero when unobserved heterogeneity is taken into account. The findings suggest that improvements in community infrastructure in urban areas of developing countries are a more favorable health policy solution at the margin than the construction of additional health care facilities. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Highland Park Environmental Health Plan: Evaluation and Recommendations for Improving the Urban Environment.

ERIC Educational Resources Information Center

Michigan State Dept. of Commerce, Lansing. Community Planning Div.

The Highland Park environmental health plan includes the following components: Legal and administrative and programmatic relationships, planning studies, residential environment, disease vector control, water and sewage systems, sanitation, air pollution, food protection, industrial and radiological health, and solid waste facilities. (JR)

R.E.A.C.H.: An After-School Approach to Physical Education

ERIC Educational Resources Information Center

Marttinen, Risto; Fredrick, Ray N., III.

2017-01-01

After-school physical activity programs are great opportunities to increase daily physical activity for adolescent youth in urban environments who often do not get the recommended amounts of physical activity needed for health benefits. Black and Hispanic youth in urban environments are particularly under-resourced in not just facilities but…

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries.

PubMed

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-06-01

Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric services" (≥30% of facility deliveries) were only found in three countries. The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care.

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

PubMed Central

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-01-01

Background Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. Methods We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities “ready to provide obstetric services” had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Results Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and “ready to provide obstetric services” were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and “ready to provide obstetric services”, respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities “ready to provide obstetric services”. Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities “ready to provide obstetric services” (≥30% of facility deliveries) were only found in three countries. Conclusions The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care. PMID:29862026

Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana

PubMed Central

Afulani, Patience A.

2015-01-01

Background Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana–focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. Methods The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. Results Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. Implications Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC. PMID:25695737

Organizational factors influencing health information technology adoption in long-term-care facilities.

PubMed

Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

2014-01-01

Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: the case of Mexico.

PubMed

Grogger, Jeffrey; Arnold, Tamara; León, Ana Sofía; Ome, Alejandro

2015-06-01

Low- and middle-income countries increasingly provide broad-based public health coverage to their residents. One of the goals of such programmes is to reduce the extent to which beneficiaries incur catastrophic out-of-pocket expenditures on health care. A recent field experiment showed that on average Mexico's new public insurance programme reduced such expenditures in rural areas. Our reanalysis of that data, augmented with administrative data on health infrastructure, shows that this effect depends strongly on the type of health facility to which the beneficiary has access. A second analysis, based on data from Mexico's National Household Income and Expenditure Surveys (abbreviated ENIGH for its name in Spanish), substantiates those findings. It shows that catastrophic expenditures have fallen sharply for rural households with access to well-staffed facilities, but that they have fallen little if at all for rural households with access to poorly staffed facilities. Our analysis of the ENIGH also shows that Mexico's public health insurance programme has sharply reduced catastrophic spending among urban households. Considering that most Mexicans live either in urban areas or in rural areas with access to well-staffed facilities, our results show that the public health insurance programme has been largely successful in achieving one of its key goals. At the same time, our results show how difficult it can be to provide effective protection against catastrophic health expenditures for residents of remote rural areas. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

PubMed

Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-06-27

To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services ( P <.001). Public facilities were less likely than private facilities to have high-quality services ( P =.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. © Mpunga et al.

Health seeking behaviour and health awareness among rural and urban adolescents in Dehradun District, Uttarakhand, India.

PubMed

Kumar, Tuhin; Pal, Piyalee; Kaur, Prabhdeep

2017-04-01

Adolescents constituted 19% population of India in 2011. Adolescents have health seeking behaviour different from that of adults. We estimated the utilisation of available health care services by adolescents and awareness regarding various health issues in the urban and rural Dehradun District, Uttarakhand, India. We also described knowledge and practices of public sector health care providers. We conducted a cross-sectional survey among adolescents 10-19 years in the urban Dehradun and rural Chakrata block of the Dehradun District. We used cluster sampling with sample size 680 each in urban and rural areas. We collected data from adolescents using semi structured questionnaire on health awareness and utilisation of health care services. Public sector health care providers were surveyed about their knowledge and practices regarding adolescents health. We surveyed 1463 adolescents. The overall mean age was 14.4 (2.6) years, about half being females. Half of the adolescents who had any illness used the public sector. Awareness about anaemia was 48% in urban and 12% in rural areas. A higher proportion of females (Rural: 89%, Urban: 76%) were aware of condoms as contraceptives than males (Rural: 68%, Urban: 12%). Only 62% of doctors and 49% of paramedical staff had knowledge regarding services under Adolescents Reproductive and Sexual Health (ARSH). Awareness regarding various health issues was low among males as compared to females, especially in rural areas. School based health promotion programs should be carried out to increase awareness among adolescents. Health facilities should be strengthened to provide adolescent friendly health services to enhance utilisation.

Reproductive healthcare utilization in urban poor settlements of Delhi: Baseline survey of ANCHUL (Ante Natal and Child Health care in Urban Slums) project.

PubMed

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Allen, Elizebeth; Sharma, Saket; Shankar, Anuraj H; Zodpey, Sanjay

2015-09-08

Disparity in utilization of reproductive healthcare services between the urban poor and the urban non-poor households in the developing nations is well known. However, disparity may also exist within urban poor households. Our objective was to document the extent of disparity in reproductive healthcare utilization among the urban poor and to identify the socio-demographic determinants of underutilization with a view to characterizing this vulnerable subpopulation. A survey of 16,221 households was conducted in 39 clusters from two large urban poor settlements in Delhi. From 13,451 consenting households, socio-demographic data and information on births, maternal and child deaths within the previous year was collected. Details of antenatal care (ANC) was collected from 597 pregnant women. Information on ANC and postnatal care was also obtained from 596 recently delivered (within six months) mothers. All data were captured electronically using a customized and validated smart phone application. Households were categorized into quintiles of socio-economic position (SEP) based on dwelling characteristics and possession of durable assets using principal component analysis. Potential socio-demographic determinants of reproductive healthcare utilization were examined using random effects logistic regression. The prevalence of facility based birthing was 77% (n = 596 mothers). Of the 596 recently delivered mothers only 70% had an ANC registration card, 46.3% had ANC in their first trimester, 46% had visited a facility within 4 weeks post-delivery and 27% were using modern contraceptive methods. Low socio-economic position was the most important predictor of underutilization with a clear gradient across SEP quintiles. Compared to the poorest, the least poor women were more likely to be registered for ANC (OR 1.96, 95%CI 0.95-4.15) and more likely to have made ≥ 4 ANC visits (OR 5.86, 95%CI 2.82-12.19). They were more likely to have given birth in a facility (OR 4.87, 95%CI 2.12-11.16), to have visited a hospital within one month of childbirth (OR 3.18, 95%CI 1.62-6.26). In general, government funded health insurance and conditional cash transfers schemes were underutilized in this community. The poorest segment of the urban poor population utilizes reproductive healthcare facilities the least. Strategies to improve access and utilization of healthcare services among the poorest of the poor may be necessary to achieve universal health coverage.

Value of urban green spaces in promoting healthy living and wellbeing: prospects for planning.

PubMed

Lee, Andrew Chee Keng; Jordan, Hannah C; Horsley, Jason

2015-01-01

There has been considerable work done in recent years exploring the value of urban green space for health and wellbeing. Urban green spaces provide environmental benefits through their effects on negating urban heat, offsetting greenhouse gas emissions, and attenuating storm water. They also have direct health benefits by providing urban residents spaces for physical activity and social interaction, and allowing psychological restoration to take place. Consequently, there is a real need to understand the mechanisms by which these benefits accrue. Previously, much of the focus has been on the characteristics of the urban green space that are likely to influence its use, such as its accessibility, quality, facilities, attractiveness, and security. This assumes a causal relationship, when in reality the relationship is more complex and multifactorial. It is more likely that it is the functionality of the green space, be it for exercise or sociocultural activities, rather than its character, which translates to the reported benefits. Challenges exist, such as competing urban planning priorities, economic considerations, and market forces. There is thus a need for urban planning to match the health benefits sought with the needs of the community and the functionality that the urban green space will serve.

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

PubMed Central

Wichaidit, Wit; Alam, Mahbub-Ul; Halder, Amal K.; Unicomb, Leanne; Hamer, Davidson H.; Ram, Pavani K.

2016-01-01

Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC. PMID:27273640

Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India.

PubMed

Sudhinaraset, May; Beyeler, Naomi; Barge, Sandhya; Diamond-Smith, Nadia

2016-07-07

In 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences. In total, we conducted 80 in-depth interviews, including 40 with recent mothers, 20 with their husbands, and 20 with their mothers-in-law. Purposeful sampling was conducted in order to obtain differences across delivery experiences (facility vs. home), followed by their family members. Major factors that influence decision-making about where to seek care included household dynamics and joint-decision-making with families, financial barriers, and perceived quality of care. Women perceived that private facilities were higher quality compared to public facilities, but also more expensive. Disrespectful care, bribes in the facility, and payment challenges were common in this population. A number of programmatic and policy recommendations are highlighted from this study. Future endeavors should include a greater focus on health education and public programs, including educating women on how to access programs, who is eligible, and how to obtain public funds. Families need to be educated on their rights and expectations in facilities. Future programs should consider the role of husbands and mothers-in-law in reproductive decision-making and support during deliveries. Triangulating information from multiple sources is important for future research efforts.

Patterns and determinants of malaria risk in urban and peri-urban areas of Blantyre, Malawi.

PubMed

Mathanga, Don P; Tembo, Atupele Kapito; Mzilahowa, Themba; Bauleni, Andy; Mtimaukenena, Kondwani; Taylor, Terrie E; Valim, Clarissa; Walker, Edward D; Wilson, Mark L

2016-12-08

Although malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study. A health facility-based, age and location-matched, case-control study of children 6-59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively. A total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones (OR = 5.1; 95% CI = 1.62, 15.8). Use of long-lasting insecticide nets (LLINs) the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households. Travel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is critical to the design of more targeted interventions for the urban setting.

Safely Managed Sanitation for All Means Fecal Sludge Management for At Least 1.8 Billion People in Low and Middle Income Countries.

PubMed

Berendes, David M; Sumner, Trent A; Brown, Joe M

2017-03-07

Although global access to sanitation is increasing, safe management of fecal waste is a rapidly growing challenge in low- and middle-income countries (LMICs). The goal of this study was to evaluate the current need for fecal sludge management (FSM) in LMICs by region, urban/rural status, and wealth. Recent Demographic and Health Survey data from 58 countries (847 685 surveys) were used to classify households by sanitation facility (facilities needing FSM, sewered facilities, ecological sanitation/other, or no facilities). Onsite piped water infrastructure was quantified to approximate need for wastewater management and downstream treatment. Over all surveyed nations, 63% of households used facilities requiring FSM, totaling approximately 1.8 billion people. Rural areas had similar proportions of toilets requiring FSM as urban areas. FSM needs scaled inversely with wealth: in the poorest quintile, households' sanitation facilities were almost 170 times more likely to require FSM (vs sewerage) than in the richest quintile. About one out of five households needing FSM had onsite piped water infrastructure, indicating domestic or reticulated wastewater infrastructure may be required if lacking for safe management of aqueous waste streams. FSM strategies must be included in future sanitation investment to achieve safe management of fecal wastes and protect public health.

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

PubMed

Bintabara, Deogratius; Mpondo, Bonaventura C T

2018-01-01

Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level. Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.

Assessment of eHealth capabilities and utilization in residential care settings.

PubMed

Towne, Samuel D; Lee, Shinduk; Li, Yajuan; Smith, Matthew Lee

2016-12-01

The US National Survey of Residential Care Facilities was used to conduct cross-sectional analyses of residential care facilities (n = 2302). Most residential care facilities lacked computerized capabilities for one or more of these capabilities in 2010. Lacking computerized systems supporting electronic health information exchange with pharmacies was associated with non-chain affiliation (p < .05). Lacking electronic health information exchange with physicians was associated with being a small-sized facility (vs large) (p < .05). Lacking computerized capabilities for discharge/transfer summaries was associated with for-profit status (p < .05) and small-sized facilities (p < .05). Lacking computerized capabilities for medical provider information was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), and for-profit status (p < .05). Lack of electronic health record was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), for-profit status (p < .05), and location in urban areas (p < .05). eHealth disparities exist across residential care facilities. As the older adult population continues to grow, resources must be in place to provide an integrated system of care across multiple settings. © The Author(s) 2015.

Mechanisms Involved in the Mitigation of Urban Heat Islands through Vegetation

NASA Astrophysics Data System (ADS)

Montalto, F. A.; Smalls-Mantey, L.

2016-12-01

Urban heat islands are one of many challenges presented by today's unprecedented patterns of urbanization. At higher densities, urban populations are more vulnerable to the increased temperatures that accompany urban landscape change. Though in the US it is funded principally as a means of stormwater management, urban green infrastructure (GI) actually alters hydrologic, energetic, and thermal budgets of urban environments, with a suite of potential co-benefits related to the health of people and ecosystems. Recent research has underscored the roles that vegetation plays in such processes, for example by facilitating evapotranspiration, and regulating air temperature and water availability. While the magnitude of these and other impacts is determined in part by the size, type, location, and configuration of GI facilities, few studies have attempted to characterize and to quantify how various vegetation-mediated processes in GI systems impact the energy and thermal properties of their surroundings. Using data collected at rooftop and ground level GI facilities including green roofs and bioretention areas monitored by Drexel University, this research illustrates the role that processes such as evapotranspiration play in the individual GI site cooling potential, reducing neighborhood vulnerability to the urban heat island effect.

Health Care in Modern Cuba

PubMed Central

Campos-Outcalt, Douglas; Janoff, Edward

1980-01-01

An extensively organized, centrally controlled system, aimed at equalizing and improving the distribution and quality of medical services according to population and geography, characterizes the modern Cuban health care complex. Facilities of increasing sophistication are located in urban areas while an expanding series of ambulatory, multipotential polyclinics attempts to provide most health services in both urban and rural settings. Maternal and child care, immunization programs and other forms of preventive medicine represent major priorities for expenditures. Occupational health is increasingly understood as a valuable resource, and medical professionals on all levels are being trained in significant numbers for Cuba and its allies. ImagesFigure 1.Figure 2.Figure 3. PMID:7376666

An exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India.

PubMed

Banerjee, Sushanta K; Kumar, Rakesh; Warvadekar, Janardan; Manning, Vinoj; Andersen, Kathryn Louise

2017-03-21

Maternal mortality, which primarily burdens developing countries, reflects the greatest health divide between rich and poor. This is especially pronounced for access to safe abortion services which alone avert 1 of every 10 maternal deaths in India. Primarily due to confidentiality concerns, poor women in India prefer private services which are often offered by untrained providers and may be expensive. In 2006 the state government of Madhya Pradesh (population 73 million) began a concerted effort to ensure access to safe abortion services at public health facilities to both rural and urban poor women. This study aims to understand the socio-economic profile of women seeking abortion services in public health facilities across this state and out of pocket cost accessing abortion services. In particular, we examine the level of access that poor women have to safe abortion services in Madhya Pradesh. This study consisted of a cross-sectional client follow-up design. A total of 19 facilities were selected using two-stage random sampling and 1036 women presenting to chosen facilities with abortion and post-abortion complications were interviewed between May and December 2014. A structured data collection tool was developed. A composite wealth index computed using principal component analysis derived weights from consumer durables and asset holding and classified women into three categories, poor, moderate, and rich. Findings highlight that overall 57% of women who received abortion care at public health facilities were poor, followed by 21% moderate and 22% rich. More poor women sought care at primary level facilities (58%) than secondary level facilities and among women presenting for postabortion complications (67%) than induced abortion. Women reported spending no money to access abortion services as abortion services are free of cost at public facilities. However, poor women spend INR 64 (1 USD) while visiting primary level facilities and INR 256 (USD 4) while visiting urban hospitals, primarily for transportation and food. Improved availability of safe abortion services at the primary level in Madhya Pradesh has helped meeting the need of safe abortion services among poor, which eventually will help reducing the maternal mortality and morbidity due to unsafe abortion.

Determinants of institutional childbirth service utilisation among women of childbearing age in urban and rural areas of Tsegedie district, Ethiopia.

PubMed

Hailu, Desta; Berhe, Hailemariam

2014-11-01

despite receiving greater attention, optimal maternal health remains a challenge in developing countries such as Ethiopia. Evidence from various studies shows that skilled attendance during childbirth is among the key strategies to reduce maternal mortality. However, in Ethiopia, the use of institutional childbirth services is very low. In Ethiopia, studies dealing with factors affecting women׳s use of institutional childbirth services are scarce and generally focus on urban settings. As such, this study aimed to explore the determinants of institutional childbirth service utilisation among urban and rural women who gave birth in the previous two years in Tsegedie district, Ethiopia. a community-based cross-sectional study was performed from 20 November 2012 to 30 June 2013 on 485 mothers. The participants were selected systematically using a multistage sampling technique. A pre-tested structured questionnaire, administered by an interviewer, was used to collect quantitative data. Focus group discussions and in-depth interviews were used to triangulate the evidence from the quantitative study. Bivariate and multivariate data analysis was performed using Statistical Package for the Social Sciences Version 17.0. this study found that 31.5% of the respondents used institutional childbirth services. The main reason for home birth was close attention from family (47%). Women׳s educational status [adjusted odds ratio (AOR) 5.3, 95% confidence interval (CI) 1.59-17.87], time taken to reach the nearest health facility (AOR 3.3, 95% CI 1.15-9.52), ultimate decision maker regarding the place of childbirth (AOR 3.7, 95% CI 1.08-12.63) and receipt of maternal and child health care information (AOR 9.4, 95% CI 2.4-36.38) were significantly associated with the use of institutional childbirth services. the proportion of births attended in health facilities was low in the study district. Women׳s educational status, distance to the nearest health facility, women׳s decision-making power and receipt of maternal and child health care information were important predictors of institutional childbirth service utilisation. This implies that women still lack physical and effective access to maternal health care services. Thus, improving community awareness about skilled providers and institutional childbirth, targeting women who prefer to give birth at home, is encouraged. Safe motherhood education using communication networks in rural and urban communities is crucial. Furthermore, it is recommended that essential obstetric care facilities (health centres) should be established within a reasonable distance of homes, women should be empowered and community midwives should be deployed. Copyright © 2014 Elsevier Ltd. All rights reserved.

A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal.

PubMed

Lee, Elizabeth H; Olsen, Cara H; Koehlmoos, Tracey; Masuoka, Penny; Stewart, Ann; Bennett, Jason W; Mancuso, James

2017-11-01

Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine 2017. This work is written by US Government employees and is in the public domain in the US.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

PubMed

Talib, Zohray; van Schalkwyk, Susan; Couper, Ian; Pattanaik, Swaha; Turay, Khadija; Sagay, Atiene S; Baingana, Rhona; Baird, Sarah; Gaede, Bernhard; Iputo, Jehu; Kibore, Minnie; Manongi, Rachel; Matsika, Antony; Mogodi, Mpho; Ramucesse, Jeremais; Ross, Heather; Simuyeba, Moses; Haile-Mariam, Damen

2017-12-01

African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement

PubMed Central

Mpunga, Dieudonné; Lumbayi, JP; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-01-01

Objective: To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Methods: Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as “high” if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or “low” if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. Results: We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services (P<.001). Public facilities were less likely than private facilities to have high-quality services (P=.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Conclusion: Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. PMID:28588047

Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda.

PubMed

Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria; Jørs, Erik

2017-01-01

Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened.

Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda

PubMed Central

Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria; Jørs, Erik

2017-01-01

Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened. PMID:28615953

Work motivation and job satisfaction of health workers in urban and rural areas.

PubMed

Grujičić, Maja; Jovičić-Bata, Jelena; Rađen, Slavica; Novaković, Budimka; Šipetić-Grujičić, Sandra

2016-08-01

Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

PROGRAMS FOR RURAL YOUTH--ARE THEY DOING THE JOB.

ERIC Educational Resources Information Center

WAGNER, CARRUTH J.

PEOPLE LIVING IN RURAL AREAS HAVE ONLY ONE-HALF THE ACCESS PER PERSON TO DOCTORS, DENTISTS, AND OTHER HEALTH RESOURCES THAT URBAN DWELLERS HAVE. THIS IS COMPOUNDED BY--(1) THE DISTANCE BETWEEN THE PATIENT AND THE HEALTH SERVICES, (2) LACK OF TRANSPORTATION, (3) LACK OF COMMUNICATION, AND (4) LACK OF HEALTH SERVICES, PERSONNEL, FACILITIES, AND…

Bio-medical waste management: situational analysis & predictors of performances in 25 districts across 20 Indian States.

PubMed

2014-01-01

A legislative framework for bio-medical waste management (BMWM) was established in the country more than a decade ago. Though some studies have identified gaps at local levels, no systematic effort was done to collect data from different parts of the country. The objective of this nationwide study was to document existing resources, infrastructure and practices related to BMWM across the study districts. The study was conducted in 25 districts spread over 20 States of India including urban and rural areas. Primary (n=388), secondary (n=25) and tertiary care (n=24) health facilities from public (n=238) and private (n=199) sector were assessed and scored for the state of BMWM through 9 items representing system capacity, availability of resources and processes in place. Health facilities were assigned into one of the three categories (Red, Yellow and Green) based on the cumulative median scores. Around 82 per cent of primary, 60 per cent of secondary and 54 per cent of tertiary care health facilities were in the 'RED' category. Multivariate analysis indicated that charts at the point of waste generation, availability of designated person, appropriate containers and bags, availability of functional needle destroyers, availability of personal protective gears, segregation of waste at point of generation and log book maintenance were independently (OR-between 1.2-1.55; P <0.03 or less) associated with better BMWM system in the health facilities. This was true for both rural-urban and public or private health facilities. The study highlighted the urgent need for greater commitments at policy and programme levels for capacity building, and resource investments in BMWM.

Barriers to formal emergency obstetric care services' utilization.

PubMed

Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

2011-06-01

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.

The determinants of exclusive breast feeding in urban slums: a community based study.

PubMed

Tiwari, Ranjana; Mahajan, P C; Lahariya, Chandrakant

2009-02-01

The actual rate of Exclusive Breast Feeding (EBF) (up to the age of 6 months) is dismally low in urban slums of India. The reasons and determinants of this are debatable. The study was planned to understand the determinants of EBF in the infants in urban slums. A community-based cross sectional study was done in urban slums of Gwalior, India. The data were collected by interviewing the caregivers of 279 infants aged between 6 and 11 months from November 2005 to July 2006. Only 11 (3.8%) mothers knew that EBF should be done till six months and 22 (7.8%) actually practiced EBF. A total of 178 (63.8%) and 212 (76.0%) newborns were given pre- and post-lacteal feeds with 26.2% discarding colostrum. Only 22 (7.8%) practiced EBF. The early breastfeeding (BF) initiation, Ante Natal Clinic (ANC) visits, mothers' education and immunization visits were significantly associated with higher probability of EBF. There were a number of myths and misconceptions about BF in this urban slum population. The correct information about BF was more common amongst the women who had frequent contacts with health facilities due to any reason or during ANC or immunization visit. Similarly, it is the continuum of good health and feeding practices and the mothers who start early BF or get their child immunized regularly are more likely to EBF their children. Considering the widely prevalent myths and low rate of utilization of health services along with high potential benefits of EBF, every opportunity of mothers' interaction with the health facility should be utilized for promoting correct and EBF practices.

Provision of mouth-care in long-term care facilities: an educational trial.

PubMed

MacEntee, M I; Wyatt, C C L; Beattie, B L; Paterson, B; Levy-Milne, R; McCandless, L; Kazanjian, A

2007-02-01

This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities. Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties. Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents. A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

The Quality of Urban Environments: Mapping Variation in Access to Community Resources.

ERIC Educational Resources Information Center

Witten, Karen; Exeter, Daniel; Field, Adrian

2003-01-01

Discusses the relationship between community infrastructure and health through the development of the Community Resource Accessibility Index (CRAI) research tool.This area-based index of community services, facilities, and amenities enables comparisons between opportunity structures in the local environment and residents' health and wellbeing. It…

Spatial accessibility to physical activity facilities and to food outlets and overweight in French youth.

PubMed

Casey, R; Chaix, B; Weber, C; Schweitzer, B; Charreire, H; Salze, P; Badariotti, D; Banos, A; Oppert, J-M; Simon, C

2012-07-01

Some characteristics of the built environment have been associated with obesity in youth. Our aim was to determine whether individual and environmental socio-economic characteristics modulate the relation between youth overweight and spatial accessibility to physical activity (PA) facilities and to food outlets. Cross-sectional study. 3293 students, aged 12 ± 0.6 years, randomly selected from eastern France middle schools. Using geographical information systems (GIS), spatial accessibility to PA facilities (urban and nature) was assessed using the distance to PA facilities at the municipality level; spatial accessibility to food outlets (general food outlets, bakeries and fast-food outlets) was calculated at individual level using the student home address and the food outlets addresses. Relations of weight status with spatial accessibility to PA facilities and to food outlets were analysed using mixed logistic models, testing potential direct and interaction effects of individual and environmental socio-economic characteristics. Individual socio-economic status modulated the relation between spatial accessibility to PA facilities and to general food outlets and overweight. The likelihood of being overweight was higher when spatial accessibility to urban PA facilities and to general food outlets was low, but in children of blue-collar-workers only. The odds ratio (OR) (95% confidence interval) for being overweight of blue-collar-workers children compared with non-blue-collar-workers children was 1.76 (1.25-2.49) when spatial accessibility to urban PA facilities was low. This OR was 1.86 (1.20-2.86) when spatial accessibility to general food outlets was low. There was no significant relationship of overweight with either nature PA facilities or other food outlets (bakeries and fast-food outlets). These results indicate that disparities in spatial accessibility to PA facilities and to general food outlets may amplify the risk of overweight in socio-economically disadvantaged youth. These data should be relevant for influencing health policies and urban planning at both a national and local level.

Urban School Facilities: An A-Z Primer. IssueTrak: A CEFPI Brief on Educational Facility Issues

ERIC Educational Resources Information Center

DeJong, William S.

2004-01-01

This "IssueTrak" addresses the condition of urban school facilities as a matter of great urgency. Facility planners, are committed to working with urban school districts to develop and implement a systematic approach for modernizing aging urban school facilities. The next generation of school children is far too important and valuable to be forced…

Factors associated with job satisfaction among commune health workers: implications for human resource policies.

PubMed

Tran, Bach Xuan; Van Hoang, Minh; Nguyen, Hinh Duc

2013-01-30

Job satisfaction among health workers is an important indicator in assessing the performance and efficiency of health services. This study measured job satisfaction and determined associated factors among health workers in 38 commune health stations in an urban district and a rural district of Hanoi, Vietnam. A total of 252 health workers (36 medical doctors and 216 nurses and technicians; 74% female) were interviewed. A job satisfaction measure was developed using factor analysis, from which four dimensions emerged, namely 'benefits and prospects,' 'facility and equipment,' 'performance,' and 'professionals.' The results demonstrate that respondents were least satisfied with the following categories: salary and incentives (24.0%), benefit packages (25.1%), equipment (35.7%), and environment (41.8%). The average satisfaction score was moderate across four domains; it was the highest for 'performance' (66.6/100) and lowest for 'facility and equipment' (50.4/100). Tobit-censored regression models, constructed using stepwise selection, determined significant predictors of job satisfaction including age, areas of work and expertise, professional education, urban versus rural setting, and sufficient number of staff. The findings highlight the need to implement health policies that focus on incentives, working conditions, workloads, and personnel management at grassroots level.

Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.

PubMed

Muhula, Samuel; Memiah, Peter; Mbau, Lilian; Oruko, Happiness; Baker, Bebora; Ikiara, Geoffrey; Mungai, Margaret; Ndirangu, Meshack; Achwoka, Dunstan; Ilako, Festus

2016-05-04

We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya. We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method. Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %-6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV. Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.

Do free caesarean section policies increase inequalities in Benin and Mali?

PubMed

Ravit, Marion; Audibert, Martine; Ridde, Valéry; De Loenzien, Myriam; Schantz, Clémence; Dumont, Alexandre

2018-06-05

Benin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in 2005 and 2009, respectively. These policies had a positive impact on access to C-sections and facility based deliveries among all women, but the impact on socioeconomic inequality is still highly uncertain. The objective of this study was to observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access to C-sections and facility based deliveries after the free C-section policy was introduced. We used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011-2012 in Benin and 2001, 2006 and 2012-13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections and facility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facility based deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the most advantaged categories (urban, educated and richest women). Concentration curves were used to observe the degree of wealth-related inequality in access to C-sections and facility based deliveries. We analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significant difference in access to C-sections between urban and rural women or between educated and non-educated women. However, the richest women had greater access to C-sections than the poorest women. There was no significant change in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the free C-section policy. In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of the policy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present. Urban/rural and socioeconomic inequalities in C-section access did not change substantially after the countries implemented free C-section policies. User fee exemption is not enough. We recommend switching to mechanisms that combine both a universal approach and targeted action for vulnerable populations to address this issue and ensure equal health care access for all individuals.

A meta-analysis of socio-demographic factors predicting birth in health facility.

PubMed

Berhan, Yifru; Berhan, Asres

2014-09-01

The low proportion of health facility delivery in developing countries is one of the main challenges in achieving the Millennium Development Goal of a global reduction of maternal deaths by 75% by 2015. There are several primary studies which identified socio-demographic and other predictors of birth in health facility. However, there are no efforts to synthesis the findings of these studies. The objective of this meta-analysis was to determine the strength of the association of birth in the health facility with selected sociodemographic factors. A meta-analysis of Mantel-Haenszel odds ratios was conducted by including 24 articles which were reported between 2000 and 2013 from developing countries. A computer-based search was done from MEDLINE, African Journals Online, Google Scholar and HINARI databases. Included studies did compare the women's' health facility delivery in relation to their selected socio-demographic characteristics. The pooled analysis demonstrated association of health facility delivery with living in urban areas (OR = 9.8), secondary and above educational level of the parents (OR = 5.0), middle to high wealth status (OR = 2.3) and first time pregnancy (OR = 2.8). The risk of delivering outside the health facility was not significantly associated with maternal age (teenage vs 20 years and above) and marital status. The distance of pregnant women's residence from the health facility was found to have an inverse relation to the proportion of health facility delivery. Although the present meta-analysis identified several variables which were associated with an increase in health facility delivery, the most important predictor of birth in the health facility amenable to intervention is educational status of the parents to be. Therefore, formal and informal education to women and family members on the importance of health facility delivery needs to be strengthened. Improving the wealth status of the population across the world may not be achieved soon, but should be in the long-term strategy to increase the birth rate in the health facility.

Factors associated with cholera in Kenya, 2008-2013.

PubMed

Cowman, Gretchen; Otipo, Shikanga; Njeru, Ian; Achia, Thomas; Thirumurthy, Harsha; Bartram, Jamie; Kioko, Jackson

2017-01-01

Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density. The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030 , call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya.

Trends and inequities in where women delivered their babies in 25 low-income countries: evidence from Demographic and Health Surveys.

PubMed

Limwattananon, Supon; Tangcharoensathien, Viroj; Sirilak, Supakit

2011-05-01

In low-income countries, the coverage of institutional births is low. Using data from the two most recent Demographic and Health Surveys (1995-2001 and 2001-2006) for 25 low-income countries, this study examined trends in where women delivered their babies--public or private facilities or non-institutional settings. More than half of deliveries were in institutional settings in ten countries, mostly public facilities. In the other 15 countries, the majority of births were in women's homes, which was often their only option. Between the two survey periods, all five Asian countries studied (except Bangladesh) had an increase of 10-20 percentage points in institutional coverage, whereas none of the 19 sub-Saharan African countries saw an increase of more than 10 percentage points. More urban women and more in the richest (least poor) quintile gave birth in public or private facilities than rural and poorest quintile women. The rich-poor gap of institutional births was wider than the urban-rural gap. Inadequate public investment in health system infrastructure in rural areas and lack of skilled health professionals are major obstacles in reducing maternal mortality. Governments in low-income countries must invest more, especially in rural maternity services. Strengthening private, for-profit providers is not a policy choice for poor, rural communities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Spatiotemporal Patterns of the Use of Urban Green Spaces and External Factors Contributing to Their Use in Central Beijing

PubMed Central

Li, Fangzheng; Zhang, Fen; Li, Xiong; Wang, Peng; Liang, Junhui; Mei, Yuting; Cheng, Wenwen; Qian, Yun

2017-01-01

Urban green spaces encourage outdoor activity and social communication that contribute to the health of local residents. Examining the relationship between the use of urban green spaces and factors influencing their utilization can provide essential references for green space site selection in urban planning. In contrast to previous studies that focused on internal factors, this study highlights the external factors (traffic convenience, population density and commercial facilities) contributing to the use of urban green spaces. We conducted a spatiotemporal analysis of the distribution of visitors in 208 selected green spaces in central Beijing. We examined the relationship between the spatial pattern of visitor distribution within urban green spaces and external factors, using the Gini coefficient, kernel density estimation, and geographical detectors. The results of the study were as follows. The spatial distribution of visitors within central Beijing’s green spaces was concentrated, forming different agglomerations. The three examined external factors are all associated with the use of green spaces. Among them, commercial facilities are the important external factor associated with the use of green spaces. For the selection of sites for urban green spaces, we recommend consideration of external factors in order to balance urban green space utilization. PMID:28264451

Spatiotemporal Patterns of the Use of Urban Green Spaces and External Factors Contributing to Their Use in Central Beijing.

PubMed

Li, Fangzheng; Zhang, Fen; Li, Xiong; Wang, Peng; Liang, Junhui; Mei, Yuting; Cheng, Wenwen; Qian, Yun

2017-02-27

Urban green spaces encourage outdoor activity and social communication that contribute to the health of local residents. Examining the relationship between the use of urban green spaces and factors influencing their utilization can provide essential references for green space site selection in urban planning. In contrast to previous studies that focused on internal factors, this study highlights the external factors (traffic convenience, population density and commercial facilities) contributing to the use of urban green spaces. We conducted a spatiotemporal analysis of the distribution of visitors in 208 selected green spaces in central Beijing. We examined the relationship between the spatial pattern of visitor distribution within urban green spaces and external factors, using the Gini coefficient, kernel density estimation, and geographical detectors. The results of the study were as follows. The spatial distribution of visitors within central Beijing's green spaces was concentrated, forming different agglomerations. The three examined external factors are all associated with the use of green spaces. Among them, commercial facilities are the important external factor associated with the use of green spaces. For the selection of sites for urban green spaces, we recommend consideration of external factors in order to balance urban green space utilization.

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey

PubMed Central

Mpondo, Bonaventura C. T.

2018-01-01

Introduction Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. Methods This study used data from the 2014–2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level. Results Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2–6.1], urban location [AOR = 2.2, 95% CI; 1.2–4.2], health centers [AOR = 5.2, 95% CI; 3.1–8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1–5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. Conclusion The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes. PMID:29447231

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana.

PubMed

Boadi, Kwasi Owusu; Kuitunen, Markku

2005-06-01

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.

Social and Physical Environments and Self-Rated Health in Urban and Rural Communities in Korea

PubMed Central

Lee, Jung-A; Park, Jong Heon; Kim, Myung

2015-01-01

This study evaluated the associations between social and physical environments and self-rated health (SRH) for urban and rural Korean adults, using data from the Korean Community Health Survey (KCHS) of 199,790 participants (115,454 urban and 84,336 rural). The main dependent variable was SRH, while the primary independent variables were social and physical characteristics. Urban residents reported better SRH than did rural residents. Five social environmental variables (trust of neighbors, residence in the area for over 20 years, exchanging help with neighbors, friend and fellowship activities, contact with relatives and neighbors over five times per month) were more prevalent among rural residents. Satisfaction with physical environment was more common among rural residents, but satisfaction with traffic and healthcare facilities was more common among urban areas. After adjusting for relevant factors, positive associations between SRH and trust of neighbors, exchanging help with neighbors, participation in social activities or organizations, and physical environment existed in both rural and urban populations. Also, in both areas, there was no demonstrated association between SRH and years of residence or frequency of contact with relatives. Our findings suggest the existence of an association between social and physical factors and perceived health status among the general population of Korea. PMID:26569279

Clients’ Willingness to Pay for Immunization Services in the Urban and Rural Primary Health Centers of Enugu State, Nigeria

PubMed Central

Ossai, Edmund Ndudi; Fatiregun, Akinola Ayoola

2015-01-01

Our study aims at determining the pattern of willingness of clients to pay for childhood immunization services in urban and rural primary health centers of Enugu state, Nigeria. Using a cross-sectional design, 800 clients who presented with their children/wards to receive childhood immunization services were selected at the primary health center in rural and urban local government areas of the state. The mean age was 28.9±4.5 and 26.7±5.1 years in the urban and rural areas respectively. About 54.5% of clients in the urban and 55.3% in the rural area were willing to pay for immunization services. The clients willingness to pay was influenced by: non satisfaction with immunization services, (OR=0.3, 95%CI: 0.2-0.5), younger age, (OR=1.4, 95%CI: 1.0-2.0) marital status (OR=2.8, 95%CI: 1.2-6.5), proximity to health centers (OR=0.6, 95%CI: 0.4-0.8), and delivering in a private health facility (OR=0.4, 95%CI: 0.1-0.9). The study suggests that the economic value that clients give to immunization services was similar in the rural and urban areas, and this could be increased by improving the level of clients’ satisfaction for the services among others. PMID:28299135

Environment and air pollution: health services bequeath to grotesque menace.

PubMed

Qureshi, Muhammad Imran; Rasli, Amran Md; Awan, Usama; Ma, Jian; Ali, Ghulam; Faridullah; Alam, Arif; Sajjad, Faiza; Zaman, Khalid

2015-03-01

The objective of the study is to establish the link between air pollution, fossil fuel energy consumption, industrialization, alternative and nuclear energy, combustible renewable and wastes, urbanization, and resulting impact on health services in Malaysia. The study employed two-stage least square regression technique on the time series data from 1975 to 2012 to possibly minimize the problem of endogeniety in the health services model. The results in general show that air pollution and environmental indicators act as a strong contributor to influence Malaysian health services. Urbanization and nuclear energy consumption both significantly increases the life expectancy in Malaysia, while fertility rate decreases along with the increasing urbanization in a country. Fossil fuel energy consumption and industrialization both have an indirect relationship with the infant mortality rate, whereas, carbon dioxide emissions have a direct relationship with the sanitation facility in a country. The results conclude that balancing the air pollution, environment, and health services needs strong policy vistas on the end of the government officials.

Quality of physical resources of health facilities in Indonesia: a panel study 1993-2007.

PubMed

Diana, Aly; Hollingworth, Samantha A; Marks, Geoffrey C

2013-10-01

The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of private facilities. This study examined the quality of physical resources of public and private facilities in Indonesia from 1993 to 2007. Data from the Indonesian Family Life Surveys in 1993, 1997, 2000 and 2007 were used to evaluate trends in the quality of physical resources for public and private facilities, stratified by urban/rural areas and Java-Bali/outer Java-Bali regions. The quality of six categories of resources was measured using an adapted MEASURE Evaluation framework. Overall quality was moderate, but higher in public than in private health facilities in all years regardless of the region. The higher proportion of nurses and midwives in private practice was a determinant of scope of services and facilities available. There was little improvement in quality of physical resources following decentralization. Despite significant increases in public investment in health between 2000 and 2006 and the potential benefits of decentralization (2001), the quality of both public and private health facilities in Indonesia did not improve significantly between 1993 and 2007. As consumers commonly believe the quality is better in private facilities and are increasingly using them, it is essential to improve quality in both private and public facilities. Implementation of minimum standards and effective partnerships with private practice are considered important.

Social-epidemiological study for evaluation of water supply and sanitation systems of low-income urban community in Dhaka, Bangladesh.

PubMed

Mollah, Kabirul A; Aramaki, Toshiya

2010-03-01

This study aims at quantification of health losses, considering social and environmental factors. Morbidity and mortality cases of diarrhoea for children under five years old were used to estimate the disability adjusted life years (DALYs) lost for the target households in low-income communities in Dhaka, Bangladesh. Water supply facilities and sanitation systems, along with hygiene practices and their health outcomes, were studied at community level. Demographic, socio-economic and socio-cultural aspects were also studied to support the research findings and give a better understanding of the local conditions. The four selected communities, Ward 60 (W60), Ward 61 (W61), Ward 62 (W62) and Ward 65 (W65), all had different existing urban services such as water supply, sanitation, garbage management and drainage facilities. All of these services existed in W62, but W60 did not have any of the services; W61 had sanitation and drainage coverage, whereas W65 had only a water supply facility. The results conclusively showed that, compared with the null (absence of services) scenario (W60), the other three scenarios (W61, W62 and W65) showed a substantial decrease of diarrhoea (1.219, 1.284 and 2.052 DALYs/household/year, respectively) reported for children under five years old. Besides urban services, other socio-economic characteristics might also influence the prevalence of diseases.

Service functions of private community health stations in China: A comparison analysis with government-sponsored community health stations.

PubMed

Hou, Wanli; Fan, Hong; Xu, Jing; Wang, Fang; Chai, Yun; Xu, Hancheng; Li, Yongbin; Liu, Liqun; Wang, Bin; Jin, Jianqiang; Lu, Zuxun

2012-04-01

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available concerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based recommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.

Social conditions and urban health inequities: realities, challenges and opportunities to transform the urban landscape through research and action.

PubMed

de Snyder, V Nelly Salgado; Friel, Sharon; Fotso, Jean Christophe; Khadr, Zeinab; Meresman, Sergio; Monge, Patricia; Patil-Deshmukh, Anita

2011-12-01

The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a "natural" or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low- and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.

Distribution of green infrastructure along walkable roads

EPA Science Inventory

Low-income and minority neighborhoods frequently lack healthful resources to which wealthier communities have access. Though important, the addition of facilities such as recreation centers can be costly and take time to implement. Urban green infrastructure, such as street trees...

24 CFR 576.56 - Homeless assistance and participation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... treatment, mental health treatment, counseling, supervision, and other services essential for achieving... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY...

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya.

PubMed

Molyneux, C S; Mung'Ala-Odera, V; Harpham, T; Snow, R W

1999-12-01

Urbanization is an important demographic phenomenon in sub-Saharan Africa, and rural-urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments in health service provision need to reflect new needs arising from demographic and disease ecology change. In malaria-endemic coastal Kenya, we compared lifelong rural (n = 248) and urban resident (n = 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biomedical services, rural and urban mothers' treatment-seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop-bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription-only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self-treatment has enormous potential to reduce morbidity and mortality in low-income urban areas, as has frequently been argued for rural areas. However, because of the underlying socio-economic, cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.

Reaching Out to Older Veterans in Need: The Elko Clinic Demonstration Project

ERIC Educational Resources Information Center

Juretic, Meghan; Hill, Robert; Luptak, Marilyn; Rupper, Randall; Bair, Byron; Floyd, James; Westfield, Brian; Dailey, Nancy K.

2010-01-01

Context: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas. Purpose: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic.…

IMPROVING HUMAN HEALTH RISK ASSESSMENT FOR TETRACHLOROETHENE BY USING BIOMARKERS AND NEUROBEHAVIORAL TESTING IN DIVERSE RESIDENTIAL POPULATIONS

EPA Science Inventory

The U.S. EPA considers tetrachloroethene (perc) a problematic pollutant in urban areas. The New York State Department of Health (NYSDOH) has documented high levels of perc in the indoor air of apartments located in the same buildings as dry cleaning facilities in New York Stat...

High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average.

PubMed

Matsumoto, Masatoshi; Okayama, Masanobu; Inoue, Kazuo; Kajii, Eiji

2004-10-01

Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. To show the technology status of rural practice and compare it to the national level. Nationwide postal survey. Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as 'rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject: As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?: In Japan, rural medical facilities are technologically better equipped than urban facilities.

Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation

PubMed Central

Speizer, Ilene S; Corroon, Meghan; Calhoun, Lisa; Lance, Peter; Montana, Livia; Nanda, Priya; Guilkey, David

2014-01-01

ABSTRACT Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all. PMID:25611476

Factors associated with cholera in Kenya, 2008-2013

PubMed Central

Cowman, Gretchen; Otipo, Shikanga; Njeru, Ian; Achia, Thomas; Thirumurthy, Harsha; Bartram, Jamie; Kioko, Jackson

2017-01-01

Introduction Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. Methods The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. Results Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density. Conclusion The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030, call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya. PMID:29515719

[Medical Service Information Seeking Behaviors in Rural and Urban Patients in Sichuan Province].

PubMed

Zhang, Wen-Jie; Xue, Li; Chen, Rao; Duan, Zhan-Qi; Liu, Dan-Ping

2018-03-01

To understand how rural and urban patients seek medical service information in Sichuan province. A self-designed questionnaire was distributed randomly to patients who visited primary,secondary and tertiary health facilities in Chengdu,Yibin and Suining,collecting data in relation to their sources of medical service information,as well as the contents and credibility of the information. The major sources of medical service information came from friends,past experiences and television programs,which were consistent with the most desirable access channels. The urban patients were more likely to trust (5.3%) and use (10.6%) the Internet to obtain medical service information compared with their rural counterparts (3.4% and 5.5%,respectively, P <0.05). The most sought after information concerned about medical staff,reputation and price. The rural patients were more likely to be concerned about price (26.7%) than their urban counterparts (20.3%, P <0.05). The choices of patients were likely to be influenced by advices from family members,relatives and friends,and doctors and nurses. The patients had a higher level of trust in doctors and nurses than their relatives and friends,but lower than their family members. Patient choices are shaped by their medical service information seeking behaviors and advices from others. Targeted marketing strategies for urban and rural patients should be developed to channel patients to appropriate health facilities. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa.

PubMed

Mphatswe, W; Mate, K S; Bennett, B; Ngidi, H; Reddy, J; Barker, P M; Rollins, N

2012-03-01

To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa.

Spatial accessibility to physical activity facilities and to food outlets and overweight in French youth

PubMed Central

Casey, R; Chaix, B; Weber, C; Schweitzer, B; Charreire, H; Salze, P; Badariotti, D; Banos, A; Oppert, J-M; Simon, C

2012-01-01

Objective: Some characteristics of the built environment have been associated with obesity in youth. Our aim was to determine whether individual and environmental socio-economic characteristics modulate the relation between youth overweight and spatial accessibility to physical activity (PA) facilities and to food outlets. Design: Cross-sectional study. Subjects: 3293 students, aged 12±0.6 years, randomly selected from eastern France middle schools. Measurements and methods: Using geographical information systems (GIS), spatial accessibility to PA facilities (urban and nature) was assessed using the distance to PA facilities at the municipality level; spatial accessibility to food outlets (general food outlets, bakeries and fast-food outlets) was calculated at individual level using the student home address and the food outlets addresses. Relations of weight status with spatial accessibility to PA facilities and to food outlets were analysed using mixed logistic models, testing potential direct and interaction effects of individual and environmental socio-economic characteristics. Results: Individual socio-economic status modulated the relation between spatial accessibility to PA facilities and to general food outlets and overweight. The likelihood of being overweight was higher when spatial accessibility to urban PA facilities and to general food outlets was low, but in children of blue-collar-workers only. The odds ratio (OR) (95% confidence interval) for being overweight of blue-collar-workers children compared with non-blue-collar-workers children was 1.76 (1.25–2.49) when spatial accessibility to urban PA facilities was low. This OR was 1.86 (1.20–2.86) when spatial accessibility to general food outlets was low. There was no significant relationship of overweight with either nature PA facilities or other food outlets (bakeries and fast-food outlets). Conclusion: These results indicate that disparities in spatial accessibility to PA facilities and to general food outlets may amplify the risk of overweight in socio-economically disadvantaged youth. These data should be relevant for influencing health policies and urban planning at both a national and local level. PMID:22310474

Health Resources in a 200,000 Urban Indian Population Argues the Need for a Policy on Private Sector Health Services

PubMed Central

Furtado, Kheya Melo; Kar, Anita

2014-01-01

Background: There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. Objective: This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Materials and Methods: Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Results: Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Conclusions: Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals. PMID:24963226

Health resources in a 200,000 urban Indian population argues the need for a policy on private sector health services.

PubMed

Furtado, Kheya Melo; Kar, Anita

2014-04-01

There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals.

Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey.

PubMed

Moyer, Cheryl A; McLaren, Zoë M; Adanu, Richard M; Lantz, Paula M

2013-09-01

To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Affordability was an important determinant of facility delivery in Ghana-even among women with health insurance-but social access variables had a mediating role. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

PubMed

Pulok, Mohammad Habibullah; Sabah, Md Nasim-Us; Uddin, Jalal; Enemark, Ulrika

2016-07-29

Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011. The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services. The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004-2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women's and their husbands' education were significantly associated with greater use of maternal health care services. In addition, women's exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services. Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study.

PubMed

Ajayi, Ikeoluwapo O; Jegede, Ayodele S; Falade, Catherine O; Sommerfeld, Johannes

2013-10-24

Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities. This study's findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.

The Urban-Rural Disparity in Nursing Home Quality Indicators: The Case of Facility-Acquired Contractures

PubMed Central

Bowblis, John R; Meng, Hongdao; Hyer, Kathryn

2013-01-01

Objective To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. Data Sources Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. Study Design We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder–Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. Principal Findings Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6–8 percent, and structure and operational characteristics account for 10–22 percent of the disparity. Conclusion While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care. PMID:22670847

Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

PubMed

Novignon, Jacob; Nonvignon, Justice

2017-06-12

Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private and public facilities. There is need for primary health facility managers to improve productivity via effective and efficient resource use. Efforts to improve efficiency should focus on training health workers and improving facility environment alongside effective monitoring and evaluation exercises.

Integrated Urban Flood Analysis considering Optimal Operation of Flood Control Facilities in Urban Drainage Networks

NASA Astrophysics Data System (ADS)

Moon, Y. I.; Kim, M. S.; Choi, J. H.; Yuk, G. M.

2017-12-01

eavy rainfall has become a recent major cause of urban area flooding due to the climate change and urbanization. To prevent property damage along with casualties, a system which can alert and forecast urban flooding must be developed. Optimal performance of reducing flood damage can be expected of urban drainage facilities when operated in smaller rainfall events over extreme ones. Thus, the purpose of this study is to execute: A) flood forecasting system using runoff analysis based on short term rainfall; and B) flood warning system which operates based on the data from pump stations and rainwater storage in urban basins. In result of the analysis, it is shown that urban drainage facilities using short term rainfall forecasting data by radar will be more effective to reduce urban flood damage than using only the inflow data of the facility. Keywords: Heavy Rainfall, Urban Flood, Short-term Rainfall Forecasting, Optimal operating of urban drainage facilities. AcknowledgmentsThis research was supported by a grant (17AWMP-B066744-05) from Advanced Water Management Research Program (AWMP) funded by Ministry of Land, Infrastructure and Transport of Korean government.

Nursing Workforce in Hubei China: Implications for the Development of Traditional Chinese Medicine Education.

PubMed

Cai, Yi; Mao, Zongfu; Corazzini, Kirsten; Petrini, Marcia A; Wu, Bei

2015-01-01

Research evidence suggests that educating nurses about traditional Chinese medicine (TCM) significantly improves their nursing care practice and the health care outcomes of community residents. The purpose of this study was to describe the current use of TCM by China's nursing workforce, as well as the typical nurse to physician ratio and types of TCM education that nurses receive in health care facilities. A large retrospective survey was conducted in Hubei Province, China, in 2010. The sample included 620 non-TCM hospitals, 120 TCM hospitals, and 1254 community health centers (CHCs). Descriptive analysis and 1-way analysis of variance were used to test statistical differences. There were 79 447 nurses employed, of which 1527 had a TCM degree and 5689 had on-the-job TCM education. Non-TCM hospitals employed more nurses than TCM hospitals and CHCs, and TCM hospitals employed more TCM nurses than non-TCM hospitals and CHCs. The median nurse to physician ratio varied by level of urbanization and type of health care facility, from 0.6 in rural CHCs to 1.3 in rural non-TCM hospitals. Differences in TCM education preparation of nurses were significantly different in the urban and rural settings and by type of health care facility. The study suggested a shortage of nurses educated in TCM in Hubei Province China, as well as uneven TCM workforce distribution. More opportunities for TCM education are needed for nurses, especially in CHCs where health promotion and chronic disease management are the most important and mandated functions.

Influence of internal migration on reproductive health in Myanmar: results from a recent cross-sectional survey.

PubMed

Sudhinaraset, May; Diamond-Smith, Nadia; Thet, May Me; Aung, Tin

2016-03-09

Maternal and reproductive health remains a significant public health issue in Myanmar. Little data exists on women's health issues, including social and demographic influences. While past studies have demonstrated rural/urban health disparities, an increasingly important population resulting from urban growth in Myanmar is the internal migrant population, individuals moving within the country for better job or educational opportunities. Past studies suggest that women make up more than half of internal migrants, yet there is a dearth of information on this new wave of migration, particularly on women's reproductive health issues. The objective of this study is to assess the influence of women's migration in Myanmar on reproductive health outcomes, including delivering in a facility, using a skilled birth attendant, and using a modern method of family planning. Data from a cross-sectional household survey using multistage cluster sampling design conducted between September to October 2014 was used to assess the accessibility and the use of maternal and child health products and services. A total of 1800 currently married women of reproductive age, including 348 from urban and 1452 from rural areas, were recruited to complete surveys. A set of multivariable regressions was performed to assess reproductive health outcomes and predictors. Across health indicators, female migrants had better health outcomes compared to non-migrants. Controlling for demographic characteristics, migrants were 1.60 times more likely to use a modern form of family planning compared to non-migrants (p < 0.01) and use antenatal care during pregnancy (p < 0.05). While not statistically significant, migrants were 1.29 times more likely to deliver with a skilled attendant and 1.08 times more likely to deliver in a facility. This study found that female migrants in Myanmar reported better health outcomes compared to non-migrant women in regards to family planning and maternal health. Future research should focus on monitoring the outcomes of migrants and their children over time to assess long-term impacts.

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries.

PubMed

Mark, Daniella; Armstrong, Alice; Andrade, Catarina; Penazzato, Martina; Hatane, Luann; Taing, Lina; Runciman, Toby; Ferguson, Jane

2017-05-16

In 2013, an estimated 2.1 million adolescents (age 10-19 years) were living with HIV globally. The extent to which health facilities provide appropriate treatment and care was unknown. To support understanding of service availability in 2014, Paediatric-Adolescent Treatment Africa (PATA), a non-governmental organisation (NGO) supporting a network of health facilities across sub-Saharan Africa, undertook a facility-level situational analysis of adolescent HIV treatment and care services in 23 countries. Two hundred and eighteen facilities, responsible for an estimated 80,072 HIV-infected adolescents in care, were surveyed. Sixty per cent of the sample were from PATA's network, with the remaining gathered via local NGO partners and snowball sampling. Data were analysed using descriptive statistics and coding to describe central tendencies and identify themes. Respondents represented three subregions: West and Central Africa ( n  = 59; 27%), East Africa ( n  = 77, 35%) and southern Africa ( n  = 82, 38%). Half (50%) of the facilities were in urban areas, 17% peri-urban and 33% rural settings. Insufficient data disaggregation and outcomes monitoring were critical issues. A quarter of facilities did not have a working definition of adolescence. Facilities reported non-adherence as their key challenge in adolescent service provision, but had insufficient protocols for determining and managing poor adherence and loss to follow-up. Adherence counselling focused on implications of non-adherence rather than its drivers. Facilities recommended peer support as an effective adherence and retention intervention, yet not all offered these services. Almost two-thirds reported attending to adolescents with adults and/or children, and half had no transitioning protocols. Of those with transitioning protocols, 21% moved pregnant adolescents into adult services earlier than their peers. There was limited sexual and reproductive health integration, with 63% of facilities offering these services within their HIV programmes and 46% catering to the special needs of HIV-infected pregnant adolescents. Results indicate that providers are challenged by adolescent adherence and reflect an insufficiently targeted approach for adolescents. Guidance on standard definitions for adherence, retention and counselling approaches is needed. Peer support may create an enabling environment and sensitize personnel. Service delivery gaps should be addressed, with standardized transition and quality counselling. Integrated, comprehensive sexual reproductive health services are needed, with support for pregnant adolescents.

Assuring the Economic Health of America's Cities.

ERIC Educational Resources Information Center

Cisneros, Henry G.

1982-01-01

Discusses the relationship of the economic conditions of cities to the national economy. A national urban policy is needed which would promote cooperation between business and government, increase investment in public facilities--roads, bridges, ports, etc.--and channel more resources to local governments. (AM)

24 CFR 582.100 - Program component descriptions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... organizations. A sponsor may be a private, nonprofit organization or a community mental health agency... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES SHELTER PLUS CARE Assistance Provided § 582.100 Program...

24 CFR 200.100 - Insurance endorsement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a commitment for insured advances, initial endorsement of the credit instrument shall occur before... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance endorsement. 200.100... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and...

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.

PubMed

Gebrehiwot, Genet; Medhanyie, Araya Abrha; Gidey, Gebreamlak; Abrha, Kidan

2018-05-30

Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers.

PubMed

Balde, Mamadou Diouldé; Diallo, Boubacar Alpha; Bangoura, Abou; Sall, Oumar; Soumah, Anne Marie; Vogel, Joshua P; Bohren, Meghan A

2017-01-11

Every woman is entitled to respectful care during childbirth; so it is concerning to hear of informal reports of mistreatment during childbirth in Guinea. This study sought to explore the perceptions and experiences of mistreatment during childbirth, from the perspectives of women and service providers, and the analysis presents findings according to a typology of mistreatment during childbirth. This study used qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) and was conducted with four groups of participants: women of reproductive age, midwives, doctors, and administrators. The study took place in two sites in Guinea, an urban area (Mamou) and peri-urban (Pita). Data collection was conducted in two health facilities for providers and administrators, and in the health facility catchment area for women. Data were collected in local languages (Pular and Malinké), then transcribed and analyzed in French. We used a thematic analysis approach and coded transcripts manually. A total of 64 IDIs and eight FGDs were conducted and are included in this analysis, including 40 IDIs and eight FGDs with women of reproductive age, 5 IDIs with doctors, 13 IDIs with midwives, and 6 IDIs with administrators. Participants described their own personal experiences, experiences of women in their communities and perceptions regarding mistreatment during childbirth. Results were organized according to a typology of mistreatment during childbirth, and included instances of physical abuse, verbal abuse, abandonment and neglect. Women described being slapped by providers, yelled at for noncompliance with provider requests, giving birth on the floor and without skilled attendance in the health facility. Poor physical conditions of health facilities and health workforce constraints contributed to experiences of mistreatment. These results are important because they demonstrate that the mistreatment of women during childbirth exists in Guinea and occurs in multiple forms. These data should be used by the Ministry of Health and other stakeholders to develop strategies to reduce and prevent the mistreatment of women during childbirth.

Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011

PubMed Central

Khan, Md. Mobarak Hossain; Zanuzdana, Arina; Kraemer, Alexander

2013-01-01

Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further. PMID:24086485

Improving Exclusive Breastfeeding in an Urban Academic Hospital.

PubMed

Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M

2017-02-01

Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.

A method for studying the development pattern of urban commercial service facilities based on customer reviews from social media

NASA Astrophysics Data System (ADS)

Wang, Y. D.; Jiang, B. T.; Ye, X. Y.

2016-06-01

Urbanization is one of the most important human social activities in the 21st century (Chaolin et al., 2012). With an increasing number of people visiting cities, the provision of adequate urban service facilities, including public and commercial service facilities, in locations where people live has become an important guarantee of the success of urbanization. Exploring the commercial service facilities in a specific area of a city can help us understand the progress and trends of urban renewal in the area, provide a quantitative basis for evaluating the rationality of planning implementation, and facilitate an analysis of the effects of different factors on the regional development of a city (Schor et al. 2003). In this paper, we proposed a data processing and analysis method for studying the distribution and development pattern of urban commercial facilities based on customer reviews. In addition, based on road network constraints, we explored the patterns contained in customer reviews data, including patterns for the spatial distribution and spatial-temporal evolution of facilities as well as the number of facilities and degree of satisfaction.

Maternal health care utilization in Viet Nam: increasing ethnic inequity.

PubMed

Målqvist, Mats; Lincetto, Ornella; Du, Nguyen Huy; Burgess, Craig; Hoa, Dinh Thi Phuong

2013-04-01

To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2). Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.

Maternal health care utilization in Viet Nam: increasing ethnic inequity

PubMed Central

Lincetto, Ornella; Du, Nguyen Huy; Burgess, Craig; Hoa, Dinh Thi Phuong

2013-01-01

Abstract Objective To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. Methods Demographic, socioeconomic and obstetric data for women aged 15–49 years were extracted from Viet Nam’s Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010–2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. Findings Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94–7.43); in 2010–2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96–39.2). Conclusion Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions. PMID:23599548

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

Do Physical Proximity and Availability of Adequate Infrastructure at Public Health Facility Increase Institutional Delivery? A Three Level Hierarchical Model Approach

PubMed Central

Patel, Rachana; Ladusingh, Laishram

2015-01-01

This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007–08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women’s residing in more urbanized districts increased the utilization. “Inter-district” variation was 14 percent whereas “between-villages” variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation. PMID:26689199

Do Physical Proximity and Availability of Adequate Infrastructure at Public Health Facility Increase Institutional Delivery? A Three Level Hierarchical Model Approach.

PubMed

Patel, Rachana; Ladusingh, Laishram

2015-01-01

This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007-08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation.

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

PubMed Central

Lankoandé, Bruno; Duthé, Géraldine; Soura, Abdramane; Pison, Gilles

2018-01-01

ABSTRACT Background: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials. PMID:29869949

Mitigating the effects of landscape development on streams in urbanizing watersheds

USGS Publications Warehouse

Hogan, Dianna M.; Jarnagin, S. Taylor; Loperfido, John V.; Van Ness, Keith

2013-01-01

This collaborative study examined urbanization and impacts on area streams while using the best available sediment and erosion control (S&EC) practices in developing watersheds in Maryland, United States. During conversion of the agricultural and forested watersheds to urban land use, land surface topography was graded and vegetation was removed creating a high potential for sediment generation and release during storm events. The currently best available S&EC facilities were used during the development process to mitigate storm runoff water quality, quantity, and timing before entering area streams. Detailed Geographic Information System (GIS) maps were created to visualize changing land use and S&EC practices, five temporal collections of LiDAR (light detection and ranging) imagery were used to map the changing landscape topography, and streamflow, physical geomorphology, and habitat data were used to assess the ability of the S&EC facilities to protect receiving streams during development. Despite the use of the best available S&EC facilities, receiving streams experienced altered flow, geomorphology, and decreased biotic community health. These impacts on small streams during watershed development affect sediment and nutrient loads to larger downstream aquatic ecosystems such as the Chesapeake Bay.

Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda.

PubMed

Kwiringira, Japheth; Atekyereza, Peter; Niwagaba, Charles; Kabumbuli, Robert; Rwabukwali, Charles; Kulabako, Robinah; Günther, Isabel

2016-04-27

The effect of seasons on health outcomes is a reflection on the status of public health and the state of development in a given society. Evidence shows that in Sub-Saharan Africa, most infectious diseases flourish during the wet months of the year; while human activities in a context of constrained choices in life exacerbate the effects of seasons on human health. The paper argues that, the wet season and when human activities are at their peak, sanitation is most dire poor slum populations. A shared latrine cleaning observation was undertaken over a period of 6 months in the slums of Kampala city. Data was collected through facility observations, user group meetings, Focus group discussions and, key informant interviews. The photos of the observed sanitation facilities were taken and assessed for facility cleanliness or dirt. Shared latrine pictures, observations, Focus Group Discussion, community meetings and key informant interviews were analysed and subjected to an analysis over the wet, dry and human activity cycles before a facility was categorised as either 'dirty' or 'clean'. Human activity cycles also referred to as socio-economic seasons were, school days, holidays, weekends and market days. These have been called 'impure' seasons, while the 'pure' seasons were the wet and dry months: improved and unimproved facilities were negatively affected by the wet seasons and the peak seasons of human activity. Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities. Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.

Use of cancer-specific mental health resources-is there an urban-rural divide?

PubMed

Beraldi, Anna; Kukk, Ene; Nest, Alexandra; Schubert-Fritschle, Gabriele; Engel, Jutta; Heußner, Pia; Herschbach, Peter

2015-05-01

The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients. Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search. Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources. Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.

The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece.

PubMed

Kontodimopoulos, Nick; Moschovakis, Giorgos; Aletras, Vassilis H; Niakas, Dimitris

2007-11-17

The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location. The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000-30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression. Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney P < 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis P < 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney P = 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis P < 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney P < 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency. Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

Using GIS and perceived distance to understand the unequal geographies of healthcare in lower-income urban neighbourhoods.

PubMed

Hawthorne, Timothy L; Kwan, Mei-Po

2012-01-01

Geographers play important roles in public health research, particularly in understanding healthcare accessibility, utilisation, and individual healthcare experiences. Most accessibility studies have benefited from the increased sophistication of geographic information systems (GIS). Some studies have been enhanced with semi-structured in-depth interviews to understand individual experiences of people as they access healthcare. However, few accessibility studies have explicitly utilised individual in-depth interview data in the construction of new GIS accessibility measures. Using mixed methods including GIS analysis and individual data from semi-structured in-depth interviews, we offer satisfaction-adjusted distance as a new way of conceptualising accessibility in GIS. Based on fieldwork in a predominantly lower-income community in Columbus, Ohio (USA), we find many residents felt neighbourhood healthcare facilities offered low-quality care, which suggested an added perceived distance as they attempt to access high-quality healthcare facilities. The satisfaction-adjusted distance measure accounts for the perceived distance some residents feel as they search for high-quality healthcare in lower-income urban neighbourhoods. In moving beyond conventional GIS and re-conceptualising accessibility in this way, we offer a more realistic portrayal of the issues lower-income urban residents face as they attempt to access high-quality healthcare facilities. The work has theoretical implications for conceptualising healthcare accessibility, advances the mixed-methodologies literature, and argues for a more equitable distribution of high-quality healthcare in urban neighbourhoods.

Implementation of tuberculosis infection prevention and control in Mozambican health care facilities.

PubMed

Brouwer, M; Coelho, E; das Dores Mosse, C; van Leth, F

2015-01-01

District and urban health care facilities in three provinces (Manica, Sofala, Tete) in central Mozambique. To assess the level of implementation of selected tuberculosis infection prevention and control (TB-IPC) measures. In a cross-sectional study of TB-IPC implementation in 29 health care facilities, we assessed TB clinics, laboratories, out-patient departments and medical and TB wards. Assessment included selected managerial, administrative and environmental measures and the availability and use of respiratory protective equipment (N95 respirators). Guidelines for diagnosis and treatment of (presumptive) TB patients were not present in all facilities. Staff instructed patients on sputum collection in 91%, but only 4% observed it. Using a pragmatic '20% rule', 52% of the rooms assessed had adequate ventilation. Potentially, this could be increased to 76%. Three quarters of the health care workers had N95 respirators. Only 36% knew how to use it correctly. Implementation of TB-IPC measures showed wide variations within health care facilities. Relatively simple measures to improve TB-IPC include the availability of guidelines, opening doors and windows to improve ventilation, and training and support on correct N95 respirator use. However, even relatively simple measures are challenging to implement, and require careful attention in and evaluation of the implementation process.

Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

PubMed

Gosain, Mudita; Goel, Akhil D; Kharya, Pradeep; Agarwal, Ramesh; Amarchand, Ritvik; Rai, Sanjay K; Kapoor, Suresh; Paul, Vinod K; Krishnan, Anand

2017-10-01

Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector. © The Author [2017]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Use of reproductive health care services among urban migrant women in Bangladesh.

PubMed

Islam, Mohammad Mainul; Gagnon, Anita J

2016-03-09

Recent internal migration flows from rural to urban areas pose challenges to women using reproductive health care services in their migratory destinations. No studies were found which examined the relationship between migration, migration-associated indicators and reproductive health care services in Bangladesh. We analyzed the 2006 Bangladesh Urban Health Survey (data made publically available in June 2013) of 14,191 ever-married women aged 10-59 years. Cross tabulations and logistic regression were conducted. Migrants and non-migrants did not differ significantly in their use of modern contraceptives and treatment for STI but were less likely to receive ANC even after controlling for a range of variables. Compared to non-migrants, more migrants had home births, did not take vitamin A after delivery, and had no medical exam post-birth. Migrant women being village-born (rather than urban-born) were associated with risk of diminished: use of ANC; treatment for STI; medical exam post-birth; vitamin A post-birth. Migrating for work or education (rather than other reasons) was associated with risk of diminished: use of ANC; use of modern facilities for birth; and medical exam post-birth. Each additional year lived in urban areas was associated with a greater likelihood of receiving ANC. Women who migrated to urban areas in Bangladesh were significantly less likely than non-migrants to use reproductive health care services related to pregnancy care. Pro-actively identifying migrant women, especially those who originated from villages or migrated for work or education may be warranted to ensure optimal use of pregnancy-related services.

Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal

PubMed Central

Thiam, Sokhna; Diène, Aminata N.; Sy, Ibrahima; Winkler, Mirko S.; Schindler, Christian; Ndione, Jacques A.; Faye, Ousmane; Vounatsou, Penelope; Utzinger, Jürg; Cissé, Guéladio

2017-01-01

We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011–2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health–climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming. PMID:28895927

Sex differences in health care-seeking behavior for acute coronary syndrome in a low income country, Peru.

PubMed

Pastorius Benziger, Catherine; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Bukhman, Gene

2011-06-01

: Recognizing reasons for prehospital delay after symptoms of acute coronary syndrome (ACS) is established in developed countries yet evidence from Latin America is limited. We aimed to assess ACS symptom recognition, health care-seeking behavior, and confidence in local health care facilities to take care of ACS by gender in a sample of Peruvians. : A community-based interview survey in a peri-urban area in Lima, Peru. The 24-item study instrument included vignettes and questions assessing identification of urgent and emergent ACS symptoms, anticipated help-seeking behaviors, and confidence in local health care facilities. : In the study population (90 people; 45.6% men; mean age, 43.5 years), women were 4 times less likely to correctly attribute symptoms of chest pain to the heart (OR = 0.23; 95% CI: 0.063-0.87; P = 0.03). Women were much more likely to respond that a man would "Seek help" (OR = 4.54; 95% CI: 1.21-16.90; P = 0.024) and that "Yes," a woman would be less likely to seek help for chest pain symptoms (OR = 3.26; 95% CI: 1.13-9.41 P = 0.029) after adjusting for age, education level, age at migration, and history of chest pain. Women were less likely than men to think that their local Health Care Post would help them if they had a heart attack (2.1% vs. 14.6%; P = 0.04), and only 18.7% of women believed that their local emergency room would help them. : Our findings suggest women are less likely to seek help for chest pain and women and men in a peri-urban area in Peru are not confident in their local health care facility to treat urgent or emergent ACS symptoms.

Factors limiting immunization coverage in urban Dili, Timor-Leste

PubMed Central

Amin, Ruhul; De Oliveira, Telma Joana Corte Real; Da Cunha, Mateus; Brown, Tanya Wells; Favin, Michael; Cappelier, Kelli

2013-01-01

ABSTRACT Background: Timor-Leste's immunization coverage is among the poorest in Asia. The 2009/2010 Demographic and Health Survey found that complete vaccination coverage in urban areas, at 47.7%, was lower than in rural areas, at 54.1%. The city of Dili, the capital of Timor-Leste, had even lower coverage (43.4%) than the national urban average. Objective: To better understand the service- and user-related factors that account for low vaccination coverage in urban Dili, despite high literacy rates and relatively good access to immunization services and communication media. Methods: A mixed-methods (mainly qualitative) study, conducted in 5 urban sub-districts of Dili, involved in-depth interviews with18 Ministry of Health staff and 6 community leaders, 83 observations of immunization encounters, 37 exit interviews with infants' caregivers at 11 vaccination sites, and 11 focus group discussions with 70 caregivers of vaccination-eligible children ages 6 to 23 months. Results: The main reasons for low vaccination rates in urban Dili included caregivers' knowledge, attitudes, and perceptions as well as barriers at immunization service sites. Other important factors were access to services and information, particularly in the city periphery, health workers' attitudes and practices, caregivers' fears of side effects, conflicting priorities, large family size, lack of support from husbands and paternal grandmothers, and seasonal migration. Conclusion: Good access to health facilities or health services does not necessarily translate into uptake of immunization services. The reasons are complex and multifaceted but in general relate to the health services' insufficient understanding of and attention to their clients' needs. Almost all families in Dili would be motivated to have their children immunized if services were convenient, reliable, friendly, and informative. PMID:25276554

Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia

PubMed Central

Sivasampu, Sheamini; Khoo, Ee Ming; Mohamad Noh, Kamaliah

2017-01-01

Background Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. Methods We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Results Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71–0.96). Conclusions Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare resources. Nonetheless, geographic expansion alone is inadequate to achieve effective coverage in a dichotomous primary care system, and the role of the private sector in primary care delivery should not be overlooked. PMID:28196113

Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia.

PubMed

Lim, Huy Ming; Sivasampu, Sheamini; Khoo, Ee Ming; Mohamad Noh, Kamaliah

2017-01-01

Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71-0.96). Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare resources. Nonetheless, geographic expansion alone is inadequate to achieve effective coverage in a dichotomous primary care system, and the role of the private sector in primary care delivery should not be overlooked.

Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

PubMed

Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

2015-07-30

To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?

PubMed Central

Ezeh, Alex; Oronje, Rose

2008-01-01

In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya’s Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services. PMID:18389376

An exploration of beliefs and attitudes regarding healthy lifestyle behaviour in an urban population in The Netherlands: Results from a focus group study in a community-based prevention project.

PubMed

Kloosterboer, Sanne M; van den Brekel, Karolien; Rengers, Antonia H; Peek, Niels; de Wit, Niek J

2015-06-01

The positive effects of lifestyle intervention programmes might be enhanced when targeted to the health-related behaviour of the users. This study explores the beliefs and attitudes regarding a healthy lifestyle, the influences on lifestyle behavioural change and the needs to support a healthy lifestyle in the local community, during an integrated community-based prevention project in newly developed urban area in the Netherlands. Three focus groups were conducted with urban residents aged 45-70 (n = 28). Thematic qualitative analysis was applied to verbatim transcripts to identify emerging themes. The following themes were identified: beliefs to healthy behaviour, responsibility for health, perceived behavioural control, external influences on behavioural change and needs in the local community. Within these themes, personal responsibility for health and the influence of the social and physical environment emerged to be important for health and lifestyle. The participants expressed the need for clearly organized health and lifestyle facilities, a personalized approach and an easily accessible health risk assessment to support lifestyle behavioural change in the community. In our study, urban residents experienced a strong influence of the social and physical environment to their lifestyle behaviour. This finding supports an integrated approach for preventive health services in this population. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The Role of Distance and Quality on Facility Selection for Maternal and Child Health Services in Urban Kenya.

PubMed

Escamilla, Veronica; Calhoun, Lisa; Winston, Jennifer; Speizer, Ilene S

2018-02-01

Universal access to health care requires service availability and accessibility for those most in need of maternal and child health services. Women often bypass facilities closest to home due to poor quality. Few studies have directly linked individuals to facilities where they sought maternal and child health services and examined the role of distance and quality on this facility choice. Using endline data from a longitudinal survey from a sample of women in five cities in Kenya, we examine the role of distance and quality on facility selection for women using delivery, facility-based contraceptives, and child health services. A survey of public and private facilities offering reproductive health services was also conducted. Distances were measured between household cluster location and both the nearest facility and facility where women sought care. A quality index score representing facility infrastructure, staff, and supply characteristics was assigned to each facility. We use descriptive statistics to compare distance and quality between the nearest available facility and visited facility among women who bypassed the nearest facility. Facility distance and quality comparisons were also stratified by poverty status. Logistic regression models were used to measure associations between the quality and distance to the nearest facility and bypassing for each outcome. The majority of women bypassed the nearest facility regardless of service sought. Women bypassing for delivery traveled the furthest and had the fewest facility options near their residential cluster. Poor women bypassing for delivery traveled 4.5 km further than non-poor women. Among women who bypassed, two thirds seeking delivery and approximately 46% seeking facility-based contraception or child health services bypassed to a public hospital. Both poor and non-poor women bypassed to higher quality facilities. Our findings suggest that women in five cities in Kenya prefer public hospitals and are willing to travel further to obtain services at public hospitals, possibly related to free service availability. Over time, it will be important to examine service quality and availability in public sector facilities with reduced or eliminated user fees, and whether it lends itself to a continuum of care where women can visit one facility for multiple services reducing travel burden.

Rural Health Issues. Keynote Address.

ERIC Educational Resources Information Center

Hart, Gary

Medical students that come from rural areas are more likely to return to rural areas to practice, but rural students apply for medical school at half the rate of urban students. Factors that contribute to this problem are the lack of rural representation on medical school selection committees; centralization of medical education facilities in…

Urban Watershed Research Facility at Edison Environmental Center

EPA Science Inventory

The Urban Watershed Research Facility (UWRF) is an isolated, 20-acre open space within EPA’s 200 acre Edison facility established to develop and evaluate the performance of stormwater management practices under controlled conditions. The facility includes greenhouses that allow ...

Can urban regeneration programmes assist coping and recovery for people with mental illness? Suggestions from a qualitative case study.

PubMed

Whitley, Rob; Prince, Martin

2006-03-01

Researchers and policy-makers are increasingly recognizing that urban socio-environmental conditions can affect the development and course of numerous health problems. The aim of this paper is to investigate the impact an urban regeneration programme can have on everyday functioning, coping and recovery for people with a mental illness. We were also interested in discerning which component parts of the regeneration are the most important in positively affecting people with mental illness. These questions were explored through an in-depth qualitative case study of the Gospel Oak neighbourhood in London, which recently underwent an intensive urban regeneration programme. Interviews and focus groups were conducted with residents living with a mental illness (n = 16). Relevant participant observation was also conducted. Participants reported that interventions that improved community safety were by far the most important in affecting everyday coping and functioning. Interventions that improved the quantity and quality of shared community facilities had a positive, but milder effect on mental health. Component parts that appeared to have little effect included environmental landscaping and greater community involvement in decision-making processes. Most participants reported that their mental illness was a consequence of severe insults over the life-span, for example childhood neglect or family breakdown. Thus, the regeneration was seen as something that could assist coping, but not something that could significantly contribute to complete recovery. Our results thus suggest that urban regeneration can have a mild impact on people with mental illness, but this appears to be outweighed by life-span experience of severe individual-level risk factors. That said, some of our findings converge with other studies indicating that community safety and community facilities can play a role in positively affecting mental health. Further ethnographic and epidemiological research is necessary to explore these two factors.

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey.

PubMed

Adewuyi, Emmanuel O; Zhao, Yun; Auta, Asa; Lamichhane, Reeta

2017-08-01

The aim of this study was to assess the rural-urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria. Dataset from the Nigeria demographic and health survey, 2013, disaggregated by rural-urban residence were analyzed with appropriate adjustment for the cluster sampling design of the survey. Factors associated with home delivery were identified using multivariable logistic regression analysis. In rural and urban residence, the prevalence of home delivery were 78.3% and 38.1%, respectively ( p < 0.001). The lowest prevalence of home delivery occurred in the South-East region for rural residence (18.6%) and the South-West region for urban residence (17.9%). The North-West region had the highest prevalence of home delivery, 93.6% and 70.5% in rural and urban residence, respectively. Low maternal as well as paternal education, low antenatal attendance, being less wealthy, the practice of Islam, and living in the North-East, North-West and the South-South regions increased the likelihood of home delivery in both rural and urban residences. Whether in rural or urban residence, birth order of one decreased the likelihood of home delivery. In rural residence only, living in the North-Central region increased the chances of home delivery. In urban residence only, maternal age ⩾ 36 years decreased the likelihood of home delivery, while 'Traditionalist/other' religion and maternal age < 20 years increased it. The prevalence of home delivery was much higher in rural than urban Nigeria and the associated factors differ to varying degrees in the two residences. Future intervention efforts would need to prioritize findings in this study.

The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis.

PubMed

Topp, Stephanie M; Black, Jim; Morrow, Martha; Chipukuma, Julien M; Van Damme, Wim

2015-02-18

Questions about the impact of large donor-funded HIV interventions on low- and middle-income countries' health systems have been the subject of a number of expert commentaries, but comparatively few empirical research studies. Aimed at addressing a particular evidence gap vis-à-vis the influence of HIV service scale-up on micro-level health systems, this article examines the impact of HIV scale-up on mechanisms of accountability in Zambian primary health facilities. Guided by the Mechanisms of Effect framework and Brinkerhoff's work on accountability, we conducted an in-depth multi-case study to examine how HIV services influenced mechanisms of administrative and social accountability in four Zambian primary health centres. Sites were selected for established (over 3 yrs) antiretroviral therapy (ART) services and urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (2 wks/centre) and key informant interviews (14). Resource-intensive investment in HIV services contributed to some early gains in administrative answerability within the four ART departments, helping to establish the material capabilities necessary to deliver and monitor service delivery. Simultaneous investment in external supervision and professional development helped to promote transparency around individual and team performance and also strengthened positive work norms in the ART departments. In the wider health centres, however, mechanisms of administrative accountability remained weak, hindered by poor data collection and under capacitated leadership. Substantive gains in social accountability were also elusive as HIV scale-up did little to address deeply rooted information and power asymmetries in the wider facilities. Short terms gains in primary-level service accountability may arise from investment in health system hardware. However, sustained improvements in service quality and responsiveness arising from genuine improvements in social and administrative accountability require greater understanding of, and investment in changing, the power relations, work norms, leadership and disciplinary mechanisms that shape these micro-level health systems.

Addressing tuberculosis control in fragile states: Urban DOTS experience in Kabul, Afghanistan, 2009-2015

PubMed Central

Sayedi, M.; Rashidi, M.; Manzoor, L.; Seddiq, M. K.; Ikram, N.

2017-01-01

Tuberculosis (TB) is a major public health problem in Afghanistan, but experience in implementing effective strategies to prevent and control TB in urban areas and conflict zones is limited. This study shares programmatic experience in implementing DOTS in the large city of Kabul. We analyzed data from the 2009–2015 reports of the National TB Program (NTP) for Kabul City and calculated treatment outcomes and progress in case notification using rates, ratios, and confidence interval. Urban DOTS was implemented by the NTP in partnership with United States Agency for International Development (USAID)-funded TB projects, the World Health Organization (WHO), and the private sector. Between 2009 and 2015, the number of DOTS-providing centers in Kabul increased from 22 to 85. In total, 24,619 TB patients were enrolled in TB treatment during this period. The case notification rate for all forms of TB increased from 59 per 100,000 population to 125 per 100,000. The case notification rate per 100,000 population for sputum-smear-positive TB increased from 25 to 33. The treatment success rate for all forms of TB increased from 31% to 67% and from 47% to 77% for sputum-smear-positive TB cases. The treatment success rate for private health facilities increased from 52% in 2010 to 80% in 2015. In 2013, contact screening was introduced, and the TB yield was 723 per 100,000—more than two times higher than the estimated national prevalence of 340 per 100,000. Contact screening contributed to identifying 2,509 child contacts of people with TB, and 76% of those children received isoniazid preventive therapy. The comprehensive urban DOTS program significantly improved service accessibility, TB case finding, and treatment outcomes in Kabul. Public- and private-sector involvement also improved treatment outcomes; however, the treatment success rate remains higher in private health facilities. While the treatment success rate increased significantly, it remains lower than the national average, and more efforts are needed to improve treatment outcomes in Kabul. We recommend that the urban DOTS approach be replicated in other countries and cities in Afghanistan with settings similar to Kabul. PMID:28562675

Addressing tuberculosis control in fragile states: Urban DOTS experience in Kabul, Afghanistan, 2009-2015.

PubMed

Qader, G; Hamim, A; Sayedi, M; Rashidi, M; Manzoor, L; Seddiq, M K; Ikram, N; Suarez, P G

2017-01-01

Tuberculosis (TB) is a major public health problem in Afghanistan, but experience in implementing effective strategies to prevent and control TB in urban areas and conflict zones is limited. This study shares programmatic experience in implementing DOTS in the large city of Kabul. We analyzed data from the 2009-2015 reports of the National TB Program (NTP) for Kabul City and calculated treatment outcomes and progress in case notification using rates, ratios, and confidence interval. Urban DOTS was implemented by the NTP in partnership with United States Agency for International Development (USAID)-funded TB projects, the World Health Organization (WHO), and the private sector. Between 2009 and 2015, the number of DOTS-providing centers in Kabul increased from 22 to 85. In total, 24,619 TB patients were enrolled in TB treatment during this period. The case notification rate for all forms of TB increased from 59 per 100,000 population to 125 per 100,000. The case notification rate per 100,000 population for sputum-smear-positive TB increased from 25 to 33. The treatment success rate for all forms of TB increased from 31% to 67% and from 47% to 77% for sputum-smear-positive TB cases. The treatment success rate for private health facilities increased from 52% in 2010 to 80% in 2015. In 2013, contact screening was introduced, and the TB yield was 723 per 100,000-more than two times higher than the estimated national prevalence of 340 per 100,000. Contact screening contributed to identifying 2,509 child contacts of people with TB, and 76% of those children received isoniazid preventive therapy. The comprehensive urban DOTS program significantly improved service accessibility, TB case finding, and treatment outcomes in Kabul. Public- and private-sector involvement also improved treatment outcomes; however, the treatment success rate remains higher in private health facilities. While the treatment success rate increased significantly, it remains lower than the national average, and more efforts are needed to improve treatment outcomes in Kabul. We recommend that the urban DOTS approach be replicated in other countries and cities in Afghanistan with settings similar to Kabul.

Does Travel Time to a Radiation Facility Impact Patient Decision-Making Regarding Treatment for Prostate Cancer? A Study of the New Hampshire State Cancer Registry.

PubMed

Ghali, Fady; Celaya, Maria; Laviolette, Michael; Ingimarsson, Johann; Carlos, Heather; Rees, Judy; Hyams, Elias

2018-02-01

We sought to determine whether further distance from a radiation center is associated with lower utilization of external beam radiation therapy (XRT). We retrospectively identified patients with a new diagnosis of localized prostate cancer (CaP) within the New Hampshire State Cancer Registry from 2004 to 2011. Patients were categorized by age, D'Amico risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were stratified into those requiring multiple trips (XRT) or a single trip (surgery or brachytherapy). Multivariable regression analysis was performed. A total of 4,731 patients underwent treatment for newly diagnosed CaP during the study period, including 1,575 multitrip (XRT) and 3,156 single-trip treatments. Of these, 87.6% lived within a 30-minute drive to a radiation facility. In multivariable analysis, time to the nearest radiation facility was not associated with treatment decisions (P = .26). However, higher risk category, older age, married status, and winter diagnosis were associated with XRT (P < .05). More recent year of diagnosis and urban residence were associated with single-trip therapy (primarily surgery) (P < .05). There was a significant interaction between travel time and season of diagnosis (P = .03), as well as a marginally significant interaction with urban/rural status (P = .07). Overall, further travel time to a radiation facility was not associated with lower utilization of XRT. These data are encouraging regarding access to care for CaP in New Hampshire. © 2016 National Rural Health Association.

Gender equality and childbirth in a health facility: Nigeria and MDG5.

PubMed

Singh, Kavita; Bloom, Shelah; Haney, Erica; Olorunsaiye, Comfort; Brodish, Paul

2012-09-01

This paper examined how addressing gender equality can lead to reductions in maternal mortality in Nigeria through an increased use of facility delivery. Because the majority of maternal complications cannot be predicted and often arise suddenly during labor, delivery and the immediate postpartum period, childbirth in a health facility is key to reducing maternal mortality. This paper used data from the 2008 Nigeria Demographic and Health Survey (DHS) to examine associations of gender measures on the utilization of facility delivery after controlling for socio-demographic factors. Four gender equality measures were studied: household decision-making, financial decision-making, attitudes towards wife beating, and attitudes regarding a wife's ability to refuse sex. Results found older, more educated, wealthier, urban, and working women were more likely to have a facility delivery than their counterparts. In addition ethnicity was a significant variable indicating the importance of cultural and regional diversity. Notably, after controlling for the socioeconomic variables, two of the gender equality variables were significant: household decision-making and attitudes regarding a wife's ability to refuse sex. In resource-poor settings such as Nigeria, women with more decision-making autonomy are likely better able to advocate for and access a health facility for childbirth. Thus programs and policies that focus on gender in addition to focusing on education and poverty have the potential to reduce maternal mortality even further.

Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania

PubMed Central

Wandwalo, Eliud; Robberstad, Bjarne; Morkve, Odd

2005-01-01

Background Identifying new approaches to tuberculosis treatment that are effective and put less demand to meagre health resources is important. One such approach is community based direct observed treatment (DOT). The purpose of the study was to determine the cost and cost effectiveness of health facility and community based directly observed treatment of tuberculosis in an urban setting in Tanzania. Methods Two alternative strategies were compared: health facility based directly observed treatment by health personnel and community based directly observed treatment by treatment supervisors. Costs were analysed from the perspective of health services, patients and community in the year 2002 in US $ using standard methods. Treatment outcomes were obtained from a randomised-controlled trial which was conducted alongside the cost study. Smear positive, smear negative and extra-pulmonary TB patients were included. Cost-effectiveness was calculated as the cost per patient successfully treated. Results The total cost of treating a patient with conventional health facility based DOT and community based DOT were $ 145 and $ 94 respectively. Community based DOT reduced cost by 35%. Cost fell by 27% for health services and 72% for patients. When smear positive and smear negative patients were considered separately, community DOT was associated with 45% and 19% reduction of the costs respectively. Patients used about $ 43 to follow their medication to health facility which is equivalent to their monthly income. Indirect costs were as important as direct costs, contributing to about 49% of the total patient's cost. The main reason for reduced cost was fewer number of visits to the TB clinic. Community based DOT was more cost-effective at $ 128 per patient successfully treated compared to $ 203 for a patient successfully treated with health facility based DOT. Conclusion Community based DOT presents an economically attractive option to complement health facility based DOT. This is particularly important in settings where TB clinics are working beyond capacity under limited resources. PMID:16018806

Child morbidity and care-seeking in Nairobi slum settlements: the role of environmental and socio-economic factors.

PubMed

Ndugwa, Robert Peter; Zulu, Eliya M

2008-12-01

The aim of this study was to investigate factors that influence morbidity patterns and health-seeking decisions in an urban slum community. Data were collected between May and August 2003 as part of the ongoing Nairobi urban demographic surveillance system and were analysed to identify factors that influence morbidity patterns and health-seeking decisions. The results show that the factors that influenced morbidity were the child's age, ethnicity and type of toilet facility. Predictors for seeking health care were the child's age, type and severity of illness, survival of father and mother, mother's education, mother's work status and wealth class. The conclusions drawn show that economic resources fall short in preventing child illnesses where children live in poor environmental conditions. However, by enhancing access to health care services, socio-economic status is critical for mitigating disease burden among children in slum settlements.

Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda.

PubMed

Doctor, Henry V; Nkhana-Salimu, Sangwani; Abdulsalam-Anibilowo, Maryam

2018-06-19

Sub-Saharan Africa remains one of the regions with modest health outcomes; and evidenced by high maternal mortality ratios and under-5 mortality rates. There are complications that occur during and following pregnancy and childbirth that can contribute to maternal deaths; most of which are preventable or treatable. Evidence shows that early and regular attendance of antenatal care and delivery in a health facility under the supervision of trained personnel is associated with improved maternal health outcomes. The aim of this study is to assess changes in and determinants of health facility delivery using nationally representative surveys in sub-Saharan Africa. This study also seeks to present renewed evidence on the determinants of health facility delivery within the context of the Agenda for Sustainable Development to generate evidence-based decision making and enable deployment of targeted interventions to improve health facility delivery and maternal and child health outcomes. We used pooled data from 58 Demographic and Health Surveys (DHS) conducted between 1990 and 2015 in 29 sub-Saharan African countries. This yielded a total of 1.1 million births occurring in the 5 years preceding the surveys. Descriptive statistics were used to describe the counts and proportions of women who delivered by place of delivery and their background characteristics at the time of delivery. We used multilevel logistic regression model to estimate the magnitude of association in the form of odds ratios between place of delivery and the predictors. Results show that births among women in the richest wealth quintile were 68% more likely to occur in health facilities than births among women in the lowest wealth quintile. Women with at least primary education were twice more likely to give birth in facilities than women with no formal education. Births from more recent surveys conducted since 2010 were 85% more likely to occur in facilities than births reported in earliest (1990s) surveys. Overall, the proportion of births occurring in facilities was 2% higher than would be expected; and varies by country and sub-Saharan African region. Proven interventions to increase health facility delivery should focus on addressing inequities associated with maternal education, women empowerment, increased access to health facilities as well as narrowing the gap between the rural and the urban areas. We further discuss these results within the agenda of leaving no one behind by 2030.

Causative Factors of Social Inequality and its Impact on Community Health: a Neighbourhood Level Study in Midnapore Municipal Area, West Bengal, India

NASA Astrophysics Data System (ADS)

Roy, U.

2016-10-01

Health is socio-demographic construct of population. In an urban area social, economic and political systems simultaneously operate within a geographically defined space in which the urban dwellers accommodate and act as key player. As such the physical and social factors virtually affect the community health as a consequence of disparity in accessing health. Health disparities in smaller towns of the developing world have drawn serious attention as they are poorly suffering from the problems of `urban penalty'. This paper deals with statistical clustering of neighbourhoods on the basis of quality of life, social deprivation and multiple suffering quantified as the variables derived from measurable parameters. Neighbourhoods inequality has been mapped as per the score received by each neighbourhood in respect to the above three variables. Principal Component Analysis (PCA) has also been employed for grouping the neighbourhoods in social terms. Then it has been tried to examine relationship between health attainment and social status of the neighbourhoods. The study shows that status of health does not merely depend on socio-demographic and political factors but availability of healthcare facilities, health related behaviour, health perception and awareness have played significant roles. The findings of the study may be helpful for setting planning strategies most important of which would be inclusion of local people in catering health services.

75 FR 5847 - Section 5309 Bus and Bus Facilities Livability Initiative and Urban Circulator Program Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... Livability Initiative and Urban Circulator Program Grants AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice to Extend Application Deadline for the Bus and Bus Facilities and Urban Circulator..., Transportation Equity Act: A Legacy for Users (SAFETEA-LU), Public Law 109-59, August 10, 2005. The Urban...

Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana.

PubMed

Owusu-Ansah, Frances E; Tagbor, Harry; Togbe, Mabel Afi

2016-03-29

Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers' quality of life. This study describes residents' access to health and factors associated with the use of healthcarefacilities. Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected. Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1%) or hospitals (33.1%). Residents' age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly (p < 0.05) associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2%) nor transportation to health facilities was a problem (74.1%). Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend.

Vaccine storage and cold chain monitoring in the North West region of Cameroon: a cross sectional study.

PubMed

Yakum, Martin Ndinakie; Ateudjieu, Jerome; Walter, Ebile Akoh; Watcho, Pierre

2015-04-14

The cold chain must be monitored continuously in order to guarantee vaccines' quality. From field reports and previous studies, cold chain monitoring for expanded program on immunization (EPI) is still not satisfactory in Cameroon. This study was conducted to evaluate the availability and functioning of cold chain equipment as well as knowledge. It was a cross-sectional study involving a multistage sampling. 3urban and 5rural districts were selected randomly from the 19 health districts of the North West region. In each district all the health facilities taking part in the EPI were targeted. Data were collected using a questionnaire administered face to face to health personnel and with an observational grid to assess availability, functioning, and monitoring of cold chain equipment and power supply. The data were analyzed using the epi-info software. A total of 70 health facilities were contacted and 65(88.6%) of them included in the study. Fifty-three (81.5%) out of 65 health facilities had at least one functional vaccine refrigerator. The national guideline of EPI was not present in 21(33.9%) health facilities. Temperature chart was complete/correctly filled in 25(50.0%) of the 50(96.2%) facilities having it. About 14 (26.9%) of the health facilities record at least one abnormal temperature during the last 2 months following data collection. Seventeen (28.3%) personnel did not know the correct vaccine storage temperature. The availability of vaccine storage equipment for EPI is acceptable in the North West Region of Cameroon but the capacity of those in charge to properly monitor it in all health facilities is still limited. To ensure that vaccines administered in the North West Region are stored at the recommended temperature, all District Health Services should train and regularly supervise the health personnel in charge of cold chain monitoring.

Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

PubMed

McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

2014-01-01

China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.

Satisfaction with local exercise facility: a rural-urban comparison in China.

PubMed

Zheng, Jiakun; An, Ruopeng

2015-01-01

Rural-urban inequalities in China have been widening over the past few decades. Compared to their urban counterparts, rural residents may encounter various barriers to equal opportunities to effectively engage in physical activity. This study examines the rural-urban disparity in physical activity, proximity and satisfaction with local exercise facilities. An in-person survey was conducted in 29 counties of 10 Chinese provinces in 2012. Five thousand questionnaires were administered by trained staff with a completion rate of 82.1%. The complete sample includes 1661 rural and 2446 urban residents. Eight dichotomous outcome measures were used, pertaining to leisure-time physical activity engagement; proximity to the nearest exercise facility from home; satisfaction level with the quantity, variety, fee levels, opening hours, and daily management and services of nearby exercise facilities; and satisfaction level with the local public sports service system. Nearest-neighbor matching was performed to match rural residents with urban residents by observed individual sociodemographics, including gender, age, education level and residential province. Pearson's χ2 test was used to assess the difference in sociodemographics and outcome measures between rural and urban residents before and after matching. Before nearest-neighbor matching, the frequency distributions of age and education level are significantly different between rural and urban residents (both p<0.0001). After matching, the differences in the frequency distributions between rural and urban residents become statistically non-significant for all observed sociodemographics: gender (p=0.170), age (p=0.934), education level (p=0.244) and residential province (p=1.000). Compared to their matched urban counterparts, rural residents are 8.1% (p<0.0001) more likely to be physically inactive in their leisure time and 5.8% (p=0.005) less likely to live within 30-minute walking distance to the nearest exercise facility. Rural residents are 15.7%, 15.7%, 8.6%, 13.5% and 14.7% more likely to be unsatisfied with the quantity, variety, fee levels, opening hours, and daily management and services of nearby exercise facilities, and 16.1% more likely to be unsatisfied with the local public sports service system than matched urban residents (all p<0.0001). Substantial rural-urban disparities tend to be present in leisure-time physical activity, proximity to the nearest exercise facility, and satisfaction level with exercise facilities and the public sports service system. Policy interventions are warranted to improve the accessibility and affordability of local exercise facilities in rural areas as a way to promote physical activity among Chinese rural residents and reduce disparities.

Signal functions for emergency obstetric care as an intervention for reducing maternal mortality: a survey of public and private health facilities in Lusaka District, Zambia.

PubMed

Tembo, Tannia; Chongwe, Gershom; Vwalika, Bellington; Sitali, Lungowe

2017-09-06

Zambia's maternal mortality ratio was estimated at 398/100,000 live births in 2014. Successful aversion of deaths is dependent on availability and usability of signal functions for emergency obstetric and neonatal care. Evidence of availability, usability and quality of signal functions in urban settings in Zambia is minimal as previous research has evaluated their distribution in rural settings. This survey evaluated the availability and usability of signal functions in private and public health facilities in Lusaka District of Zambia. A descriptive cross sectional study was conducted between November 2014 and February 2015 at 35 public and private health facilities. The Service Availability and Readiness Assessment tool was adapted and administered to overall in-charges, hospital administrators or maternity ward supervisors at health facilities providing maternal and newborn health services. The survey quantified infrastructure, human resources, equipment, essential drugs and supplies and used the UN process indicators to determine availability, accessibility and quality of signal functions. Data on deliveries and complications were collected from registers for periods between June 2013 and May 2014. Of the 35 (25.7% private and 74.2% public) health facilities assessed, only 22 (62.8%) were staffed 24 h a day, 7 days a week and had provided obstetric care 3 months prior to the survey. Pre-eclampsia/ eclampsia and obstructed labor accounted for most direct complications while postpartum hemorrhage was the leading cause of maternal deaths. Overall, 3 (8.6%) and 5 (14.3%) of the health facilities had provided Basic and Comprehensive EmONC services, respectively. All facilities obtained blood products from the only blood bank at a government referral hospital. The UN process indicators can be adequately used to monitor progress towards maternal mortality reduction. Lusaka district had an unmet need for BEmONC as health facilities fell below the minimum UN standard. Public health facilities with capacity to perform signal functions should be upgraded to Basic EmONC status. Efforts must focus on enhancing human resource capacity in EmONC and improving infrastructure and supply chain. Obstetric health needs and international trends must drive policy change.

The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania

PubMed Central

Borghi, Josephine; Makawia, Suzan; Kuwawenaruwa, August

2015-01-01

Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged. PMID:24334331

Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

PubMed

Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

2015-01-01

Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi.

PubMed

Carvajal-Aguirre, Liliana; Mehra, Vrinda; Amouzou, Agbessi; Khan, Shane M; Vaz, Lara; Guenther, Tanya; Kalino, Maggie; Zaka, Nabila

2017-12-01

Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P  = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P  < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.

Inequities in utilization of reproductive and maternal health services in Ethiopia.

PubMed

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

A Qualitative Study Investigating Experiences, Perceptions, and Healthcare System Performance in Relation to the Surveillance of Typhoid Fever in Madagascar.

PubMed

Pach, Alfred; Warren, Michelle; Chang, Irene; Im, Justin; Nichols, Chelsea; Meyer, Christian G; Pak, Gi Deok; Panzner, Ursula; Park, Se Eun; von Kalckreuth, Vera; Baker, Stephen; Rabezanahary, Henintsoa; Rakotondrainiarivelo, Jean Philibert; Raminosoa, Tiana Mirana; Rakotozandrindrainy, Raphaël; Marks, Florian

2016-03-15

The burden of typhoid fever (TF) in sub-Saharan Africa is largely unknown but is increasingly thought to be high, given that water and sanitary conditions remain unimproved in many countries. To address this gap in information, the Typhoid Fever Surveillance in Africa Program (TSAP) founded a surveillance system for TF in 10 African countries. This study was a component of the TSAP surveillance project in Madagascar. The study entailed a qualitative assessment of patients' experiences and perceptions of services for febrile symptoms at the studies' rural and urban sentinel public health clinics. The study examined influences on the use of these facilities, alternative sources of care, and providers' descriptions of medical consultations and challenges in providing services. Data were collected through semistructured and open-ended individual interviews and a focus group with patients, caregivers, and medical personnel. Thirty-three patients and 12 healthcare providers participated in the data collection across the 2 healthcare facilities. The quality of services, cost, and travel distance were key factors that enabled access to and use of these clinics. Divergent healthcare-seeking patterns were related to variability in the care utilized, socioeconomic status, and potential distance from the facilities : These factors influenced delivery of care, patient access, and the health facilities' capacity to identify cases of febrile illness such as TF. This approach provided an in-depth investigation and understanding of healthcare-seeking behavior at the study facilities, and factors that facilitated or acted as barriers to their use. Our findings demonstrate the relevance of these public health clinics as sites for the surveillance of TF in their role as central healthcare sources for families and communities within these rural and urban areas of Madagascar. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The comparison of fossil carbon fraction and greenhouse gas emissions through an analysis of exhaust gases from urban solid waste incineration facilities.

PubMed

Kim, Seungjin; Kang, Seongmin; Lee, Jeongwoo; Lee, Seehyung; Kim, Ki-Hyun; Jeon, Eui-Chan

2016-10-01

In this study, in order to understand accurate calculation of greenhouse gas emissions of urban solid waste incineration facilities, which are major waste incineration facilities, and problems likely to occur at this time, emissions were calculated by classifying calculation methods into 3 types. For the comparison of calculation methods, the waste characteristics ratio, dry substance content by waste characteristics, carbon content in dry substance, and (12)C content were analyzed; and in particular, CO2 concentration in incineration gases and (12)C content were analyzed together. In this study, 3 types of calculation methods were made through the assay value, and by using each calculation method, emissions of urban solid waste incineration facilities were calculated then compared. As a result of comparison, with Calculation Method A, which used the default value as presented in the IPCC guidelines, greenhouse gas emissions were calculated for the urban solid waste incineration facilities A and B at 244.43 ton CO2/day and 322.09 ton CO2/day, respectively. Hence, it showed a lot of difference from Calculation Methods B and C, which used the assay value of this study. It is determined that this was because the default value as presented in IPCC, as the world average value, could not reflect the characteristics of urban solid waste incineration facilities. Calculation Method B indicated 163.31 ton CO2/day and 230.34 ton CO2/day respectively for the urban solid waste incineration facilities A and B; also, Calculation Method C indicated 151.79 ton CO2/day and 218.99 ton CO2/day, respectively. This study intends to compare greenhouse gas emissions calculated using (12)C content default value provided by the IPCC (Intergovernmental Panel on Climate Change) with greenhouse gas emissions calculated using (12)C content and waste assay value that can reflect the characteristics of the target urban solid waste incineration facilities. Also, the concentration and (12)C content were calculated by directly collecting incineration gases of the target urban solid waste incineration facilities, and greenhouse gas emissions of the target urban solid waste incineration facilities through this survey were compared with greenhouse gas emissions, which used the previously calculated assay value of solid waste.

Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009-2012.

PubMed

Wagenaar, Bradley H; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Manuel, João Luis; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Porthé, Victoria; Gloyd, Stephen; Sherr, Kenneth

2015-01-01

We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors. Monthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010-2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants. Median concordance increased from 56.3% during the baseline period (2009-2010) to 87.5% during 2012-2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010-2011 and 1.6% (CI: 0.89, 2.2) per month from 2011-2012. No significant improvements were observed from 2009-2010 (during baseline period) or 2012-2013. Facilities with more technical staff (aβ: 0.71; CI: 0.14, 1.3), more first antenatal care visits (aβ: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aβ: -0.94; CI: -1.7, -0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: -64.8 -38.6) lower data concordance. A data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.

Building a partnership to evaluate school-linked health services: the Cincinnati School Health Demonstration Project.

PubMed

Rose, Barbara L; Mansour, Mona; Kohake, Kelli

2005-12-01

The Cincinnati School Health Demonstration Project was a 3-year collaboration that evaluated school-linked health services in 6 urban elementary (kindergarten to eighth grade) schools. Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati.

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

PubMed Central

2011-01-01

Background Widespread urbanization over the next 20 years has the potential to drastically change the risk of malaria within Africa. The burden of the disease, its management, risk factors and appropriateness of targeted intervention across varied urban environments in Africa remain largely undefined. This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya. Methods A review of historical reported malaria case burdens since 1911 within Nairobi was undertaken using archived government and city council reports. Contemporary information on out-patient case burdens due to malaria were assembled from the National Health Management and Information System (HMIS). Finally, an audit of 22 randomly selected health facilities within Nairobi was undertaken covering 12 months 2009-2010. The audit included interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria. Results From the 1930's through to the mid-1960's malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. A more detailed facility review suggests, however that malaria remains a common diagnosis (11% of all paediatric diagnoses made) and where laboratories (n = 15) exist slide positivity rates are on average 15%. Information on the quality of diagnosis, slide reading and whether those reported as positive were imported infections was not established. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria. Conclusion Combined with historical evidence there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation. To be prepared for effective prevention and case-management of malaria among a diverse, mobile population in Nairobi requires a major paradigm shift and investment in improved quality of malaria diagnosis and case management, health system strengthening and case reporting. PMID:21599931

Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

PubMed

Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

2016-10-07

Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving delivery of animal health and extension services. It is recommended that more development and refinement of the system should be conducted to ensure that this potential is tapped to revolutionalise delivery of animal health services in rural areas.

24 CFR 242.57 - Maintenance of hospital facility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Maintenance of hospital facility. 242.57 Section 242.57 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR HOUSING-FEDERAL HOUSING COMMISSIONER, DEPARTMENT OF...

Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation.

PubMed

Speizer, Ilene S; Corroon, Meghan; Calhoun, Lisa; Lance, Peter; Montana, Livia; Nanda, Priya; Guilkey, David

2014-11-06

Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all. © Speizer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-14-00109.

Ownership and use of mobile phones among health workers, caregivers of sick children and adult patients in Kenya: cross-sectional national survey.

PubMed

Zurovac, Dejan; Otieno, Gabriel; Kigen, Samuel; Mbithi, Agneta M; Muturi, Alex; Snow, Robert W; Nyandigisi, Andrew

2013-05-14

The rapid growth in mobile phone penetration and use of Short Message Service (SMS) has been seen as a potential solution to improve medical and public health practice in Africa. Several studies have shown effectiveness of SMS interventions to improve health workers' practices, patients' adherence to medications and availability of health facility commodities. To inform policy makers about the feasibility of facility-based SMS interventions, the coverage data on mobile phone ownership and SMS use among health workers and patients are needed. In 2012, a national, cross-sectional, cluster sample survey was undertaken at 172 public health facilities in Kenya. Outpatient health workers and caregivers of sick children and adult patients were interviewed. The main outcomes were personal ownership of mobile phones and use of SMS among phone owners. The predictors analysis examined factors influencing phone ownership and SMS use. The analysis included 219 health workers and 1,177 patients' respondents (767 caregivers and 410 adult patients). All health workers possessed personal mobile phones and 98.6% used SMS. Among patients' respondents, 61.2% owned phones and 71.4% of phone owners used SMS. The phone ownership and SMS use was similar between caregivers of sick children and adult patients. The respondents who were male, more educated, literate and living in urban area were significantly more likely to own the phone and use SMS. The youngest respondents were less likely to own phones, however when the phones were owned, younger age groups were more likely to use SMS. Respondents living in wealthier areas were more likely to own phones; however when phones are owned no significant association between the poverty and SMS use was observed. Mobile phone ownership and SMS use is ubiquitous among Kenyan health workers in the public sector. Among patients they serve the coverage in phone ownership and SMS use is lower and disparities exist with respect to gender, age, education, literacy, urbanization and poverty. Some of the disparities on SMS use can be addressed through the modalities of mHealth interventions and enhanced implementation processes while further growth in mobile phone penetration is needed to reduce the ownership gap.

Perceived health status and environmental quality in the assessment of external costs of waste disposal facilities. An empirical investigation.

PubMed

Giaccaria, Sergio; Frontuto, Vito

2012-08-01

Taxation for urban waste management has been reformed in Italy by the introduction of an environmental law in 2006. In the planning phase of waste management, externalities generated by new facilities remain widely unaccounted, with a consequent distortion for prices, often raising local conflicts. The paper presents a survey based on the choice modelling methodology, aimed to evaluate on a monetary scale the disamenity effect perceived by incinerator and landfills in an Italian urban context: the city of Turin. In a random utility framework the behaviour of respondents, whose choices are found to be driven by the endowment of information about technological options, socio-economic characteristics as income, education, family composition, and also by their health status was modelled. Furthermore, empirical evidence that the behaviour in residential location choices is affected by different aspects of the respondent life and in particular by the health status was found. Distinct estimates of willingness to accept compensation for disamenity effects of incinerator (Euro 2670) and landfill (Euro 3816) are elicited. The effect of health status of the respondents, their level of information about the waste disposal infrastructure, the presence of a subjective strong aversion (NIMBY) and the actual endowment and concentration of infrastructures are demonstrated to be significant factors determining the choice behaviour, but differentiated and specific for incinerators and landfills.

24 CFR 984.204 - On-site facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SECTION 8 AND PUBLIC HOUSING FAMILY SELF-SUFFICIENCY PROGRAM Program Development and Approval Procedures... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false On-site facilities. 984.204 Section 984.204 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued...

24 CFR 8.23 - Alterations of existing housing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Alterations of existing housing facilities. 8.23 Section 8.23 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development NONDISCRIMINATION BASED ON HANDICAP IN FEDERALLY ASSISTED PROGRAMS AND...

24 CFR 8.22 - New construction-housing facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false New construction-housing facilities. 8.22 Section 8.22 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development NONDISCRIMINATION BASED ON HANDICAP IN FEDERALLY ASSISTED PROGRAMS AND ACTIVITIES OF...

24 CFR 8.23 - Alterations of existing housing facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Alterations of existing housing facilities. 8.23 Section 8.23 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development NONDISCRIMINATION BASED ON HANDICAP IN FEDERALLY ASSISTED PROGRAMS AND...

24 CFR 242.59 - Inspection of facilities by Commissioner.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Inspection of facilities by Commissioner. 242.59 Section 242.59 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR HOUSING-FEDERAL HOUSING COMMISSIONER, DEPARTMENT OF...

Impact of waste disposal on health of a poor urban community in Zimbambwe.

PubMed

Makoni, F S; Ndamba, J; Mbati, P A; Manase, G

2004-08-01

To assess excreta and waste disposal facilities available and their impact on sanitation related diseases in Epworth, an informal settlement on the outskirts of Harare. Descriptive cross-sectional survey. This was a community based study of Epworth informal settlement. A total of 308 households were interviewed. Participating households were randomly selected from the three communities of Epworth. Secondary medical archival data on diarrhoeal disease prevalence was collected from local clinics and district health offices in the study areas. Only 7% of households were connected to the sewer system. The study revealed that in Zinyengere extension 13% had no toilet facilities, 48% had simple pits and 37% had Blair VIP latrines. In Overspill 2% had no toilet facilities, 28% had simple latrines and 36% had Blair VIP latrines while in New Gada 20% had no toilet facilities, 24% had simple pits and 23% had Blair VIP latrines. Although a significant percentage had latrines (83.2%), over 50% of the population were not satisfied with the toilet facilities they were using. All the respondents expressed dissatisfaction with their domestic waste disposal practices with 46.6% admitting to have indiscriminately dumped waste. According to the community, diarrhoeal diseases were the most prevalent diseases (50%) related to poor sanitation. Health statistics also indicated that diarrhoea was a major problem in this community. It is recommended that households and the local authorities concentrate on improving the provision of toilets, water and waste disposal facilities as a way of improving the health state of the community.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania

PubMed Central

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-01-01

Background Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries. Methods In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. Findings In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Conclusions Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower–level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women’s use of services need to increase, but facility capacity to provide those services must also be enhanced. PMID:29423186

Reasons for attending dental-care services in Ouagadougou, Burkina Faso.

PubMed Central

Varenne, Benoît; Msellati, Philippe; Zoungrana, Célestin; Fournet, Florence; Salem, Gérard

2005-01-01

OBJECTIVE: To determine why patients attend dental-care facilities in Ouagadougou, Burkina Faso and to improve understanding of the capacity of oral health-care services in urban west Africa. METHODS: We studied a randomly selected sample of patients attending 15 dental-care facilities in Ouagadougou over a 1-year period in 2004. Data were collected using a simple daily record form. FINDINGS: From a total of 44,975 patients, the final sample was established at 14,591 patients, of whom 55.4% were new patients and 44.6% were "booking patients". Most patients seeking care (71.9%) were aged 15-44 years. Nongovernmental not-for-profit dental services were used by 41.5% of all patients, 36% attended private dental-care services, and 22.5% of patients visited public services. The most common complaint causing the patient to seek dental-care services was caries with pulpal involvement (52.4%), and 60% of all complaints were associated with pain. The patients' dental-care requirements were found to differ significantly according to sex, health insurance coverage and occupation. CONCLUSION: Urban district health authorities should ensure provision of primary health-care services, at the patients' first point of contact, which are directed towards the relief of pain. In addition to the strengthening of outreach emergency care, health centres should also contribute to the implementation of community-based programmes for the prevention of oral disease and the promotion of oral health. Exchange of experiences from alternative oral health-care systems relevant to developing countries is urgently needed for tackling the growing burden of oral disease. PMID:16211155

Young women's access to and use of contraceptives: the role of providers' restrictions in urban Senegal.

PubMed

Sidze, Estelle M; Lardoux, Solène; Speizer, Ilene S; Faye, Cheikh M; Mutua, Michael M; Badji, Fanding

2014-12-01

Contraceptive prevalence is very low in Senegal, particularly among young women. Greater knowledge is needed about the barriers young women face to using contraceptives, including barriers imposed by health providers. Survey data collected in 2011 for the evaluation of the Urban Reproductive Health Initiative in Senegal were used to examine contraceptive use, method mix, unmet need and method sources among urban women aged 15-29 who were either currently married or unmarried but sexually active. Data from a sample of family planning providers were used to examine the prevalence of contraceptive eligibility restrictions based on age and marital status, and differences in such restrictions by method, facility type and provider characteristics. Modern contraceptive prevalence was 20% among young married women and 27% among young sexually active unmarried women; the levels of unmet need for contraception-mostly for spacing-were 19% and 11%, respectively. Providers were most likely to set minimum age restrictions for the pill and the injectable-two of the methods most often used by young women in urban Senegal. The median minimum age for contraceptive provision was typically 18. Restrictions based on marital status were less common than those based on age. Training and education programs for health providers should aim to remove unnecessary barriers to contraceptive access.

Distribution of physical activity facilities in Scotland by small area measures of deprivation and urbanicity

PubMed Central

2010-01-01

Background The aim of this study was to examine the distribution of physical activity facilities by area-level deprivation in Scotland, adjusting for differences in urbanicity, and exploring differences between and within the four largest Scottish cities. Methods We obtained a list of all recreational physical activity facilities in Scotland. These were mapped and assigned to datazones. Poisson and negative binomial regression models were used to investigate associations between the number of physical activity facilities relative to population size and quintile of area-level deprivation. Results The results showed that prior to adjustment for urbanicity, the density of all facilities lessened with increasing deprivation from quintiles 2 to 5. After adjustment for urbanicity and local authority, the effect of deprivation remained significant but the pattern altered, with datazones in quintile 3 having the highest estimated mean density of facilities. Within-city associations were identified between the number of physical activity facilities and area-level deprivation in Aberdeen and Dundee, but not in Edinburgh or Glasgow. Conclusions In conclusion, area-level deprivation appears to have a significant association with the density of physical activity facilities and although overall no clear pattern was observed, affluent areas had fewer publicly owned facilities than more deprived areas but a greater number of privately owned facilities. PMID:20955548

Elemental Concentrations in Urban Green Stormwater Infrastructure Soils.

PubMed

Kondo, Michelle C; Sharma, Raghav; Plante, Alain F; Yang, Yunwen; Burstyn, Igor

2016-01-01

Green stormwater infrastructure (GSI) is designed to capture stormwater for infiltration, detention, evapotranspiration, or reuse. Soils play a key role in stormwater interception at these facilities. It is important to assess whether contamination is occurring in GSI soils because urban stormwater drainage areas often accumulate elements of concern. Soil contamination could affect hydrologic and ecosystem functions. Maintenance workers and the public may also be exposed to GSI soils. We investigated soil elemental concentrations, categorized as macro- and micronutrients, heavy metals, and other elements, at 59 GSI sites in the city of Philadelphia. Non-GSI soil samples 3 to 5 m upland of GSI sites were used for comparison. We evaluated differences in elemental composition in GSI and non-GSI soils; the comparisons were corrected for the age of GSI facility, underlying soil type, street drainage, and surrounding land use. Concentrations of Ca and I were greater than background levels at GSI sites. Although GSI facilities appear to accumulate Ca and I, these elements do not pose a significant human health risk. Elements of concern to human health, including Cd, Hg, and Pb, were either no different or were lower in GSI soils compared with non-GSI soils. However, mean values found across GSI sites were up to four times greater than soil cleanup objectives for residential use. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Neighbourhood typology based on virtual audit of environmental obesogenic characteristics.

PubMed

Feuillet, T; Charreire, H; Roda, C; Ben Rebah, M; Mackenbach, J D; Compernolle, S; Glonti, K; Bárdos, H; Rutter, H; De Bourdeaudhuij, I; McKee, M; Brug, J; Lakerveld, J; Oppert, J-M

2016-01-01

Virtual audit (using tools such as Google Street View) can help assess multiple characteristics of the physical environment. This exposure assessment can then be associated with health outcomes such as obesity. Strengths of virtual audit include collection of large amount of data, from various geographical contexts, following standard protocols. Using data from a virtual audit of obesity-related features carried out in five urban European regions, the current study aimed to (i) describe this international virtual audit dataset and (ii) identify neighbourhood patterns that can synthesize the complexity of such data and compare patterns across regions. Data were obtained from 4,486 street segments across urban regions in Belgium, France, Hungary, the Netherlands and the UK. We used multiple factor analysis and hierarchical clustering on principal components to build a typology of neighbourhoods and to identify similar/dissimilar neighbourhoods, regardless of region. Four neighbourhood clusters emerged, which differed in terms of food environment, recreational facilities and active mobility features, i.e. the three indicators derived from factor analysis. Clusters were unequally distributed across urban regions. Neighbourhoods mostly characterized by a high level of outdoor recreational facilities were predominantly located in Greater London, whereas neighbourhoods characterized by high urban density and large amounts of food outlets were mostly located in Paris. Neighbourhoods in the Randstad conurbation, Ghent and Budapest appeared to be very similar, characterized by relatively lower residential densities, greener areas and a very low percentage of streets offering food and recreational facility items. These results provide multidimensional constructs of obesogenic characteristics that may help target at-risk neighbourhoods more effectively than isolated features. © 2016 World Obesity.

Rural-urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged?

PubMed

Islam, M Mazharul; Azad, Kazi Md Abul Kalam

2008-01-01

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban-rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural-urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant-native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural-urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor-non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.

Does contracting of health care in Afghanistan work? Public and service-users' perceptions and experience

PubMed Central

2011-01-01

Background In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Methods Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. Results The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Conclusions Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan. PMID:22376191

Does contracting of health care in Afghanistan work? Public and service-users' perceptions and experience.

PubMed

Cockcroft, Anne; Khan, Amir; Md Ansari, Noor; Omer, Khalid; Hamel, Candyce; Andersson, Neil

2011-12-21

In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.

The neighborhood recreational environment and physical activity among urban youth: an examination of public and private recreational facilities.

PubMed

Ries, Amy V; Yan, Alice F; Voorhees, Carolyn C

2011-08-01

Recreational facility availability has been shown to associate positively with youth physical activity levels. Nonetheless, little is known about additional facility characteristics affecting their use for physical activity as well as differences between private and public facilities. This study examines (1) perceptions and use of public and private recreational facilities and (2) environmental and individual-level correlates of both facility use and physical activity among urban adolescents. Physical activity was assessed using accelerometry, objective measures of facility availability were obtained using Geographical Information Systems data, and facility use and perceptions were measured with a survey (N = 327). Adolescents were more likely to use public than private facilities despite perceiving that private facilities were of higher quality. Adolescents' use of both public and private facilities was associated with perceived (but not objective) availability, perceived quality, and use by friends and family. Public, but not private, facility use was associated with physical activity. This study reveals the importance of public facilities to the physical activity of urban youth.

Travel by public transit to mammography facilities in 6 US urban areas.

PubMed

Graham, S; Lewis, B; Flanagan, B; Watson, M; Peipins, L

2015-12-01

We examined lack of private vehicle access and 30 minutes or longer public transportation travel time to mammography facilities for women 40 years of age or older in the urban areas of Boston, Philadelphia, San Antonio, San Diego, Denver, and Seattle to identify transit marginalized populations - women for whom these travel characteristics may jointly present a barrier to clinic access. This ecological study used sex and race/ethnicity data from the 2010 US Census and household vehicle availability data from the American Community Survey 2008-2012, all at Census tract level. Using the public transportation option on Google Trip Planner we obtained the travel time from the centroid of each census tract to all local mammography facilities to determine the nearest mammography facility in each urban area. Median travel times by public transportation to the nearest facility for women with no household access to a private vehicle were obtained by ranking travel time by population group across all U.S. census tracts in each urban area and across the entire study area. The overall median travel times for each urban area for women without household access to a private vehicle ranged from a low of 15 minutes in Boston and Philadelphia to 27 minutes in San Diego. The numbers and percentages of transit marginalized women were then calculated for all urban areas by population group. While black women were less likely to have private vehicle access, and both Hispanic and black women were more likely to be transit marginalized, this outcome varied by urban area. White women constituted the largest number of transit marginalized. Our results indicate that mammography facilities are favorably located for the large majority of women, although there are still substantial numbers for whom travel may likely present a barrier to mammography facility access.

Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey.

PubMed

Peck, Robert; Mghamba, Janneth; Vanobberghen, Fiona; Kavishe, Bazil; Rugarabamu, Vivian; Smeeth, Liam; Hayes, Richard; Grosskurth, Heiner; Kapiga, Saidi

2014-05-01

Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, noncommunicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and fi rst-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hypertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than fi ve patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV. Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identifi ed crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements.

Biological and chemical terrorism scenarios and implications for detection systems needs

NASA Astrophysics Data System (ADS)

Gordon, Susanna P.; Chumfong, Isabelle; Edwards, Donna M.; Gleason, Nathaniel J.; West, Todd; Yang, Lynn

2007-04-01

Terrorists intent on causing many deaths and severe disruption to our society could, in theory, cause hundreds to tens of thousands of deaths and significant contamination of key urban facilities by using chemical or biological (CB) agents. The attacks that have occurred to date, such as the 1995 Aum Shinrikyo CB attacks and the 2001 anthrax letters, have been very small on the scale of what is possible. In order to defend against and mitigate the impacts of large-scale terrorist attacks, defensive systems for protection of urban areas and high-value facilities from biological and chemical threats have been deployed. This paper reviews analyses of such scenarios and of the efficacy of potential response options, discusses defensive systems that have been deployed and detectors that are being developed, and finally outlines the detection systems that will be needed for improved CB defense in the future. Sandia's collaboration with San Francisco International Airport on CB defense will also be briefly reviewed, including an overview of airport facility defense guidelines produced in collaboration with Lawrence Berkeley National Laboratory. The analyses that will be discussed were conducted by Sandia National Laboratories' Systems Studies Department in support of the U.S. Department of Homeland Security (DHS) Science and Technology Directorate, and include quantitative analyses utilizing simulation models developed through close collaboration with subject matter experts, such as public health officials in urban areas and biological defense experts.

Quality of care and contraceptive use in urban Kenya

PubMed Central

Pence, Brian W.; Curtis, Siân L.; Marshall, Stephen W.; Speizer, Ilene S.

2015-01-01

CONTEXT Family planning is highly beneficial to women’s overall health, morbidity, and mortality, particularly in developing countries. Yet, in much of sub-Saharan Africa, contraceptive prevalence remains low while unmet need for family planning remains high. It has been frequently hypothesized that the poor quality of family planning service provision in many low-income settings acts as a barrier to optimal rates of contraceptive use but this association has not been rigorously tested. METHODS Using data collected from 3,990 women in 2010, this study investigates the association between family planning service quality and current modern contraceptive use in five cities in Kenya. In addition to individual-level data, audits of select facilities and service provider interviews were conducted in 260 facilities. Within 126 higher-volume clinics, exit interviews were conducted with family planning clients. Individual and facility-level data are linked based on the source of the woman’s current method or other health service. Adjusted prevalence ratios are estimated using binomial regression and we account for clustering of observations within facilities using robust standard errors. RESULTS Solicitation of client preferences, assistance with method selection, provision of information by providers on side effects, and provider treatment of clients were all associated with a significantly increased likelihood of current modern contraceptive use and effects were often stronger among younger and less educated women. CONCLUSION Efforts to strengthen contraceptive security and improve the content of contraceptive counseling and treatment of clients by providers have the potential to significantly increase contraceptive use in urban Kenya. PMID:26308259

Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.

PubMed

Lund, S; Hemed, M; Nielsen, B B; Said, A; Said, K; Makungu, M H; Rasch, V

2012-09-01

To examine the association between a mobile phone intervention and skilled delivery attendance in a resource-limited setting. Pragmatic cluster-randomised controlled trial with primary healthcare facilities as the unit of randomisation. Primary healthcare facilities in Zanzibar. Two thousand, five hundred and fifty pregnant women (1311 interventions and 1239 controls) who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. All pregnant women were eligible for study participation. Twenty-four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention (n = 12) or standard care (n = 12). The intervention consisted of a short messaging service (SMS) and mobile phone voucher component. Skilled delivery attendance. The mobile phone intervention was associated with an increase in skilled delivery attendance: 60% of the women in the intervention group versus 47% in the control group delivered with skilled attendance. The intervention produced a significant increase in skilled delivery attendance amongst urban women (odds ratio, 5.73; 95% confidence interval, 1.51-21.81), but did not reach rural women. The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence. Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5, and should be considered by maternal and child health policy makers in developing countries. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Young people's perception of sexual and reproductive health services in Kenya.

PubMed

Godia, Pamela M; Olenja, Joyce M; Hofman, Jan J; van den Broek, Nynke

2014-04-15

Addressing the Sexual and Reproductive Health (SRH) needs of young people remains a big challenge. This study explored experiences and perceptions of young people in Kenya aged 10-24 with regard to their SRH needs and whether these are met by the available healthcare services. 18 focus group discussions and 39 in-depth interviews were conducted at health care facilities and youth centres across selected urban and rural settings in Kenya. All interviews were tape recorded and transcribed. Data was analysed using the thematic framework approach. Young people's perceptions are not uniform and show variation between boys and girls as well as for type of service delivery. Girls seeking antenatal care and family planning services at health facilities characterise the available services as good and staff as helpful. However, boys perceive services at health facilities as designed for women and children, and therefore feel uncomfortable seeking services. At youth centres, young people value the non-health benefits including availability of recreational facilities, prevention of idleness, building of confidence, improving interpersonal communication skills, vocational training and facilitation of career progression. Providing young people with SRH information and services through the existing healthcare system, presents an opportunity that should be further optimised. Providing recreational activities via youth centres is reported by young people themselves to not lead to increased uptake of SRH healthcare services. There is need for more research to evaluate how perceived non-health benefits young people do gain from youth centres could lead to improved SRH of young people.

Women's social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: a community-based case-control study.

PubMed

Asrese, Kerebih; Adamek, Margaret E

2017-12-28

High maternal mortality has remained an unmet public health challenge in the developing world. Maternal mortality in Ethiopia is among the highest in the world. Since most maternal deaths occur during labor, delivery, and the immediate postpartum period, facility delivery with skilled birth attendants is recommended to reduce maternal mortality. Nonetheless, the majority of women in Ethiopia give birth at home. Individual attributes and availability and accessibility of services deter service utilization. The role of social networks that may facilitate or constrain service use is not well studied. Community-based case-control study was conducted between February and March 2014 in Jabi Tehinan District, North West Ethiopia. Retrospective data were collected from 134 women who had uncomplicated births at health facilities and 140 women who had uncomplicated births at home within a year preceding the survey. Interviews were held with eight women who had uncomplicated births at health facilities and 11 who had uncomplicated births at home. The quantitative data were entered and analyzed using SPSS for Windows versions 16.0 and hierarchical logistic regression model was used for analysis. The qualitative data were transcribed verbatim and data were used to substantiate the quantitative data. The results indicated that social network variables were significantly associated with the use of health facilities for delivery. Taking social networks into account improved the explanation of facility use for delivery services over women's individual attributes. Women embedded within homogeneous network members (Adjusted OR 2.53; 95% CI: 1.26-5.06) and embedded within high SBA endorsement networks (Adjusted OR 7.97; 95% CI: 4.07-12.16) were more likely to deliver at health facilities than their counterparts. Women living in urban areas (Adjusted OR 3.32; 95% CI: 1.37-8.05) and had better knowledge of obstetric complications (Adjusted OR 3.01; 95% CI: 1.46-6.18) were more likely to deliver at health facilities. Social networks facilitate SBA utilization by serving as a reference for the behavior to deliver at health facilities. These findings inform health professionals and other stakeholders regarding the importance of considering women's social networks in designing intervention to increase the proportion of women who deliver at health facilities.

24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily housing facilities. (a) Substantial alteration. If the agency undertakes alterations to a PDP multifamily...

24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily housing facilities. (a) Substantial alteration. If the agency undertakes alterations to a PDP multifamily...

78 FR 16279 - HUD Healthcare Facility Documents: Notice Announcing Final Approved Documents and Assignment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-14

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5623-N-03] HUD Healthcare Facility... notice announces that the healthcare facility documents have completed the notice and comment processes... of Healthcare Programs, Office of Housing, Department of Housing and Urban Development, 451 7th...

Optimal capacity design of LID facility for conserving natural water cycle and its sensitivity analysis

NASA Astrophysics Data System (ADS)

Lee, O.; Choi, J.; Lee, J.; Kim, S.

2017-12-01

Since the 20th century, urbanization has resulted in increased impermeable land surface and reduced infiltration capacity in catchment scale. Especially, when agriculture area or forest area would be developed into urban area, it can cause more runoff in the same climate condition. Such urbanization causes problems such as changes in hydrological cycle and ecosystem disturbance. Various methods have been proposed worldwide to reduce the impact of such urbanization. Among the various strategies, the low-impact development is a development strategy that aims to return to pre-development state by minimizing the change of the hydrological cycle due to urbanization. In this strategy, the infiltration and/or surface storage of stormwater runoff can be increased through the installation of various facilities. In this study, a facility capacity design strategy is proposed to return into the natural water cycle through the installation of various LID facilities. This is accomplished by determining the optimal LID facility design capacity through which flow duration curves remain the same before and after urban development. For this purpose, EPA-SWMM is constructed with a part of Busan Metropolitan City Noksan Industrial Complex as a virtual processing area. Under the various land-use scenarios, the optimum design capacity of various LID facilities capable of retaining the flow duration curve before and after development is determined. In addition, the sensitivity of the optimal design capacity of LID facilities is analyzed according to the design specifications of various LID facilities, the local rainfall characteristics, and the size of the treatment area. Acknowledgement This research was supported by a grant (2016000200002) from Public Welfare Technology Development Program funded by Ministry of Environment of Korean government.

Urbanization and Spatial Organization: Hospital and Orphanage Location in Chicago, 1848-1916

ERIC Educational Resources Information Center

Britton, Marcus; Ocasio, William

2007-01-01

What factors affect where organizations locate facilities in local communities? This paper examines how urban development influenced the neighborhood location of two very different types of facilities, general hospitals and orphanages, over the 70-year period during which Chicago emerged as an urban metropolis. Our results suggest that the human…

Urban-Rural Disparity of Generics Prescription in Taiwan: The Example of Dihydropyridine Derivatives

PubMed Central

Chiang, Shu-Chiung; Chou, Li-Fang

2014-01-01

The aim of the current study was to investigate the urban-rural disparity of prescribing generics, which were usually cheaper than branded drugs, within the universal health insurance system in Taiwan. Data sources were the cohort datasets of National Health Insurance Research Database with claims data in 2010. The generic prescribing ratios of dihydropyridine (DHP) derivatives (the proportion of DHP prescribed as generics to all prescribed DHP) of medical facilities were examined against the urbanization levels of the clinic location. Among the total 21,606,914 defined daily doses of DHP, 35.7% belonged to generics. The aggregate generic prescribing ratio rose from 6.7% at academic medical centers to 15.3% at regional hospitals, 29.4% at community hospital, and 66.1% at physician clinics. Among physician clinics, the generic prescribing ratio in urban areas was 63.9 ± 41.0% (mean ± standard deviation), lower than that in suburban (69.6 ± 38.7%) and in rural (74.1% ± 35.3%). After adjusting the related factors in the linear regression model, generic prescribing ratios of suburban and rural clinics were significantly higher than those of urban clinics (β = 0.043 and 0.077; P = 0.024 and 0.008, resp.). The generic prescribing ratio of the most popular antihypertensive agents at a clinic was reversely associated with the urbanization level. PMID:24683364

Lost in care pathway: a qualitative investigation on the health system delay of extra pulmonary tuberculosis patients in Bangladesh.

PubMed

Sarker, Malabika; Mohammad, Din; Paul, Sukanta; Akter, Rahima; Islam, Shayla; Biswas, Goutam; Hossain, Asheque; Islam, Akramul

2017-03-28

Although extra pulmonary tuberculosis (EPTB) has long been known as a major public health concern globally, the complex healthcare-seeking pathways of EPTB patients are not widely studied. This study aims to explore the pattern of healthcare-seeking pathways of rural and urban EPTB patients registered with the BRAC TB control programme. BRAC is a Bangladesh-based non-governmental organization dedicated to alleviating poverty through empowering the poor. Data were collected through 60 in-depth interviews with rural and urban EPTB patients in Bangladesh. The findings reveal that the rural EPTB patients encountered a substantial diagnostic delay as compared to the urban patients. However, the difference between the average number of healthcare providers consulted by the rural verses the urban EPTB patients was not significant. This study also shows that the healthcare-seeking journey of rural and urban EPTB patients usually starts either at pharmacies or private facilities. Through exploring the detailed nature of the pathway, this study reveals the ways in which non-medical informants, mainly relatives and friends, can benefit patients. The private and informal healthcare providers should receive appropriate training on the diagnosis of EPTB. Such training could effectively shorten the long and complex healthcare-seeking pathways of EPTB patients.

A comparative analysis of vaccine administration in urban and non-urban skilled nursing facilities.

PubMed

Pu, Yuan; Dolar, Veronika; Gucwa, Azad L

2016-07-29

The U.S. population is aging at an unprecedented rate, resulting in an increased demand for skilled nursing facilities (SNFs) and long-term care. Residents of these facilities are at a high risk for pneumococcal disease or severe influenza-related illnesses and death. For these reasons, the Centers for Medicare and Medicaid Services use influenza and pneumococcal vaccination rates as a quality measure in the assessment of SNFs, as complications related to these infections increase morbidity and mortality rates. Disparities have been reported amongst vaccination with increased rates in urban areas as compared to their non-urban counterparts. Statistical analyses were performed to compare influenza and pneumococcal vaccination in urban and non-urban SNFs to determine variables that may influence vaccination status. Of the 15,639 nursing homes included in the study, 10,107 were in urban areas, while 5532 were considered non-urban. We found the percent of eligible and willing residents with up-to-date influenza and pneumococcal vaccinations increased with overall five-star ratings of SNFs. Somewhat paradoxically, although urban SNFs had higher mean overall five-star ratings, they showed lower rates of influenza and pneumococcal vaccination compared to non-urban SNFs. Ordinary least squares regression analysis comparing overall ratings, type of ownership, and geographic location by region yielded statistically significant results in which the overall rating, ownership-type and certificate-type favored urban SNFs (p < 0.001). This is the first systematic and comparative analysis to use the Nursing Home Compare database to assess vaccine administration of urban and non-urban SNFs. The findings of this study may be used to encourage the development of programs to improve vaccination rates and the quality of care in these facilities.

Black carbon concentrations in a goods-movement neighborhood of Philadelphia, PA

Treesearch

Michelle C. Kondo; Chris Mizes; John Lee; Igor Burstyn

2014-01-01

Communities along the Delaware River in Philadelphia, USA such as Port Richmond, are subject to traffic associated with goods movement to and from port facilities and local industry. Air pollution associated with this traffic poses an environmental health concern in this and other urban areas. Our study measures black carbon (BC) in Port Richmond and examines its...

Strengthening health services to deliver nutrition education to promote complementary feeding and healthy growth of infants and young children: formative research for a successful intervention in peri-urban Trujillo, Peru.

PubMed

Robert, Rebecca C; Creed-Kanashiro, Hilary M; Villasante, Ruben; Narro, M Rocio; Penny, Mary E

2017-04-01

Formative research is critical for developing effective nutrition-specific interventions to improve infant and young child (IYC) feeding practices and promote healthy growth. Health workers interact with caregivers during health facility visits, yet there is limited research about how to optimize delivery of such interventions during these visits. The extensive reach of IYC health services globally calls for research to address this gap. In Trujillo, Peru, formative research was conducted to explore complementary feeding practices with caregivers as well as health worker routines and interactions with caregivers related to feeding and healthy growth; results informed the development and delivery of an educational intervention. Multiple qualitative methods were used to collect data on a purposive sample of health workers and caregivers from three health facilities and communities: household trials followed. Complementary feeding messages with doable behaviours were developed, and three were selected as key to promote based on their nutritional impact and cultural acceptability. In the health facilities, medical consultation, well-child visits and nutrition consultation all dealt with aspects of IYC nutrition/growth during their interactions with caregivers but were independent and inconsistent in approach. A nutrition education strategy was developed based on consistency, quality and coverage in the IYC health services. We conclude that formative research undertaken in the community and IYC health services was critical to developing a successful and culturally relevant intervention to promote optimal complementary feeding practices and healthy growth during interactions between health workers and caregivers at routine health facility visits. © 2016 John Wiley & Sons Ltd. © 2016 John Wiley & Sons Ltd.

Report: Hospital waste management--awareness and practices: a study of three states in India.

PubMed

Rao, P Hanumantha

2008-06-01

The study was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. Hospitals/nursing homes and private medical practitioners in urban as well as rural areas and those from the private as well as the government sector were covered. Information on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with respect to segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. Awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to Common Waste facilities is still limited. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities.

Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys.

PubMed

Diamond-Smith, Nadia; Sudhinaraset, May

2015-01-16

In the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level. Demographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital. The majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home. Most women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and maternal health complications.

Newborn Care Practices among Mother-Infant Dyads in Urban Uganda

PubMed Central

Kayom, Violet Okaba; Kakuru, Abel; Kiguli, Sarah

2015-01-01

Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators. PMID:26713096

Determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania: analysis of data from the 2010 Tanzania Demographic and Health Survey.

PubMed

Wilunda, Calistus; Massawe, Siriel; Jackson, Caroline

2013-12-01

To identify determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania. We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio-demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio-demographic, contextual, reproductive and lifestyle factors, and moderate-to-severe anaemia and investigated interactions between certain risk factors. Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43-2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43-0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00-1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis. Pregnant women in Tanzania are particularly at risk of moderate-to-severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups. © 2013 John Wiley & Sons Ltd.

An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.

PubMed

Chama-Chiliba, Chitalu Miriam; Koch, Steven Fredric

2016-12-07

Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

PubMed

Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

2015-10-02

Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Health care utilization during terminal child illness in squatter settlements of Karachi.

PubMed

Hasan, I J; Khanum, A

2000-12-01

Information on health seeking behavior and health care utilization has important policy implications in health systems development. The paper presents some of the issues related to health care utilization and health seeking behavior in case of terminal child illness in seven squatter settlements of Karachi. From seven squatter settlements of Karachi, with a population of 100,000 approximately, we collected information, using pretested structured questionnaire, from the mothers on health care utilization during the final illness of under five children dying during 1995-1996. These deaths were identified from an earlier baseline health and demographic survey in these areas. Interviews were completed for 259 infant and child deaths of which 57% were boys. Of all deaths 72% were taken to a health care provider, of which 82% went as soon as the child got ill. Private sector is the most preferred first choice i.e., 83%. Of all those who had been to a health care provider, 65% were referred to some other place and 72% of them took more than 12 hours altogether to reach the referred facility. Children in older age categories (OR 4.4 95% CI 2.22-8.67 and OR 5.0, 95% CI 2.09-12.31), boys (OR 2.6, 95% CI 1.46-4.77) and those with appropriate or incomplete immunization (OR 4.1, 95% CI 2.13-7.94) were significantly associated with the health care utilization as compared to their counterparts. Living in urban areas does not ensure accessibility to effective health care. In poor urban communities, referral to other facility delay the initiation of effective treatment in case of child illness leading to death which could be prevented otherwise. Private sector constitutes an important segment of our health care system, which requires strengthening and back up support. Furthermore, the study finding is suggestive of gender discrimination in health seeking behavior.

Rural-urban differences in end-of-life nursing home care: facility and environmental factors.

PubMed

Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B

2012-06-01

This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used CY2005-2007 100% Minimum Data Set, Medicare beneficiary file, and inpatient and hospice claims. Logistic regression models were estimated to predict the probability of each outcome conditional on decedents' risk factors. For each facility, QMs were calculated as the difference between the actual and the expected risk-adjusted outcome rates. We fit multivariate linear regression models, with fixed state effects, for each QM to assess the association with urban-rural location. We found urban-rural differences for in-hospital death and hospice QMs, but not for pain. Compared with NHs located in urban areas, facilities in smaller towns and in isolated rural areas have significantly (p < .001) worse EOL quality for in-hospital death and hospice use. Whereas the differences in these QMs are statistically significant between facilities located in large versus small towns, they are not statistically significant between facilities located in small towns and isolated rural areas. This study provides empirical evidence for urban-rural differences in EOL quality of care using a national sample of NHs. Identifying differences is a necessary first step toward improving care for dying NH residents and for bridging the urban-rural gap.

How federal health-care policies interface with urban and rural areas: a comparison of three systems.

PubMed

Baracskay, Daniel

2012-01-01

Global public health policies span national borders and affect multitudes of people. The spread of infectious disease has neither political nor economic boundaries, and when elevated to a status of pandemic proportions, immediate action is required. In federal systems of government, the national level leads the policy formation and implementation process, but also collaborates with supranational organisations as part of the global health network. Likewise, the national level of government cooperates with sub-national governments located in both urban and rural areas. Rural areas, particularly in less developed countries, tend to have higher poverty rates and lack the benefits of proper medical facilities, communication modes and technology to prevent the spread of disease. From the perspective of epidemiological surveillance and intervention, this article will examine federal health policies in three federal systems: Australia, Malaysia and the USA. Using the theoretical foundations of collaborative federalism, this article specifically examines how collaborative arrangements and interactions among governmental and non-governmental actors help to address the inherent discrepancies that exist between policy implementation and reactions to outbreaks in urban and rural areas. This is considered in the context of the recent H1N1 influenza pandemic, which spread significantly across the globe in 2009 and is now in what has been termed the 'post-pandemic era'.

Disparities in child mortality trends in two new states of India.

PubMed

Minnery, Mark; Jimenez-Soto, Eliana; Firth, Sonja; Nguyen, Kim-Huong; Hodge, Andrew

2013-08-27

India has the world's highest total number of under-five deaths of any nation. While progress towards Millennium Development Goal 4 has been documented at the state level, little information is available for greater disaggregation of child health markers within states. In 2000, new states were created within the country as a partial response to political pressures. State-level information on child health trends in the new states of Chhattisgarh and Jharkhand is scarce. To fill this gap, this article examines under-five and neonatal mortality across various equity markers within these two new states, pre-and post-split. Both direct and indirect estimation using pooled data from five available sources were undertaken. Inter-population disparities were evaluated by mortality data stratification of rural-urban location, ethnicity, wealth and districts. Both states experienced an overall reduction in under-five and neonatal mortality, however, this has stagnated post-2001 and various disparities persist. In cases where disparities have declined, such as between urban-rural populations and low- and high-income groups, this has been driven by modest declines within the disadvantaged groups (i.e. low-income rural households) and stagnation or worsening of outcomes within the advantaged groups. Indeed, rising trends in mortality are most prevalent in urban middle-income households. The results suggest that rural health improvements may have come at the expense of urban areas, where poor performance may be attributed to factors such as lack of access to quality private health facilities. In addition, the disparities may in part be associated with geographical access, traditional practices and district-level health resource allocation.

Barriers to and suggestions for a healthful, active lifestyle as perceived by rural and urban Costa Rican adolescents.

PubMed

Monge-Rojas, Rafael; Garita-Arce, Carlos; Sánchez-López, Marta; Colón-Ramos, Uriyoán

2009-01-01

To assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle. Data were collected in focus group discussions. 108 male and female adolescents aged 12 to 18 from the 7th to 11th grades. Two urban and 1 rural high school in San José, Costa Rica. Active lifestyle; barriers and motivators for active life. Data were reviewed for emerging themes, and themes were coded using content analysis procedures. Major barriers: (a) physical education curriculum was focused on competitive sports; (b) lack of facilities in the school and community environments; (c) family did not provide good role models and reinforced the socially expected gender roles. Key motivators: (a) changed the physical education curriculum to focus on leisure and recreational activities; (b) increased the availability of facilities both in the school and in the community; and (c) provided a strong social support network. The school, community, and family environments are potential targets for physical activity interventions for adolescents. Future studies should explore in depth the influence of adolescent socialization patterns (particularly for females) in the establishment of an active lifestyle.

Perceptions of physical activity, activity preferences and health among a group of adult women in urban Ghana: a pilot study.

PubMed

Tuakli-Wosornu, Y A; Rowan, M; Gittelsohn, J

2014-03-01

Obesity and other lifestyle-related chronic diseases impact urban West African women at high rates. Physical activity (PA) can improve these health outcomes but there is little published data on the associated psychosocial predictors in this population. We aimed to explore preliminary associations between perceptions of PA, PA behaviours, and health in a group of Ghanaian women. Non-experimental, cross-sectional case study using a mixed-methods approach. Focus groups and in-depth interviews with a convenience sample of Ghanaian women, fitness trainers and clergy comprised the qualitative phase. A self-administered survey (n=218) comprised the quantitative phase. Constant comparative method, logistic regression, component and factor analyses were used for analysis. Women viewed activities of daily living like housework as PA; rarely utilized organized fitness facilities; understood "rigorous" PA as professional male athleticism; and took interest in socialized PA. Mean age was 49.4 years. Mean body mass index was 30.3 kg/m2. The majority (75.9 %) reported exercising sometimes or often. Half (48.4%) reported a lifestyle-related chronic disease. "Weight loss," "health concerns" and "increased energy," were top motivators for PA. "Can't find the time," "work/family obligations," and "don't have a facility" were top barriers. Presence of hypertension, hypercholesterolemia and prior weight loss correlated with the slimming motivator (adjusted odds ratio 2.59, p=0.008; AOR 3.56, p=0.012; AOR 3.36, p=<0.001). Among those surveyed, PA motivators and barriers were associated with demographics, PA exposure, and health status. Further research on unique PA perceptions, behaviours and health could catalyze health promotion through culturally relevant fitness programming.

Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

PubMed

Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

2015-11-01

Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

Travel by public transit to mammography facilities in 6 US urban areas

PubMed Central

Graham, S; Lewis, B; Flanagan, B; Watson, M; Peipins, L

2017-01-01

We examined lack of private vehicle access and 30 minutes or longer public transportation travel time to mammography facilities for women 40 years of age or older in the urban areas of Boston, Philadelphia, San Antonio, San Diego, Denver, and Seattle to identify transit marginalized populations - women for whom these travel characteristics may jointly present a barrier to clinic access. This ecological study used sex and race/ethnicity data from the 2010 US Census and household vehicle availability data from the American Community Survey 2008–2012, all at Census tract level. Using the public transportation option on Google Trip Planner we obtained the travel time from the centroid of each census tract to all local mammography facilities to determine the nearest mammography facility in each urban area. Median travel times by public transportation to the nearest facility for women with no household access to a private vehicle were obtained by ranking travel time by population group across all U.S. census tracts in each urban area and across the entire study area. The overall median travel times for each urban area for women without household access to a private vehicle ranged from a low of 15 minutes in Boston and Philadelphia to 27 minutes in San Diego. The numbers and percentages of transit marginalized women were then calculated for all urban areas by population group. While black women were less likely to have private vehicle access, and both Hispanic and black women were more likely to be transit marginalized, this outcome varied by urban area. White women constituted the largest number of transit marginalized. Our results indicate that mammography facilities are favorably located for the large majority of women, although there are still substantial numbers for whom travel may likely present a barrier to mammography facility access. PMID:29285434

75 FR 42885 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-22

...: Rates. As discussed in section I.G.1. of this notice, we established per diem Federal rates for urban... Virus (HIV) Infection). For FY 2011, an urban facility with a resident with AIDS in hybrid RUG-III (HR... application of the MMA adjustment. After an increase of 128 percent, this urban facility would receive a case...

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire.

PubMed

Delvaux, Thérèse; Konan, Jean-Paul Diby; Aké-Tano, Odile; Gohou-Kouassi, Valérie; Bosso, Patrice Emery; Buvé, Anne; Ronsmans, Carine

2008-08-01

To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services. Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff. HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme. Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.

The Relationship between Obesity and Urban Environment in Seoul

PubMed Central

Kim, Jungah; Shon, Changwoo; Yi, Seonju

2017-01-01

Obesity is a global pandemic that brings about a myriad of health consequences. In the past, policies for combating obesity mainly focused on improving individual health and behavior, but nowadays some policies have changed and now concentrate on improving the built environment believing this can improve health through positive changes to health-related behaviors. We examined whether both individual and environmental factors were associated with body mass index in Seoul, the capital city of South Korea. Data from the 2011 and 2013 Community Health Surveys were used (n = 20,147 men and 25,300 women). We staged multilevel logistic regression models to estimate the effect of individual and environmental factors on obesity. Among individual covariates, high-risk drinking, the time spent watching TV and surfing the Internet, high salt intake, stress, and the negative recognition of health were significantly associated with obesity. When controlling individual covariates, the number of sports facilities, number of fried chicken stores, and food insecurity level were statistically associated with probability of obesity. Therefore, this study emphasizes that it is important not only to improve the health behavior of the individual, but also to improve the urban environment in order to reduce the obesity rates of city dwellers. PMID:28792465

The Relationship between Obesity and Urban Environment in Seoul.

PubMed

Kim, Jungah; Shon, Changwoo; Yi, Seonju

2017-08-09

Obesity is a global pandemic that brings about a myriad of health consequences. In the past, policies for combating obesity mainly focused on improving individual health and behavior, but nowadays some policies have changed and now concentrate on improving the built environment believing this can improve health through positive changes to health-related behaviors. We examined whether both individual and environmental factors were associated with body mass index in Seoul, the capital city of South Korea. Data from the 2011 and 2013 Community Health Surveys were used ( n = 20,147 men and 25,300 women). We staged multilevel logistic regression models to estimate the effect of individual and environmental factors on obesity. Among individual covariates, high-risk drinking, the time spent watching TV and surfing the Internet, high salt intake, stress, and the negative recognition of health were significantly associated with obesity. When controlling individual covariates, the number of sports facilities, number of fried chicken stores, and food insecurity level were statistically associated with probability of obesity. Therefore, this study emphasizes that it is important not only to improve the health behavior of the individual, but also to improve the urban environment in order to reduce the obesity rates of city dwellers.

Information and Communications Technology Industry: Spring 2007 Industry Study

DTIC Science & Technology

2007-01-01

service “contributions” from telecommunications providers to subsidize basic phone service for low- income or rural providers, to subsidize high-cost phone...companies, to provide reduced-price Internet service to schools and libraries, and to offer lower-priced telecommunications services to rural ...health care facilities (Ellig, 2006, p. 57). Overall, the Universal Service Fund is intended 11 to provide “parity among rural and urban consumers

Breast cancer stage at diagnosis: is travel time important?

PubMed

Henry, Kevin A; Boscoe, Francis P; Johnson, Christopher J; Goldberg, Daniel W; Sherman, Recinda; Cockburn, Myles

2011-12-01

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

Role of Sports Facilities in the Process of Revitalization of Brownfields

NASA Astrophysics Data System (ADS)

Taraszkiewicz, Karolina; Nyka, Lucyna

2017-10-01

The paper gives an evidence that building a large sports facility can generate beneficial urban space transformation and a significant improvement in the dilapidated urban areas. On the basis of theoretical investigations and case studies it can be proved that sports facilities introduced to urban brownfields could be considered one of the best known large scale revitalization methods. Large urban spaces surrounding sport facilities such as stadiums and other sports arenas create excellent conditions for designing additional recreational function, such as parks and other green areas. Since sports venues are very often located on brownfields and post-industrial spaces, there are usually well related with canals, rivers and other water routes or reservoirs. Such spaces become attractors for large groups of people. This, in effect initiate the process of introducing housing estates to the area and gradually the development of multifunctional urban structure. As research shows such process of favourable urban transformation could be based on implementing several important preconditions. One of the most significant one is the formation of the new communication infrastructure, which links newly formed territories with the well-structured urban core. Well planned program of the new sports facilities is also a very important factor. As research shows multifunctional large sports venues may function in the city as a new kind of public space that stimulates new genres of social relations, offers entertainment and free time activities, not necessarily related with sport. This finally leads to the creation of new jobs and more general improvement of a widely understood image of the district, growing appreciation for the emerging new location and consequently new investments in the neighbouring areas. The research gives new evidence to the ongoing discussion on the drawbacks and benefits of placing stadiums and sports arenas in the urban core.

Ecological Model of Australian Indigenous Men's Health.

PubMed

McCabe, Marita P; Mellor, David; Ricciardelli, Lina A; Mussap, Alexander J; Hallford, David J

2016-11-01

This study was designed to examine the health behaviors as well as the enablers and barriers to health behaviors among Indigenous Australian men. One hundred and fifty Indigenous Australian men in rural, regional, and urban locations were interviewed about their health behaviors. The results revealed several themes of importance: (a) role of community activities, (b) the Indigenous man as a leader and role model, (c) negative impact of discrimination/racism, (d) importance of partner and family, (e) positive and negative role of peer relationships, (f) central role of culturally appropriate health care facilities, and (g) association between employment and health care problems. These findings highlight the importance of broad community-based (rather than individualistic) approaches to promoting health behavior in Indigenous men. © The Author(s) 2015.

Ownership and use of mobile phones among health workers, caregivers of sick children and adult patients in Kenya: cross-sectional national survey

PubMed Central

2013-01-01

Background The rapid growth in mobile phone penetration and use of Short Message Service (SMS) has been seen as a potential solution to improve medical and public health practice in Africa. Several studies have shown effectiveness of SMS interventions to improve health workers’ practices, patients’ adherence to medications and availability of health facility commodities. To inform policy makers about the feasibility of facility-based SMS interventions, the coverage data on mobile phone ownership and SMS use among health workers and patients are needed. Methods In 2012, a national, cross-sectional, cluster sample survey was undertaken at 172 public health facilities in Kenya. Outpatient health workers and caregivers of sick children and adult patients were interviewed. The main outcomes were personal ownership of mobile phones and use of SMS among phone owners. The predictors analysis examined factors influencing phone ownership and SMS use. Results The analysis included 219 health workers and 1,177 patients’ respondents (767 caregivers and 410 adult patients). All health workers possessed personal mobile phones and 98.6% used SMS. Among patients’ respondents, 61.2% owned phones and 71.4% of phone owners used SMS. The phone ownership and SMS use was similar between caregivers of sick children and adult patients. The respondents who were male, more educated, literate and living in urban area were significantly more likely to own the phone and use SMS. The youngest respondents were less likely to own phones, however when the phones were owned, younger age groups were more likely to use SMS. Respondents living in wealthier areas were more likely to own phones; however when phones are owned no significant association between the poverty and SMS use was observed. Conclusions Mobile phone ownership and SMS use is ubiquitous among Kenyan health workers in the public sector. Among patients they serve the coverage in phone ownership and SMS use is lower and disparities exist with respect to gender, age, education, literacy, urbanization and poverty. Some of the disparities on SMS use can be addressed through the modalities of mHealth interventions and enhanced implementation processes while further growth in mobile phone penetration is needed to reduce the ownership gap. PMID:23672301

Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

PubMed

Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

2017-12-01

Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Application of Satellite Remote Sensing to Identify Climatic and Anthropogenic Changes Related to Water and Health Conditions in Emerging Megacities

NASA Astrophysics Data System (ADS)

Akanda, A. S.; Serman, E. A.; Jutla, A.

2014-12-01

By 2050, more than 70% of the world's population is expected to be living in a city. In many of the urbanizing regions in Asia and Africa, most new development is taking place without adequate urban or regional planning, and a majority population is crowded into densely populated unplanned settlements, also known as slums. During the same period, precipitation and temperature patterns are likely to see significant changes in many of these regions while coastal megacities will have to accommodate sea-level rise in their ecosystems. The rapid increase in population is usually observed in fringes of the urban sprawl without adequate water or sanitation facilities or access to other municipal amenities (such as utilities, healthcare, and education). Collectively, these issues make the ever increasing slum dwellers in emerging megacities significantly vulnerable to a combination of climatic and anthropogenic threats. However, how the growth of unplanned urban and peri-urban sprawl and simultaneous change in climatic patterns have impacted public health in the emerging megacities remain largely unexplored due to lack of readily available and usable data. We employ a number of Remote Sensing products (GRACE, LANDSAT, MODIS) to bridge above knowledge gaps and to identify relevant hydrologic and anthropogenic changes in emerging megacities that are most vulnerable due to the climate-water-health nexus. We explore one of the largest and the fastest growing megacities in the world - Dhaka, Bangladesh - on identifying and investigating the changes in the water environment and growth of slum areas, and impact on water services and health outcomes. The hydroclimatology of South Asia is highly seasonal and the asymmetric availability of water affects vast areas of Bangladesh differently in space and time, exposing the population of Dhaka region to both droughts and floods and periodic spring-fall outbreaks of diarrheal diseases, such as cholera and rotavirus. This research focuses on stretching this understanding to water and health implications in this growing megacity and adjoining slum areas, and how satellite remote sensing data products and derived knowledge can inform urban planning, water management, and public health sectors to adapt to these climatic and anthropogenic changes for the benefit of societies.

Peculiarities of tuberculosis control in a scenario of urban violence in a disadvantaged community in Rio de Janeiro, Brazil.

PubMed

Souza, Fabiana Barbosa Assumpção de; Villa, Tereza Cristina Scatena; Cavalcante, Solange Cesar; Ruffino Netto, Antonio; Lopes, Luciane Blanco; Conde, Marcus Barreto

2007-01-01

To describe the difficulties and peculiarities encountered by health professionals during the treatment and investigation of contacts of tuberculosis (TB) patients in disadvantaged communities. A qualitative study carried out at health care facilities in Health Programming Area 1.0, located in the city of Rio de Janeiro, Brazil, which has a TB incidence rate of 240/100,000 inhabitants. From among the professionals responsible for visiting and treating TB cases and their contacts, two home visit agents and one clinical nurse were selected to be interviewed for the study. Data were transcribed and structured in the form of quotations, emphasizing the predominant ideas. The central ideas focus on the issue of violence, one significant facet of which is the set of rules imposed by narcotraffickers, and on the barriers to the movement of patients/health professionals for TB treatment, as well as on public safety (police). This study provides public health officials, as well as institutions that graduate health professionals, data for reflection and analysis of the difficulties that urban violence creates for the control of TB in a disadvantaged community.

The public's rating of hospitals.

PubMed

Boscarino, J A

1988-01-01

Increasingly, hospital administrators have been concerned about the public's perception of the facility. Nationwide, they have engaged marketing firms to study how consumers rate their local facilities in comparison to others. This type of information has been important to develop effective marketing and advertising programs (Steiber and Boscarino 1985). In this study, hospital ratings were analyzed for 65 short-term (nongovernment), medical and surgical hospitals across the United States. These hospitals represented different regions of the country (east, west, north, south, and central), as well as urban, suburban, and rural areas. Over 14,000 consumers were surveyed in these local market surveys. The public's ratings of these local hospitals were analyzed in terms of hospital size (number of beds), inpatient census, the "urbanicity" level of the local area, the level of care provided (primary, secondary, or tertiary), geographic region, and the 1984 Health Care Financing Administration death rate reported for Medicare patients. A multivariate analysis of the data indicates that hospital ratings are significantly related to the level of care provided and to the hospital's census level. Both of these are positively related to the public's attitude toward that facility (the higher the rating, the more specialized the care provided and the higher the census at that facility). Other variables are also positively related to ratings for example, bed size), but this is because of the relationship of these variables to either census or care level.

Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry.

PubMed

Sprague, Courtenay; Chersich, Matthew F; Black, Vivian

2011-03-03

HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of maternal and child care as a framework to track and document women's experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) programmes in the Eastern Cape (three peri-urban facilities) and Gauteng provinces (one academic hospital). In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation). By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate. A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing accountability systems; improving HIV services in labour wards; ensuring quality HIV and infant feeding counselling; and improved monitoring for performance management using robust systems for data collection and utilisation.

[Porto and the construction of the modern city: the case of Hospital Geral de Santo António in the eighteenth and nineteenth centuries].

PubMed

da Silva, Helena

2014-01-01

During a period of demographic and urban growth of the city of Porto, the need arose for a new hospital. The Santa Casa da Misericórdia of Porto, in charge of erecting the new health facility, appointed the British architect John Carr to design the project. By means of the analysis of a set of archival sources and sundry literature on the topic, we examine the criteria chosen for the design and construction of Hospital Geral de Santo António and if it fulfilled expectations, becoming a special space in the city. This article opens up a perspective on the study of the development of the city and the creation of this health facility, contributing to the historical trajectory of hospital architecture.

Physician Satisfaction With Integrated Behavioral Health in Pediatric Primary Care.

PubMed

Hine, Jeffrey F; Grennan, Allison Q; Menousek, Kathryn M; Robertson, Gail; Valleley, Rachel J; Evans, Joseph H

2017-04-01

As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, those who otherwise would seek services through referrals to traditional tertiary care facilities).

Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services.

PubMed

Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

2014-05-01

Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current "pull-based" distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015.

Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services

PubMed Central

Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

2014-01-01

Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current “pull-based” distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015. PMID:25276582

Factors affecting minority population proximity to hazardous facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nieves, L.A.; Nieves, A.L.

1995-04-01

Disproportionate exposure of minority groups to environmental hazards has been attributed to ``environmental racism`` by some authors, without systematic investigation of the factors underlying this exposure pattern. This study examines regional differences in the proximity of African-Americans, Hispanics, Asians, and non-Hispanic Whites to a broad range of facility types and explores the effects of urban and income factors. A statistically significant inverse relationship is found between the percentage of non-Hispanic Whites and virtually all facility categories in all regions. Except for Hispanics in the South, all such associations for minority groups show a direct relationship, though some are nonsignificant. Themore » geographic concentration of facilities is more closely tied to urbanization than to economic factors. Controlling for both urban and economic factors, minority population concentration is still a significant explanatory variable for some facility types in some regions. This finding is most consistent for African-Americans.« less

Main components and human health risks assessment of PM10, PM2.5, and PM1 in two areas influenced by cement plants

NASA Astrophysics Data System (ADS)

Sánchez-Soberón, Francisco; Rovira, Joaquim; Mari, Montse; Sierra, Jordi; Nadal, Martí; Domingo, José L.; Schuhmacher, Marta

2015-11-01

Particulate matter (PM) is widely recorded as a source of diseases, being more harmful those particles with smaller size. PM is released to the environment as a consequence of different activities, being one of them cement production. The objective of this pilot study was to characterize PM of different sizes around cement facilities to have a preliminary approach of their origin, and evaluate their potential health risks. For that purpose, three fractions of PM (10, 2.5, and 1) were collected in the nearby area of two cement plants with different backgrounds (urban and rural) in different seasons. Subsequently, main components, outdoor and indoor concentrations, exposure, and human health risks were assessed. Greatest levels of PM1, organic matter, and metals were found in urban location, especially in winter. Consequently, environmental exposure and human health risks registered their highest values in the urban plant during wintertime. Exposure was higher for indoor activities, expressing some metals their peak values in the PM1 fraction. Non-carcinogenic risks were below the safety threshold (HQ < 1). Carcinogenic risks for most of the metals were below the limit of 10-5, except for Cr (VI), which exceeded it in both locations, but being in the range considered as assumable (10-6-10-4).

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study

PubMed Central

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Sharma, Saket; Allen, Elizabeth; Shankar, Anuraj H; Zodpey, Sanjay

2016-01-01

Objectives Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. Setting Urban poor community in the Southeast district of Delhi, India. Participants We randomly sampled 1849 children aged 1–3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria–pertussis–tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers’ recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. Results Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. Conclusions Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities. Trial registration number CTRI/2011/091/000095. PMID:27566644

Water Security, Climate Forcings and Public Health Impacts in Emerging Regions

NASA Astrophysics Data System (ADS)

Serman, E. A.; Akanda, A. S.; Craver, V.; Boving, T. B.

2014-12-01

Our world is rapidly urbanizing, with more than 80% of world's population is expected to be living in a city by the end of the century. A majority of these nations are rapidly urbanizing due to massive rural-to-urban migratory trends, with rapid development of unplanned urban settlements, or slums, with lack of adequate water or sanitation facilities and other municipal amenities. With global environmental change, natural disasters will expose millions more to drought, floods, and disease epidemics, and existing vulnerabilities will worsen. At the same time, rapid urbanization and fast changing land-use leads to widespread damage of infrastructure by stormwater, especially in lowlands and economically poor areas. The factor that consistently stands out among different cities from both the developed and the developing worlds is that the slums are typically the most vulnerable to water related natural hazards and climatic threats, such as water scarcity and quality issues in drought conditions, or water and sanitation breakdown and stormwater contamination problems. Onsite or decentralized water, wastewater and stormwater treatment as well as point-of-use water treatment options can be an economic, safe, and reliable alternative to conventional large-scale treatment especially, in urban fringes as well as rural areas. These systems can be designed to fit communities in terms of their economic, cultural, environmental, and demographic resources. As part of this study, we develop a database of urban water quality and quantity indices such as with urban land-use, water usage, climate, and socio-economic characteristics in various emerging regions in the world. We analyze past and current data to identify and quantify long-term trends and the impacts of large-scale climatic and anthropogenic changes on urban hydrology and health impacts. We specifically focus on five major cities from distinct groups of countries and geographies: Providence, RI, USA from the developed world, Lagos, Nigeria, Lima, Peru and Jakarta, Indonesia from the Middle-Income Countries, and Dhaka, Bangladesh from the Least Developed Countries, to compare and contrast leading drivers and sensitivities of water, climate, and health indicators.

Developing a performance measurement framework and indicators for community health service facilities in urban China.

PubMed

Wong, Sabrina T; Yin, Delu; Bhattacharyya, Onil; Wang, Bin; Liu, Liqun; Chen, Bowen

2010-11-18

China has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report on the development of the China results-based Logic Model for Community Health Facilities and Stations (CHS) and a set of relevant PHC indicators intended to measure CHS priorities. We adapted the PHC Results Based Logic Model developed in Canada and current work conducted in the community health system in China to create the China CHS Logic Model framework. We used a staged approach by first constructing the framework and indicators and then validating their content through an interactive process involving policy analysis, critical review of relevant literature and multiple stakeholder consultation. The China CHS Logic Model includes inputs, activities, outputs and outcomes with a total of 287 detailed performance indicators. In these indicators, 31 indicators measure inputs, 64 measure activities, 105 measure outputs, and 87 measure immediate (n = 65), intermediate (n = 15), or final (n = 7) outcomes. A Logic Model framework can be useful in planning, implementation, analysis and evaluation of PHC at a system and service level. The development and content validation of the China CHS Logic Model and subsequent indicators provides a means for stronger accountability and a clearer sense of overall direction and purpose needed to renew and strengthen the PHC system in China. Moreover, this work will be useful in moving towards developing a PHC information system and performance measurement across districts in urban China, and guiding the pursuit of quality in PHC.

First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project's Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh.

PubMed

Marcil, Lucy; Afsana, Kaosar; Perry, Henry B

2016-02-01

The processes for implementing effective programs at scale in low-income countries have not been well-documented in the peer-reviewed literature. This article describes the initial steps taken by one such program--the BRAC Manoshi Project, which now reaches a population of 6.9 million. The project has achieved notable increases in facility births and reductions in maternal and neonatal mortality. The focus of the paper is on the initial steps--community engagement, social mapping, and census taking. Community engagement began with (1) engaging local leaders, (2) creating Maternal, Neonatal, and Child Health Committees for populations of approximately 10,000 people, (3) responding to advice from the community, (4) social mapping of the community, and (5) census taking. Social mapping involved community members working with BRAC staff to map all important physical features that affect how the community carries out its daily functions--such as alleys, lanes and roads, schools, mosques, markets, pharmacies, health facilities, latrine sites, and ponds. As the social mapping progressed, it became possible to conduct household censuses with maps identifying every household and listing family members by household. Again, this was a process of collaboration between BRAC staff and community members. Thus, social mapping and census taking were also instrumental for advancing community engagement. These three processes-community engagement, social mapping, and census taking--can be valuable strategies for strengthening health programs in urban slum settings of low-income countries.

Developing a Performance Measurement Framework and Indicators for Community Health Service Facilities in Urban China

PubMed Central

2010-01-01

Background China has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report on the development of the China results-based Logic Model for Community Health Facilities and Stations (CHS) and a set of relevant PHC indicators intended to measure CHS priorities. Methods We adapted the PHC Results Based Logic Model developed in Canada and current work conducted in the community health system in China to create the China CHS Logic Model framework. We used a staged approach by first constructing the framework and indicators and then validating their content through an interactive process involving policy analysis, critical review of relevant literature and multiple stakeholder consultation. Results The China CHS Logic Model includes inputs, activities, outputs and outcomes with a total of 287 detailed performance indicators. In these indicators, 31 indicators measure inputs, 64 measure activities, 105 measure outputs, and 87 measure immediate (n = 65), intermediate (n = 15), or final (n = 7) outcomes. Conclusion A Logic Model framework can be useful in planning, implementation, analysis and evaluation of PHC at a system and service level. The development and content validation of the China CHS Logic Model and subsequent indicators provides a means for stronger accountability and a clearer sense of overall direction and purpose needed to renew and strengthen the PHC system in China. Moreover, this work will be useful in moving towards developing a PHC information system and performance measurement across districts in urban China, and guiding the pursuit of quality in PHC. PMID:21087516

Study of knowledge and attitudes on medical abortion among Chinese health providers.

PubMed

Cheng, Yimin; Zhou, You; Zhang, Ying; Jiang, Xiaomei; Xi, Maomao; Gan, Kang; Ren, Shanshan

2012-09-01

To investigate providers' knowledge and attitudes about medical abortion (MA) and their views regarding the main challenges to expanding the use of MA in urban and rural areas in China. A total of 658 abortion providers were surveyed from November 7, 2009, to May 29, 2010. The providers' knowledge about MA was relatively poor, and most thought the risks of severe complications of MA were much higher than they are. Urban nonphysician providers were the least informed about MA. Most providers thought that the main challenges to an expanded use of MA were its lesser effectiveness in comparison to surgical abortion and women's lack of knowledge about it. In rural areas many providers thought that deficiencies of clinics, such as limited bed space and inadequate toilets and washing facilities, also posed serious obstacles to expanding MA use. Abortion providers, especially urban nonphysician providers, need refresher training to strengthen their knowledge of the approved protocol for providing MA in China, and also of the indications, contraindications, and safety and efficacy of the method. Deficiencies at abortion facilities should be addressed as well, and they are more numerous in rural areas. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Do socially deprived urban areas have lesser supplies of cancer care services?

PubMed

Lamont, Elizabeth B; He, Yulei; Subramanian, S V; Zaslavsky, Alan M

2012-09-10

Area social deprivation is associated with unfavorable health outcomes of residents across the full clinical course of cancer from the stage at diagnosis through survival. We sought to determine whether area social factors are associated with the area health care supply. We studied the area supply of health services required for the provision of guideline-recommended care for patients with breast cancer and colorectal cancer (CRC) in each of the following three distinct clinical domains: screening, treatment, and post-treatment surveillance. We characterized area social factors in 3,096 urban zip code tabulation areas by using Census Bureau data and the health care supply in the corresponding 465 hospital service areas by using American Hospital Association, American Medical Association, and US Food and Drug Administration data. In two-level hierarchical models, we assessed associations between social factors and the supply of health services across areas. We found no clear associations between area social factors and the supply of health services essential to the provision of guideline recommended breast cancer and CRC care in urban areas. The measures of health service included the supply of physicians who facilitate screening, treatment, and post-treatment care and the supply of facilities required for the same services. Because we found that the supply of types of health care required for the provision of guideline-recommended cancer care for patients with breast cancer and CRC did not vary with markers of area socioeconomic disadvantage, it is possible that previously reported unfavorable breast cancer and CRC outcomes among individuals living in impoverished areas may have occurred despite an apparent adequate area health care supply.

Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents.

PubMed

Paez, Antonio; Mercado, Ruben G; Farber, Steven; Morency, Catherine; Roorda, Matthew

2010-10-25

Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required. Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons. The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists). Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns. The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.

Engaging with peri-urban woodlands in England: the contribution to people's health and well-being and implications for future management.

PubMed

O'Brien, Liz; Morris, Jake; Stewart, Amy

2014-06-12

In this paper we engage with debates concerning people and their contact with the natural environment as part of everyday life drawing on Irwin's ideas of co-construction and Gibson's theory of affordances. We focus on peri-urban woodlands in England as important places where people can interact with nature for health and well-being. Qualitative data were collected in situ via walks in the woods, focus group discussions and photo elicitation, with a sample of 49 people. These methods provide rich data on the wide range of meanings associated with woodlands that can have a perceived impact on people's health and well-being. The findings link to contemporary debates about health, well-being and ecosystem services. We explore the inter-play between attributes of the physical environment and the range of facilities provided to enable access, social interactions and the benefits people attribute to their woodland experiences. We conclude that peri-urban woodlands can clearly contribute to self-reported health and well-being in multiple ways, and that organized activities can be important for those who face barriers to accessing woodlands. A strong message emerging from the research is the opportunity afforded by woodlands for social connections with others, as well as the provision of a range of sensory benefits and opportunities to observe and enjoy seasonal change in woodlands. Mental restoration via connection with nature also emerged as important, confirming previous research.

Engaging with Peri-Urban Woodlands in England: The Contribution to People’s Health and Well-Being and Implications for Future Management

PubMed Central

O’Brien, Liz; Morris, Jake; Stewart, Amy

2014-01-01

In this paper we engage with debates concerning people and their contact with the natural environment as part of everyday life drawing on Irwin’s ideas of co-construction and Gibson’s theory of affordances. We focus on peri-urban woodlands in England as important places where people can interact with nature for health and well-being. Qualitative data were collected in situ via walks in the woods, focus group discussions and photo elicitation, with a sample of 49 people. These methods provide rich data on the wide range of meanings associated with woodlands that can have a perceived impact on people’s health and well-being. The findings link to contemporary debates about health, well-being and ecosystem services. We explore the inter-play between attributes of the physical environment and the range of facilities provided to enable access, social interactions and the benefits people attribute to their woodland experiences. We conclude that peri-urban woodlands can clearly contribute to self-reported health and well-being in multiple ways, and that organized activities can be important for those who face barriers to accessing woodlands. A strong message emerging from the research is the opportunity afforded by woodlands for social connections with others, as well as the provision of a range of sensory benefits and opportunities to observe and enjoy seasonal change in woodlands. Mental restoration via connection with nature also emerged as important, confirming previous research. PMID:24927035

Health care expenditure of households in magway, myanmar.

PubMed

Khaing, Inn Kynn; Malik, Amonov; Oo, Myo; Hamajima, Nobuyuki

2015-02-01

Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73-16.26) for hospitalization and 1.08 (95% CI 0.36-3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential.

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model.

PubMed

Matsumoto, Masatoshi; Ogawa, Takahiko; Kashima, Saori; Takeuchi, Keisuke

2012-07-23

Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p<0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using the capacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model

PubMed Central

2012-01-01

Background Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Methods Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. Results The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p < 0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Conclusions Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using thecapacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned. PMID:22824294

City kids in the absence of. . . .

Treesearch

Florence C. Ladd

1977-01-01

Environmental requirements for adolescents are rarely met in urban settings. There are few opportunities and facilities for legitimate adventure. Public amenities and public places for private moments are inadequate. Programs and facilities that would enhance the "personhood" of the urban adolescent and increase the comfort and dignity adolescents experience...

Identifying built environmental patterns using cluster analysis and GIS: relationships with walking, cycling and body mass index in French adults.

PubMed

Charreire, Hélène; Weber, Christiane; Chaix, Basile; Salze, Paul; Casey, Romain; Banos, Arnaud; Badariotti, Dominique; Kesse-Guyot, Emmanuelle; Hercberg, Serge; Simon, Chantal; Oppert, Jean-Michel

2012-05-23

Socio-ecological models suggest that both individual and neighborhood characteristics contribute to facilitating health-enhancing behaviors such as physical activity. Few European studies have explored relationships between local built environmental characteristics, recreational walking and cycling and weight status in adults. The aim of this study was to identify built environmental patterns in a French urban context and to assess associations with recreational walking and cycling behaviors as performed by middle-aged adult residents. We used a two-step procedure based on cluster analysis to identify built environmental patterns in the region surrounding Paris, France, using measures derived from Geographic Information Systems databases on green spaces, proximity facilities (destinations) and cycle paths. Individual data were obtained from participants in the SU.VI.MAX cohort; 1,309 participants residing in the Ile-de-France in 2007 were included in this analysis. Associations between built environment patterns, leisure walking/cycling data (h/week) and measured weight status were assessed using multinomial logistic regression with adjustment for individual and neighborhood characteristics. Based on accessibility to green spaces, proximity facilities and availability of cycle paths, seven built environmental patterns were identified. The geographic distribution of built environmental patterns in the Ile-de-France showed that a pattern characterized by poor spatial accessibility to green spaces and proximity facilities and an absence of cycle paths was found only in neighborhoods in the outer suburbs, whereas patterns characterized by better spatial accessibility to green spaces, proximity facilities and cycle paths were more evenly distributed across the region. Compared to the reference pattern (poor accessibility to green areas and facilities, absence of cycle paths), subjects residing in neighborhoods characterized by high accessibility to green areas and local facilities and by a high density of cycle paths were more likely to walk/cycle, after adjustment for individual and neighborhood sociodemographic characteristics (OR = 2.5 95%CI 1.4-4.6). Body mass index did not differ across patterns. Built environmental patterns were associated with walking and cycling among French adults. These analyses may be useful in determining urban and public health policies aimed at promoting a healthy lifestyle.

Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya.

PubMed

Cohen, Jessica; Golub, Ginger; Kruk, Margaret E; McConnell, Margaret

2016-11-01

Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Human papillomavirus vaccination practices among providers in Indian health service, tribal and urban Indian healthcare facilities.

PubMed

Jim, Cheyenne C; Lee, Jennifer Wai-Yin; Groom, Amy V; Espey, David K; Saraiya, Mona; Holve, Steve; Bullock, Ann; Howe, Jean; Thierry, Judith

2012-04-01

The human papillomavirus (HPV) vaccine is of particular importance in American Indian/Alaska Native women because of the higher rate of cervical cancer incidence compared to non-Hispanic white women. To better understand HPV vaccine knowledge, attitudes, and practices among providers working with American Indian/Alaska Native populations, we conducted a provider survey in Indian Health Service, Tribal and Urban Indian (I/T/U) facilities. During December 2009 and January 2010, we distributed an on-line survey to providers working in I/T/U facilities. We also conducted semistructured interviews with a subset of providers. There were 268 surveys and 51 provider interviews completed. Providers were more likely to administer vaccine to 13-18-year-olds (96%) than to other recommended age groups (89% to 11-12-year-olds and 64% to 19-26-year-olds). Perceived barriers to HPV vaccination for 9-18-year-olds included parental safety and moral/religious concerns. Funding was the main barrier for 19-26-year-olds. Overall, providers were very knowledgeable about HPV, although nearly half of all providers and most obstetricians/gynecologists thought that a pregnancy test should precede vaccination. Sixty-four percent of providers of patients receiving the vaccine do not routinely discuss the importance of cervical cancer screening. Recommendations for HPV vaccination have been broadly implemented in I/T/U settings. Vaccination barriers identified by I/T/U providers are similar to those reported in other provider surveys. Provider education efforts should stress that pregnancy testing is not needed before vaccination and the importance of communicating the need for continued cervical cancer screening.

24 CFR 597.500 - Indian Reservations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE DESIGNATIONS Special Rules § 597.500 Indian Reservations. No urban Empowerment Zone or Enterprise Community may...

Innovative partnerships: the clinical nurse leader role in diverse clinical settings.

PubMed

Lammon, Carol Ann Barnett; Stanton, Marietta P; Blakney, John L

2010-01-01

The American Association of Colleges of Nursing in collaboration with leaders in the health care arena has developed a new role in nursing, the clinical nurse leader (CNL). The CNL is a master's-prepared advanced nurse generalist, accountable for providing high-quality, cost-effective care for a cohort of patients in a specific microsystem. Although initial implementation of the CNL has been predominantly in urban acute care settings, the skill set of the CNL role is equally applicable to diverse clinical settings, such as smaller rural hospitals, home-based home care providers, long-term care facilities, schools, Veteran's Administration facilities, and public health settings. This article reports the strategies used and the progress made at The University of Alabama Capstone College of Nursing in the development of innovative partnerships to develop the role of the CNL in diverse clinical settings. With academia and practice working in partnership, the goal of transforming health care and improving patient outcomes can be achieved. Copyright © 2010 Elsevier Inc. All rights reserved.

The human resource for health situation in Zambia: deficit and maldistribution.

PubMed

Ferrinho, Paulo; Siziya, Seter; Goma, Fastone; Dussault, Gilles

2011-12-19

Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care. We used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them. The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers).The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces.This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763.In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other.The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus. This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity.

Health care utilisation under the 30-Baht Scheme among the urban poor in Mitrapap slum, Khon Kaen, Thailand: a cross-sectional study

PubMed Central

Coronini-Cronberg, Sophie; Laohasiriwong, Wongsa; Gericke, Christian A

2007-01-01

Background In 2001, the Government of Thailand introduced a universal coverage scheme with the aim of ensuring equitable health care access for even the poorest citizens. For a flat user fee of 30 Baht per consultation, or for free for those falling into exemption categories, every scheme participant may access registered health services. The exemption categories include children under 12 years of age, senior citizens aged 60 years and over, the very poor, and volunteer health workers. The functioning of these exemption mechanisms and the effect of the scheme on health service utilisation among the poor is controversial. Methods This cross-sectional study investigated the prevalence of 30-Baht Scheme registration and subsequent self-reported health service utilisation among an urban poor population in the Teparuk community within the Mitrapap slum in Khon Kaen city, northeastern Thailand. Furthermore, the effectiveness of the exemption mechanisms in reaching the very poor and the elderly was examined. Factors for users' choice of health facilities were identified. Results Overall, the proportion of the Teparuk community enrolled with the 30-Baht Scheme was high at 86%, with over one quarter of these exempted from paying the consultation fee. User fee exemption was significantly more frequent among households with an above-poverty-line income (64.7%) compared to those below the poverty line (35.3%), χ2 (df) = 5.251 (1); p-value = 0.018. In addition, one third of respondents over 60 years of age were found to be still paying user fees. Self-reported use of registered medical facilities in case of illness was stated to be predominantly due to the service being available through the scheme, with service quality not a chief consideration. Overall consumer satisfaction was high, especially among those not required to pay the 30 Baht user fee. Conclusion Whilst the 30-Baht Scheme seems to cover most of the poor population of Mitrapap slum in Khon Kaen, the user fee exemption mechanism only works partially with regard to reaching the poorest and exempting senior citizens. Service utilisation and satisfaction are highest amongst those who are fee-exempt. Service quality was not an important factor influencing choice of health facility. Ways should be sought to improve the effectiveness of the current exemption mechanisms. PMID:17883874

The effect of access to contraceptive services on injectable use and demand for family planning in Malawi.

PubMed

Skiles, Martha Priedeman; Cunningham, Marc; Inglis, Andrew; Wilkes, Becky; Hatch, Ben; Bock, Ariella; Barden-O'Fallon, Janine

2015-03-01

Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance. Kernel density estimation was used to geographically link Malawi women's use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services-measured by distance alone and by distance combined with supply reliability-and injectable use and family planning demand among rural and urban populations. Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access. Product availability in the local service environment plays a critical role in women's demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.

No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India.

PubMed

Bhojani, Upendra; Beerenahalli, Thriveni S; Devadasan, Roopa; Munegowda, C M; Devadasan, Narayanan; Criel, Bart; Kolsteren, Patrick

2013-08-13

The burden of chronic conditions is high in low- and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health- seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services. Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities.

Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

PubMed

Alcock, Glyn; Das, Sushmita; Shah More, Neena; Hate, Ketaki; More, Sharda; Pantvaidya, Shanti; Osrin, David; Houweling, Tanja A J

2015-09-28

Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.

Low risk of attrition among adults on antiretroviral therapy in the Rwandan national program: a retrospective cohort analysis of 6, 12, and 18 month outcomes.

PubMed

Nuwagaba-Biribonwoha, Harriet; Jakubowski, Aleksandra; Mugisha, Veronicah; Basinga, Paulin; Asiimwe, Anita; Nash, Denis; Elul, Batya

2014-08-29

We report levels and determinants of attrition in Rwanda, one of the few African countries with universal ART access. We analyzed data abstracted from health facility records of a nationally representative sample of adults [≥ 18 years] who initiated ART 6, 12, and 18 months prior to data collection; and collected facility characteristics with a health facility assessment questionnaire. Weighted proportions and rates of attrition [loss to follow-up or death] were calculated, and patient- and health facility-level factors associated with attrition examined using Cox proportional hazard models. 1678 adults initiated ART 6, 12 and 18 months prior to data collection, with 1508 person-years [PY] on ART. Attrition was 6.8% [95% confidence interval [CI] 6.0-7.8]: 2.9% [2.4-3.5] recorded deaths and 3.9% [3.4-4.5] lost to follow-up. Population attrition rate was 7.5/100 PY [6.1-9.3]. Adjusted hazard ratio [aHR] for attrition was 4.2 [3.0-5.7] among adults enrolled from in-patient wards [vs 2.2 [1.6-3.0] from PMTCT, ref: VCT]. Compared to adults who initiated ART 18 months earlier, aHR for adults who initiated ART 12 and 6 months earlier was 1.8 [1.3-2.5] and 1.3 [0.9-1.9] respectively. Male aHR was 1.4 [1.0-1.8]. AHR of adults enrolled at urban health facilities was 1.4 [1.1-1.8, ref: rural health facilities]. AHR for adults with CD4+ ≥ 200 cells/μL vs <200 cells/μL was 0.8 [0.6-1.0]; and adults attending facilities with performance-based financing since 2004-2006 [vs. 2007-2008] had aHR 0.8 [0.6-0.9]. Attrition was low in the Rwandan national program. The above patient and facility correlates of attrition can be the focus of interventions to sustain high retention.

Cost of hospitalization for childbirth in India: how equitable it is in the post-NRHM era?

PubMed

Tripathy, Jaya Prasad; Shewade, Hemant D; Mishra, Sanskruti; Kumar, A M V; Harries, A D

2017-08-15

Information on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services. We undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households. This is a secondary data analysis of a nationwide household survey by the National Sample Survey Organization in 2014. The survey reported health service utilization and health care related expenditure by income quintiles and type of health facility. The recall period for hospitalization expenditure was 365 days. OOP expenditure amounting to more than 10% of annual consumption expenditure was termed as catastrophic. Median expenditure per episode of hospitalisation due to childbirth was US$54. The expenditure incurred was about six times higher among the richest quintile compared to the poorest quintile. Median private sector OOP hospitalization expenditure was nearly nine times higher than in the public sector. Hospitalization in a private sector facility leads to a significantly higher prevalence of catastrophic expenditure than hospitalization in a public sector (60% vs. 7%). Indirect cost (43%) constituted the largest share in the total expenditure in public sector hospitalizations. Urban residence, poor wealth quintile, residing in eastern and southern regions of India and delivery in private hospital were significantly associated with catastrophic expenditure. We strongly recommend cash transfer schemes with effective pro-poor targeting to reduce the impact of catastrophic expenditure. Strengthening of public health facilities is required along with private sector regulation.

76 FR 40386 - Federal Property Suitable as Facilities To Assist the Homeless

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75 FR 75487 - Federal Property Suitable as Facilities To Assist the Homeless

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2010-12-03

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76 FR 2702 - Federal Property Suitable as Facilities To Assist the Homeless

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2011-01-14

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24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

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2010-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily...) in such a project shall be accessible for persons with hearing or vision impairments. If state or...

24 CFR 9.152 - Program accessibility: alterations of Property Disposition Program multifamily housing facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... of Property Disposition Program multifamily housing facilities. 9.152 Section 9.152 Housing and Urban... URBAN DEVELOPMENT § 9.152 Program accessibility: alterations of Property Disposition Program multifamily...) in such a project shall be accessible for persons with hearing or vision impairments. If state or...

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2010-02-05

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5375-N-05] Federal Property Suitable as Facilities to Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... Urban Development, 451 Seventh Street, SW., Room 7262, Washington, DC 20410; telephone (202) 708-1234...

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2010-07-16

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... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5375-N-31] Federal Property Suitable as Facilities To Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... Urban Development, 451 Seventh Street SW., Room 7262, Washington, DC 20410; telephone (202) 708-1234...

76 FR 22719 - Federal Property Suitable as Facilities To Assist the Homeless

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2011-04-22

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... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5375-N-36] Federal Property Suitable as Facilities To Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... Urban Development, 451 Seventh Street, SW., Room 7262, Washington, DC 20410; telephone (202) 708-1234...

76 FR 75554 - Federal Property Suitable as Facilities to Assist the Homeless

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76 FR 47606 - Federal Property Suitable as Facilities To Assist the Homeless

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76 FR 28058 - Federal Property Suitable as Facilities To Assist the Homeless

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75 FR 82409 - Federal Property Suitable as Facilities To Assist the Homeless

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77 FR 29680 - Federal Property Suitable as Facilities To Assist the Homeless

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24 CFR 597.2 - Objective and purpose.

Code of Federal Regulations, 2012 CFR

2012-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... establishment of Empowerment Zones and Enterprise Communities in urban areas, to stimulate the creation of new...

24 CFR 597.2 - Objective and purpose.

Code of Federal Regulations, 2013 CFR

2013-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... establishment of Empowerment Zones and Enterprise Communities in urban areas, to stimulate the creation of new...

24 CFR 597.2 - Objective and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... establishment of Empowerment Zones and Enterprise Communities in urban areas, to stimulate the creation of new...

Do the Preferences of Healthcare Provider Selection Vary among Rural and Urban Patients with Different Income and Cause Different Outcome?

PubMed

Yu, Tsung-Hsien; Chung, Kuo-Piao; Wei, Chung-Jen; Chien, Kuo-Liong; Hou, Yu-Chang

2016-01-01

Equal access to healthcare facilities and high-level quality of care are important strategies to eliminate the disparity in outcome of care. However, the existing literature regarding how urban or rural dwelling patients with different income level select healthcare providers is insufficient. The purposes of this study were to examine whether differences of healthcare provider selection exist among urban and rural coronary artery bypass surgery (CABG) patients with different income level. If so, we further investigated the associated impact on mortality. A retrospective, multilevel study design was conducted using claims data from 2007-2011 Taiwan's Universal Health Insurance Scheme. Healthcare providers' performance and patients' travelling distance to hospitals were used to define the patterns of healthcare provider selection. Baron and Kenny's procedures for mediation effect were conducted. There were 10,108 CABG surgeries included in this study. The results showed that urban dwelling and higher income patients were prone to receive care from better-performance providers. The travelling distances of urban dwelling patients was 15 KM shorter, especially when they received better-performance provider's care. The results also showed that the difference of healthcare provider selection and mortality rate existed between rural and urban dwelling patients with different income levels. After the procedure of mediation effect testing, the results showed that the healthcare provider selection partially mediated the relationships between patients' residential areas with different income levels and 30-day mortality. Preferences of healthcare provider selection vary among rural and urban patients with different income, and such differences partially mediated the outcome of care. Health authorities should pay attention to this issue, and propose appropriate solutions to eliminate the disparity in outcome of CABG care.

Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey

PubMed Central

2015-01-01

Background Acute respiratory infection is a major contributor to morbidity and mortality among children under five years of age in Ethiopia. While facilities have been implemented to address this problem they are underused due to a lack in help-seeking behavior. This study investigates factors related to the help-seeking behavior of mothers for children with acute respiratory infection using data from the 2011 Ethiopia Demographic and Health Survey. Methods Data on 11,030 children aged 0–59 months obtained through interviewing women aged 15–49 years throughout Ethiopia was available. Descriptive statistics and logistic regression analyses were performed to determine which factors are related to help-seeking behavior for acute respiratory infection. Results In the two weeks prior to the survey, 773(7%) of the children were reported to have symptoms of acute respiratory infection while treatment was sought for only 209 (27.2%). The odds ratio for acute respiratory infection was 1.6 (95% CI: 1.2–2.0) for rural residence with only 25.2% of these mothers seeking help compared to 46.4% for mothers with an urban residence. Smaller family size, younger mothers’ age and having had prenatal care had a statistically significant odds ratio greater than 1 for both urban and rural residences. Highest wealth index had a statistically significant odds ratio greater than 1 for rural residence only, whereas primary education or higher had a statistically significant odds ratio greater than 1 for urban residence. Conclusions Children from rural areas are more at risk for acute respiratory infection while their mothers are less likely to seek help. Nevertheless, there is also underuse of available services in urban areas. Interventions should target mothers with less education and wealth and older mothers. Expanding prenatal care among these groups would encourage a better use of available facilities and subsequently better care for their children. PMID:26560469

[Factors contributing to endemic cholera in Douala, Cameroon].

PubMed

Guévart, E; Noeske, J; Solle, J; Essomba, J M; Edjenguele, Mbonji; Bita, A; Mouangue, A; Manga, B

2006-06-01

Cholera has been endemic in Douala, Cameroon since 1971. A number of environmental factors favourize the survival of the Vibrio in Douala including location at the mouth of Wouri delta on the Atlantic Ocean, sandy clay soil, shallow dirty polluted foul-smelling groundwater, presence of vast expanses of swamp, streams/drainage ditches infested with algae, and high temperatures with low rainfall and drought during certain periods of the year. Most outbreaks have started in Bepanda, a slum area built on a garbage dump in a swampy zone fed by drainage ditches carrying the faecal pollution from neighbouring upstream districts. It is a densely overcrowded area of uncontrolled urbanization generated by the influx of poor city new-comers who live without adequate access to clean water or basic sanitary facilities. The most affected areas are those resulting from recent unregulated urban sprawl in polluted swamp zones or garbage dumps. Since access to the public water system is inadequate with only 65000 persons connected for 3 million inhabitants, dwellers in most areas must take water from the 70000 urban wells (estimated in 2004) that are often not more than 1.5 m deep. Sewage facilities are insufficient to provide complete evacuation of solid and liquid waste. The network of rivers, streams and man-made ditches waste are poorly maintained and often overflow during the rainy season. The contents of latrines are often discharged directly into the environment. Social factors such as the reformation of urban tribes and persistence of traditional attitudes toward waste disposal and water use have not only led to high-risk behaviour but also created barriers to sanitation and hygiene education. With an inadequate sanitation inspection system, a large but purely accessible public health system and a highly disorganized private health sector exists, effective preventive measures are difficult to implement. The combination of these factors probably account for the endemicity of cholera in Douala.

Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey.

PubMed

Astale, Tigist; Chenault, Michelene

2015-01-01

Acute respiratory infection is a major contributor to morbidity and mortality among children under five years of age in Ethiopia. While facilities have been implemented to address this problem they are underused due to a lack in help-seeking behavior. This study investigates factors related to the help-seeking behavior of mothers for children with acute respiratory infection using data from the 2011 Ethiopia Demographic and Health Survey. Data on 11,030 children aged 0-59 months obtained through interviewing women aged 15-49 years throughout Ethiopia was available. Descriptive statistics and logistic regression analyses were performed to determine which factors are related to help-seeking behavior for acute respiratory infection. In the two weeks prior to the survey, 773(7%) of the children were reported to have symptoms of acute respiratory infection while treatment was sought for only 209 (27.2%). The odds ratio for acute respiratory infection was 1.6 (95% CI: 1.2-2.0) for rural residence with only 25.2% of these mothers seeking help compared to 46.4% for mothers with an urban residence. Smaller family size, younger mothers' age and having had prenatal care had a statistically significant odds ratio greater than 1 for both urban and rural residences. Highest wealth index had a statistically significant odds ratio greater than 1 for rural residence only, whereas primary education or higher had a statistically significant odds ratio greater than 1 for urban residence. Children from rural areas are more at risk for acute respiratory infection while their mothers are less likely to seek help. Nevertheless, there is also underuse of available services in urban areas. Interventions should target mothers with less education and wealth and older mothers. Expanding prenatal care among these groups would encourage a better use of available facilities and subsequently better care for their children.

Breast cancer stage at diagnosis and geographic access to mammography screening (New Hampshire, 1998-2004).

PubMed

Celaya, Maria O; Berke, Ethan M; Onega, Tracy L; Gui, Jiang; Riddle, Bruce L; Cherala, Sai S; Rees, Judy R

2010-01-01

Early detection of breast cancer by screening mammography aims to increase treatment options and decrease mortality. Recent studies have shown inconsistent results in their investigations of the possible association between travel distance to mammography and stage of breast cancer at diagnosis. The purpose of the study was to investigate whether geographic access to mammography screening is associated with the stage at breast cancer diagnosis. Using the state's population-based cancer registry, all female residents of New Hampshire aged > or =40 years who were diagnosed with breast cancer during 1998-2004 were identified. The factors associated with early stage (stages 0 to 2) or later stage (stages 3 and 4) diagnosis of breast cancer were compared, with emphasis on the distance a woman lived from the closest mammography screening facility, and residence in rural and urban locations. A total of 5966 New Hampshire women were diagnosed with breast cancer during 1998-2004. Their mean driving distance to the nearest mammography facility was 8.85 km (range 0-44.26; 5.5 miles, range 0-27.5), with a mean estimated travel time of 8.9 min (range 0.0-42.2). The distribution of travel distance (and travel time) was substantially skewed to the right: 56% of patients lived within 8 km (5 miles) of a mammography facility, and 65% had a travel time of less than 10 min. There was no significant association between later stage of breast cancer and travel time to the nearest mammography facility. Using 3 categories of rural/urban residence based on Rural Urban Commuting Area classification, no significant association between rural residence and stage of diagnosis was found. New Hampshire women were more likely to be diagnosed with breast cancer at later stages if they lacked private health insurance (p<0.001), were not married (p<0.001), were older (p<0.001), and there was a borderline association with diagnosis during non-winter months (p=0.074). Most women living in New Hampshire have good geographical access to mammography, and no indication was found that travel time or travel distance to mammography significantly affected stage at breast cancer diagnosis. Health insurance, age and marital status were the major factors associated with later stage breast cancer. The study contributes to an ongoing debate over geographic access to screening mammography in different states, which have given contradictory results. These inconsistencies in the rural health literature highlight a need to understand the complexity of defining rural and urban residence; to characterize more precisely the issues that contribute to good preventive care in different rural communities; and to appreciate the efforts already made in some rural states to provide good geographic access to preventive care. In New Hampshire, specific subgroups such as the uninsured and the elderly remain at greatest risk of being diagnosed with later stage breast cancer and may benefit from targeted interventions to improve early detection.

International variation in neighborhood walkability, transit, and recreation environments using geographic information systems: the IPEN adult study.

PubMed

Adams, Marc A; Frank, Lawrence D; Schipperijn, Jasper; Smith, Graham; Chapman, James; Christiansen, Lars B; Coffee, Neil; Salvo, Deborah; du Toit, Lorinne; Dygrýn, Jan; Hino, Adriano Akira Ferreira; Lai, Poh-chin; Mavoa, Suzanne; Pinzón, José David; Van de Weghe, Nico; Cerin, Ester; Davey, Rachel; Macfarlane, Duncan; Owen, Neville; Sallis, James F

2014-10-25

The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions. The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant's residential address using 1-km and 500-m street network buffers. Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability. Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals' physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose-response relationships from projected changes to the built environment that would otherwise be impossible.

Connecting Primary Health Care: A Comprehensive Pilot Study.

PubMed

Maghsoudloo, Mehran; Abolhassani, Farid; Lotfibakhshaiesh, Nasrin

2016-07-01

The collection of data within the primary health care facilities in Iran is essentially paper-based. It is focused on family's health, monitoring of non-infectious and infectious diseases. Clearly due to the paper-based nature of the tasks, timely decision making at most can be difficult if not impossible. As part of an on-going electronic health record implementation project at Tehran University of Medical Sciences, for the first time in the region, based on a comprehensive pilot project, four urban healthcare facilities are connected to their headquarters and beyond, covering all aspects of primary health care, for the last four years. Without delving into the technical aspects of its software engineering processes, the progress of the implementation is reported, selection of summarized data is presented, and experience gained thus far are discussed. Four years passed and if time is any important reason to go by, then it is safe to accept that the software architecture and electronic health record structural model implemented are robust and yet extensible. Aims and duration of a pilot study should be clearly defined prior to start and managed till its completion. Resistance to change and particularly to information technology, apart from its technical aspects, is also based on human factors.

Water and health.

PubMed

Guidotti, T L; Conway, J B

1984-10-01

The systems protecting the quality of drinking water in the United States are deteriorating. Many urban water and sewer systems are obsolete. Industrial wastes are imposing a burden on wastewater treatment facilities. In the U.S., outbreaks of water-borne disease are primarily limited to enteritis associated with viruses or Giardia. Issues in the contamination of drinking water by toxic substances include disposal practices, accidental contamination, agricultural runoff and chlorination byproducts. Physicians must support stringent enforcement of water quality standards.

Settlement preferences in the disaster-prone areas of Brantas River

NASA Astrophysics Data System (ADS)

Hariyani, S.

2018-01-01

Kota Lama is one of the urban villages in Malang city that has settlements along the Brantas River. Kota Lama experienced three landslides and flooding in 2015 and one in 2016. Those disasters caused the community to take action of post-disaster recovery, yet the people still choose to remain living in Kota Lama. Therefore, the study aims at determining the preferences of the citizens living in disaster-prone areas in Brantas River. The research used a factor analysis of 12 variables: 1) neighbourhood situation, 2) air condition, 3) relations between neighbours, 4) security, 5) location, 6) customs, 7) ethnic diversity, 8) the presence of social groups, 9) the community’s customs and habits, 10) proximity to the economic facilities, 11) adequate educational facilities, and 12) adequate medical/health facilities. The results show that two factors have been formed, namely Factor 1 (access) comprising variables of neighbourhood situation, air condition, relations between neighbours, location, ethnic diversity, the presence of a social group, supporting positive habits at home, close to the economic facilities, educational facilities, as well as medical facilities, and Factor 2 (assurance) consisting of customs and security.

Consequences of hypertension and chronic obstructive pulmonary disease, healthcare-seeking behaviors of patients, and responses of the health system: a population-based cross-sectional study in Bangladesh.

PubMed

Uddin, Md Jasim; Alam, Nurul; Koehlmoos, Tracey P; Sarma, Haribondhu; Chowdhury, Muhammad Ashique Haider; Alam, Dewan S; Niessen, Louis

2014-06-03

Non-communicable diseases are a threat to human health and economic development of low-income countries. Hypertension (HT) and chronic obstructive pulmonary disease (COPD) are two major causes of deaths, worldwide. This study assesses the health status, health-care seeking, and health provider responses among patients with these conditions. The study carried out population-based cross-sectional survey in a rural and an urban surveillance area in Bangladesh. It interviewed all patients identified with HT and COPD at home using a structured questionnaire on the health consequences, healthcare-seeking behaviours, and coping strategies. Qualitative techniques identified key factors relating to the behaviours of patients and providers. COPD and HT correlate with lower activities of daily living (ADL) scores. The odds ratio (OR) for ADL scores in the combied conditions are high (OR: 3.04, p < 0.05) as compared to hypertension. Financial crises occur significantly more frequently among COPD patients in the urban site as compared to those in rural ares (12.5% vs. 2.4%, p < 0.01). Self-treatment at the onset is common. Seeking care from trained providers is higher in urban settings and is higher for HT. Referral for both COPD and hypertension was inadequate until the disease severity increased. COPD and HT significantly are associated with lower ADL scores and financial problems. Public-sector primary healthcare facilities should be better organised to address both conditions with the aim to reduce household poverty.

Knowledge and provision practices regarding medical abortion among public providers in Hanoi, Khanh Hoa, and Ho Chi Minh City, Vietnam.

PubMed

Ngo, Thoai D; Free, Caroline; Le, Hoan T; Edwards, Phil; Pham, Kiet H T; Nguyen, Yen B T; Nguyen, Thang H

2014-03-01

To assess public service providers' knowledge of medical abortion (MA) and practices, and perspectives on expanding the use of MA to primary and secondary health facilities in Vietnam. A cross-sectional study was conducted via an interviewer-administered questionnaire among abortion providers (n=905) from public health facilities between August 2011 and January 2012. Overall, 31.1% of providers performed both surgical and medical abortions; 68.9% offered only surgical abortion. Providers were knowledgeable about the regimen/dosage of mifepristone plus misoprostol regimen; however, knowledge scores were low for gestational age limits for MA, adverse effects of the combined drug regimen, and safety and effectiveness of MA compared with surgical abortion. Knowledge scores were significantly lower among providers in rural areas than among those in urban settings. A large proportion of providers (82.9%) thought that MA should be expanded to primary and secondary health facilities. Perceived barriers to MA expansion included lack of knowledge and training, qualified staff, adequate drug supplies, equipment, or facilities, guidelines and protocols on MA, and patient awareness. Provision of MA in Vietnam was found to be disproportionate to surgical abortion provision and to vary by region. Knowledge of MA was moderate, but poorer among providers in rural settings. Copyright © 2013 International Federation of Gynecology and Obstetrics. All rights reserved.

Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study.

PubMed

Kyaddondo, David; Mugerwa, Kidza; Byamugisha, Josaphat; Oladapo, Olufemi T; Bohren, Meghan A

2017-12-01

To describe the experiences, expectations, and needs of urban Ugandan women in relation to good-quality facility childbirth. Women who had given birth in the 12 months prior to the study were purposively sampled and interviewed, or included in focus groups. Thematic analysis was used, and the data were interpreted within the context of an existing quality of care framework. Forty-five in-depth interviews and six focus group discussions were conducted. Respect and dignity, timely communication, competent skilled staff, and availability of medical supplies were central to women's accounts of quality care, or a lack of it. The hope for a live baby motivated women to seek facility-based childbirth. They expected to encounter competent, respectful, and caring staff with appropriate skills. In some cases, they could only fulfill these expectations through additional personal financial payments to staff, for clinical supplies, or to guarantee that they would be attended by someone with suitable skills. Long-term improvement in quality of maternity care in Uganda requires enhancement of the interaction between women and health staff in facilities, and investment in staff and resources to ensure that safe, respectful care is not dependent on willingness and/or capacity to pay. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Reconsidering access: park facilities and neighborhood disamenities in New York City.

PubMed

Weiss, Christopher C; Purciel, Marnie; Bader, Michael; Quinn, James W; Lovasi, Gina; Neckerman, Kathryn M; Rundle, Andrew G

2011-04-01

With increasing concern about rising rates of obesity, public health researchers have begun to examine the availability of parks and other spaces for physical activity, particularly in cities, to assess whether access to parks reduces the risk of obesity. Much of the research in this field has shown that proximity to parks may support increased physical activity in urban environments; however, as yet, there has been limited consideration of environmental impediments or disamenities that might influence individuals' perceptions or usage of public recreation opportunities. Prior research suggests that neighborhood disamenities, for instance crime, pedestrian safety, and noxious land uses, might dissuade people from using parks or recreational facilities and vary by neighborhood composition. Motivated by such research, this study estimates the relationship between neighborhood compositional characteristics and measures of park facilities, controlling for variation in neighborhood disamenities, using geographic information systems (GIS) data for New York City parks and employing both kernel density estimation and distance measures. The central finding is that attention to neighborhood disamenities can appreciably alter the relationship between neighborhood composition and spatial access to parks. Policy efforts to enhance the recreational opportunities in urban areas should expand beyond a focus on availability to consider also the hazards and disincentives that may influence park usage.

Email consultations in general practice.

PubMed

Neville, Ron G; Marsden, Wendy; McCowan, Colin; Pagliari, Claudia; Mullen, Helen; Fannin, Allison

2004-01-01

Email is an established method of communication in business, leisure and education but not yet health care. To evaluate an email service enabling communication between patients and their general practice regarding repeat prescriptions, appointment booking and clinical enquiries. Qualitative analysis of interactions and an electronic user survey. An urban practice in Dundee, Scotland. 150 patients aged 24 to 85. We set up a practice facility to allow our patients to use email to book appointments, order repeat prescriptions and consult their general practitioner (GP). Patient satisfaction with the service was very high. Patients specifically commended the practice for setting up a facility to allow communication outside standard working hours and for the ease of ordering repeat prescriptions. Patients were pleased to have a means of seeking their doctor's comment or opinion without bothering him or her by making and attending a formal face-to-face consultation. Email dialogue was polite, factual, but less formal than standard letters. Staff did not experience any perceptible rise in workload. Use of an email consultation facility worked well within an urban practice, was deemed helpful by patients, and resulted in no apparent increase in GP workload. Our results suggest that there may be an unmet need amongst patients for clinical email services, and that such services may have positive outcomes for patients and practices.

Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011

PubMed Central

2014-01-01

Background Postnatal care is essential to save the life of the mother and newborn. Knowledge on the determinants of postnatal care assists the policy makers to design, justify and implement appropriate interventions. The current study aimed to analyse the factors associated with utilisation of postnatal care services by mothers in Nepal based on the data from Nepal Demographic and Health Survey (NDHS) 2011. Methods This study utilised the data from NDHS 2011. The association between utilisation of at least one postnatal care visit (within 6 weeks of delivery) and immediate postnatal care (within 24 hours of delivery) with selected factors was examined by using Chi-square test (χ2), followed by multiple logistic regression. Result Of the 4079 mothers, 43.2% reported attending postnatal care within the first six weeks of birth, while 40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families, who were educated, whose partners were educated, who delivered in a health facility, who had attended a four or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report attending at least one postnatal care visit. On the other hand, mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the urban areas, from rich families, who were educated, whose partners were educated, who had attended four or more antenatal visits, who delivered in a health facility and had delivered in the presence of a skilled birth attendant were more likely to report attending immediate postnatal care. Mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to attend immediate postnatal care. Conclusion The majority of postnatal mothers in Nepal did not seek postnatal care. Increasing utilisation of the recommended four or more antenatal visits, delivery at health facility and increasing awareness and access to services through community-based programs especially for the rural, poor, and less educated mothers may increase postnatal care attendance in Nepal. PMID:24484933

Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya.

PubMed

Bellows, Ben; Kyobutungi, Catherine; Mutua, Martin Kavao; Warren, Charlotte; Ezeh, Alex

2013-03-01

To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements. Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08. Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother's place of delivery, NUHDSS-MCH recorded the use of the voucher. There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme. A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations.

Still too far to walk: literature review of the determinants of delivery service use.

PubMed

Gabrysch, Sabine; Campbell, Oona M R

2009-08-11

Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.

Factors associated with institutional delivery service utilization in Ethiopia.

PubMed

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government's efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel-Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I (2) test. People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women's autonomy was not significantly associated with institutional delivery service utilization. Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.

Factors associated with institutional delivery service utilization in Ethiopia

PubMed Central

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended. PMID:27672342

24 CFR 585.204 - Locational considerations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES YOUTHBUILD PROGRAM Youthbuild Planning Grants § 585.204... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Locational considerations. 585.204 Section 585.204 Housing and Urban Development Regulations Relating to Housing and Urban Development...

24 CFR 585.204 - Locational considerations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES YOUTHBUILD PROGRAM Youthbuild Planning Grants § 585.204... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Locational considerations. 585.204 Section 585.204 Housing and Urban Development Regulations Relating to Housing and Urban Development...

24 CFR 598.1 - Applicability and scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS General... the second and third rounds of designations of urban Empowerment Zones, authorized under Subchapter U... contains provisions relating to area requirements, the nomination process for urban Empowerment Zones, and...

24 CFR 598.1 - Applicability and scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS General... the second and third rounds of designations of urban Empowerment Zones, authorized under Subchapter U... contains provisions relating to area requirements, the nomination process for urban Empowerment Zones, and...

24 CFR 598.2 - Objective and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS General... Empowerment Zones in urban areas, to stimulate the creation of new jobs—empowering low-income persons and...

Rural versus urban academic hospital mortality following stroke in Canada.

PubMed

Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

2018-01-01

Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

Proportion and factors associated with depressive symptoms among elderly in an urban slum in Bangalore.

PubMed

Thirthahalli, Chethana; Suryanarayana, S P; Sukumar, Gautham Melur; Bharath, Srikala; Rao, Girish N; Murthy, Nandagudi Srinivasa

2014-12-01

Depression among elderly is emerging as an important public health issue in developing countries like India. Published evidence regarding the magnitude and determinants of depression among elderly hailing from urban slum is currently limited. Hence, the current study was conducted to assess magnitude of the problem and identify factors associated with depression among the elderly in an urban slum. A cross-sectional study was done to cover total of 473 elderly persons from an urban slum in Bangalore, India. They were assessed for depression using Center for Epidemiologic Studies Depression scale. The overall prevalence of depression was found to be 37.8 (95% CI = 33.43-42.16). Multivariate analysis revealed that unemployment (self or children) (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.41-4.72), illness of self (OR 2.2; 95% CI 1.45-3.21), female gender (OR 1.9; 95% CI 1.19-2.89), conflicts in family (OR 1.6; 95% CI 1.03-2.43), and marriage of children or grandchildren (OR 1.6; 95% CI 1.02-2.68) as independent risk factors. Depression among elderly is an important health issue of this area. Psychological intervention need to be provided for all elderly persons especially at the time of being diagnosed with any kind of illness. Strategies should be targeted to the females. The stressful life events need to be identified and remedial actions taken. This facility should be made available to them at the primary level of health care. There is a need to include screening of depression in our national health programs.

Achievements and future path of Tehran municipality in urban health domain: An Iranian experience

PubMed Central

Damari, Behzad; Riazi-Isfahani, Sahand

2016-01-01

Background: According to national laws and world experiences; provision, maintenance, and improving citizens’ health are considered to be the essential functions of municipalities as a "social institute". In order to equitably promote health conditions at urban level, particularly in marginal areas, since 2004 targeted efforts have been implemented in the municipality of Tehran metropolis. This study was intended to identify and analyze these targeted measures and tries to analyze health interventions in a conceptual framework and propose a future path. Methods: This is a qualitative study with content analysis approach. Reviewing documents and structured interviews with national health policy making and planning experts and executive managers of 22-region municipalities of Tehran metropolis were used to collect data. The data were analyzed on the basis of conceptual framework prepared for urban health in 4 domains including municipal interventions, goal achievements, drivers and obstacles of success, and the way forward. Results: From the viewpoint of interviewees, these new health actions of Tehran municipality are more based on public participation and the municipality was able to prioritize health issue in the programs and policies of Tehran city council. Tehran municipality has accomplished three types of interventions to improve health, which in orders of magnitude are: facilitative, promotional, and mandatory interventions. Development and institutionalization of public participation is the greatest achievement in health-oriented actions; and expansion of environmental and physical health-oriented facilities and promoting a healthy lifestyle are next in ranks. Conclusion: Since management alterations seriously challenges institutionalization of actions and innovations especially in the developing countries, it is suggested that mayors of metropolitan cities like Tehran document and review municipal health measures as soon as possible and while eliminating overlapping of interventions with other sectors, design and approve the charter of "health promoting municipality". The most important role of municipalities in this charter would be coordinating health improvement of citizens. This charter, when approved as a national policy could be used for other cities too. PMID:27390693

A comparison of financial performance, organizational characteristics and management strategy among rural and urban nursing facilities.

PubMed

Smith, H L; Piland, N F; Fisher, N

1992-01-01

Despite efforts to deinstitutionalize long-term care, it is estimated that 43 percent of the elderly will use a nursing facility at some point. Whether sufficient nursing facility services will be available to rural elderly is debatable due to cutbacks in governmental expenditures and recent financial losses among nursing facilities. This paper explores the challenges confronting rural nursing facilities in maintaining their viability and strategies that might be considered to improve their longevity. A comparative analysis of 18 urban and 34 rural nursing facilities in New Mexico is used in identifying promising strategic adaptations available to rural facilities. Among other considerations, rural facilities should strive to enhance revenue streams, implement strict cost control measures, emphasize broader promotional tactics, and diversify services commensurate with the constraints of the communities and populations served.

Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review

PubMed Central

2016-01-01

Introduction The Revised National Tuberculosis Control Programme’s (RNTCP) passive case finding approach strongly influence the health seeking behaviour of patients and the timing of health seeking as well. Aim A systematic review was carried out to understand the health seeking behaviour, related delays and the knowledge and attitude regarding Tuberculosis (TB) and the health services linked with it. Materials and Methods A manual search strategy was adopted using PUBMED and Google Scholar search engines to obtain research papers in the said subject. Of 113 articles obtained by the end of this search process 10 full text articles were finally selected for the purpose of this review. Results Of the 10 studies identified, the results were delineated in 7 thematic areas such as: (1) Knowledge and perception of TB patients regarding TB and health services for TB; (2) Delays in seeking help; (3) Facility based health seeking behaviour; (4) Reasons for not seeking care/Delay in seeking care; (5) Geographical pattern (Rural-Urban) of health seeking; (6) Socio-cultural factors associated with health seeking; and (7) Gender based health seeking behaviour. Conclusion Health seeking behaviour and related delays are of utmost importance in TB care from two important perspectives; firstly TB requires timely treatment and secondly it requires protracted treatment. Required level of knowledge and positive health behaviour helps the patients in taking timely help from appropriate health facility. PMID:27891362

Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review.

PubMed

Samal, Janmejaya

2016-10-01

The Revised National Tuberculosis Control Programme's (RNTCP) passive case finding approach strongly influence the health seeking behaviour of patients and the timing of health seeking as well. A systematic review was carried out to understand the health seeking behaviour, related delays and the knowledge and attitude regarding Tuberculosis (TB) and the health services linked with it. A manual search strategy was adopted using PUBMED and Google Scholar search engines to obtain research papers in the said subject. Of 113 articles obtained by the end of this search process 10 full text articles were finally selected for the purpose of this review. Of the 10 studies identified, the results were delineated in 7 thematic areas such as: (1) Knowledge and perception of TB patients regarding TB and health services for TB; (2) Delays in seeking help; (3) Facility based health seeking behaviour; (4) Reasons for not seeking care/Delay in seeking care; (5) Geographical pattern (Rural-Urban) of health seeking; (6) Socio-cultural factors associated with health seeking; and (7) Gender based health seeking behaviour. Health seeking behaviour and related delays are of utmost importance in TB care from two important perspectives; firstly TB requires timely treatment and secondly it requires protracted treatment. Required level of knowledge and positive health behaviour helps the patients in taking timely help from appropriate health facility.

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy.

PubMed

Ngo, Anh D; Hill, Peter S

2011-05-01

This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011-2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Empowering low-income community in Kampong settlement by exploring people's activities in surrounding environment

NASA Astrophysics Data System (ADS)

Bawole, Paulus; Sutanto, Haryati B.

2017-11-01

Urban Kampong is a spontaneous settlement growing in several big cities within developing countries including Indonesia. This settlement is developed by low-income people without any plan. Therefore there is no specific housing pattern in the settlement. The characteristics of the settlements is dominated by Javanese traditional roof typology and narrow path with minimal public open spaces. People's creativity in building their houses often uses second hand building materials that make their houses look specific. Besides, infrastructure facilities within Kampong Settlement are very poor. Because the poor living in Urban Kampong have to adjust their live with minimum infrastructure facilities available, they have to be creative in using all facilities available. Through the creativities of low-income people living in Urban Kampong the research will show how the inhabitants can be empowered by exploring inhabitant's creativities and consequently the environmental quality within Urban Kampong can be improved as well.

24 CFR 585.307 - Environmental procedures and standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Environmental procedures and standards. 585.307 Section 585.307 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES YOUTHBUILD PROGRAM Youthbuild Implementation Grants...

24 CFR 585.307 - Environmental procedures and standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Environmental procedures and standards. 585.307 Section 585.307 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES YOUTHBUILD PROGRAM Youthbuild Implementation Grants...

24 CFR 585.307 - Environmental procedures and standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Environmental procedures and standards. 585.307 Section 585.307 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES YOUTHBUILD PROGRAM Youthbuild Implementation Grants...

24 CFR 597.4 - Secretarial review and designation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES... § 597.200(c). (b) Period of designation. The designation of an urban area as an Empowerment Zone or...

24 CFR 597.4 - Secretarial review and designation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES... § 597.200(c). (b) Period of designation. The designation of an urban area as an Empowerment Zone or...

24 CFR 597.4 - Secretarial review and designation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES... § 597.200(c). (b) Period of designation. The designation of an urban area as an Empowerment Zone or...

24 CFR 598.105 - Data used for eligibility determinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE... boundaries. The boundary of an urban area nominated for designation as an Empowerment Zone must coincide with...

24 CFR 598.4 - Period of designation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS General Provisions § 598.4 Period of designation. The designation of an urban area as an Empowerment Zone will remain...

24 CFR 597.4 - Secretarial review and designation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES... § 597.200(c). (b) Period of designation. The designation of an urban area as an Empowerment Zone or...

24 CFR 598.105 - Data used for eligibility determinations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE... boundaries. The boundary of an urban area nominated for designation as an Empowerment Zone must coincide with...

Portfolio of Outpatients Attending Centre for Urban Health, Madhya Pradesh, Central India.

PubMed

Gupta, Arti; Reddy, B Venkatashiva; Nagar, Mukesh Kumar; Chandel, Ajeet; Bali, Surya

2015-01-01

Knowledge on distribution and burden of diseases in a community is essential for planning of public health services. In the absence of information on morbidity profile through community-based surveys, facility-based data provide a good alternative. The aim of this study was to describe the morbidity profile of patients attending the Centre for Urban Health All India Institute of Medical Sciences (AIIMS) Bhopal (CUHA). A record-based descriptive study was carried out in the CUHA Bhopal, Madhya Pradesh, Central India. Information on age, gender, residence, new case, and principal diagnosis were extracted from the outpatient registers for the period between January 2014 and December 2014. Only newly registered patients for the study year (2014) were included. Descriptive analysis was done. A total of 6685 new episodes of illnesses were treated. Adults (>15 years) constituted about 85.0%. Overall, the respiratory disorders were the most common (27.2%) followed by the digestive disorders (10.9%), circulatory disorders (9.9%), musculoskeletal disorders (8.8%), and infectious and parasitic disorders (7.4%). This study gives a brief description of the morbidity profile of patients attending a primary health care center over a period of 1 year. This knowledge would help in planning health services to meet the patients' needs and help in training health staff.

Functional independence of residents in urban and rural long-term care facilities in Taiwan.

PubMed

Lin, Kwan-Hwa; Wu, Shiao-Chi; Hsiung, Chia-Ling; Hu, Ming-Hsia; Hsieh, Ching-Lin; Lin, Jau-Hong; Kuo, Mei-Ying

2004-02-04

To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan. A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score. (1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76). Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo.

PubMed

Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

2013-01-01

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored.

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years.

PubMed

Santas, Fatih; Celik, Yusuf; Eryurt, Mehmet Ali

2018-01-01

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth. Copyright © 2017 John Wiley & Sons, Ltd.

Urban sprawl and flooding in southern California

USGS Publications Warehouse

Rantz, S.E.

1970-01-01

The floods of January 1969 in south-coastal California provide a timely example of the effect of urban sprawl on flood damage. Despite recordbreaking, or near recordbreaking, stream discharges, damage was minimal in the older developed areas that are protected against inundation and debris damage by carefully planned flood-control facilities, including debris basins and flood-conveyance channels. By contrast, heavy damage occurred in areas of more recent urban sprawl, where the hazards of inundation and debris or landslide damage have not been taken into consideration, and where the improvement and development of drainage or flood-control facilities have not kept pace with expanding urbanization.

24 CFR 597.403 - Revocation of designation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... Secretary may revoke the designation of an urban area as an Empowerment Zone or Enterprise Community if the... the designation of an urban area as an Empowerment Zone or Enterprise Community, the Secretary will...

24 CFR 597.403 - Revocation of designation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... Secretary may revoke the designation of an urban area as an Empowerment Zone or Enterprise Community if the... the designation of an urban area as an Empowerment Zone or Enterprise Community, the Secretary will...

24 CFR 597.403 - Revocation of designation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... Secretary may revoke the designation of an urban area as an Empowerment Zone or Enterprise Community if the... the designation of an urban area as an Empowerment Zone or Enterprise Community, the Secretary will...

24 CFR 597.403 - Revocation of designation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... Secretary may revoke the designation of an urban area as an Empowerment Zone or Enterprise Community if the... the designation of an urban area as an Empowerment Zone or Enterprise Community, the Secretary will...

Beyond urban penalty and urban sprawl: back to living conditions as the focus of urban health.

PubMed

Freudenberg, Nicholas; Galea, Sandro; Vlahov, David

2005-02-01

Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.

Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations.

PubMed

Alghanim, Saad Abdullah

2010-01-01

The study was set to determine whether knowledge and attitudes toward organ donation differ according to geographical location. Self-administered questionnaires were employed to collect data such as demographic characteristics, basic knowledge, attitudes and source of information about organ donation from subjects in rural and urban areas. The questionnaires were distributed randomly to 1,000 individuals in both areas during 2008. The data were analyzed in a descriptive fashion. Despite similarities in knowledge and attitudes of respondents in both areas, rural respondents were less likely to have information about organ donation, to report willingness to donate organs, and to have knowledge about "brain death" or the "organ donation card" than their counterparts in urban areas. The study identified that the principle respondents' source of information about organ donation was the television. More than 90% of respondents in rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ donation and transplantation was "none" or "little". Respondents identified several reasons, which may influence their decisions to donate organs. In conclusion, the deficit in knowledge and attitudes of rural respondents about organ donation may be justified by the lack of information about this significant issue. Accordingly, health facilities, local mass media and educational institutions should provide intensive educational programs to encourage the public donate organs.

Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.

PubMed

Tam, Yvonne; Huicho, Luis; Huayanay-Espinoza, Carlos A; Restrepo-Méndez, María Clara

2016-10-04

Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence. Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

Physical Exposure to Seismic Hazards of Health Facilities in Mexico City, Mexico

NASA Astrophysics Data System (ADS)

Rodriguez, S. M.; Novelo Casanova, D.

2010-12-01

Although health facilities are essential infrastructure during disasters and emergencies, they are also usually highly vulnerable installations in the case of the occurrence of large and major earthquakes. Hospitals are one of the most complex critical facilities in modern cities and they are used as first response in emergency situations. The operability of a hospital must be maintained after the occurrence of a local strong earthquake in order to satisfy the need for medical care of the affected population. If a health facility is seriously damaged, it cannot fulfill its function when most is needed. In this case, hospitals become a casualty of the disaster. To identify the level of physical exposure of hospitals to seismic hazards in Mexico City, we analyzed their geographic location with respect to the seismic response of the different type of soils of the city from past earthquakes, mainly from the events that occurred on September 1985 (Ms= 8.0) and April 1989 (Ms= 6.9). Seismic wave amplification in this city is the result of the interaction of the incoming seismic waves with the soft and water saturated clay soils, on which a large part of Mexico City is built. The clay soils are remnants of the lake that existed in the Valley of Mexico and which has been drained gradually to accommodate the growing urban sprawl. Hospital facilities were converted from a simple database of names and locations into a map layer of resources. This resource layer was combined with other map layers showing areas of seismic microzonation in Mexico City. This overlay was then used to identify those hospitals that may be threatened by the occurrence of a large or major seismic event. We analyzed the public and private hospitals considered as main health facilities. Our results indicate that more than 50% of the hospitals are highly exposed to seismic hazards. Besides, in most of these health facilities we identified the lack of preventive measures and preparedness to reduce their vulnerability. For proper interpretation, our results are also presented in a Geographical Information System (GIS) that provides elements to support government plans to mitigate the impact of future earthquakes.

Spatial Analysis of the Level of Exposure to Seismic Hazards of Health Facilities in Mexico City, Mexico

NASA Astrophysics Data System (ADS)

Moran, S.; Novelo-Casanova, D. A.

2011-12-01

Although health facilities are essential infrastructure during disasters and emergencies, they are also usually highly vulnerable installations in the case of the occurrence of large and major earthquakes. Hospitals are one of the most complex critical facilities in modern cities and they are used as first response in emergency situations. The operability of a hospital must be maintained after the occurrence of a local strong earthquake in order to satisfy the need for medical care of the affected population. If a health facility is seriously damaged, it cannot fulfill its function when most is needed. In this case, hospitals become a casualty of the disaster. To identify the level of physical exposure of hospitals to seismic hazards in Mexico City, we analyzed their geographic location with respect to the seismic response of the different type of soils of the city from past earthquakes, mainly from the events that occurred on September 1985 (Ms= 8.0) and April 1989 (Ms= 6.9). Seismic wave amplification in this city is the result of the interaction of the incoming seismic waves with the soft and water saturated clay soils, on which a large part of Mexico City is built. The clay soils are remnants of the lake that existed in the Valley of Mexico and which has been drained gradually to accommodate the growing urban sprawl. Hospital facilities were converted from a simple database of names and locations into a map layer of resources. This resource layer was combined with other map layers showing areas of seismic microzonation in Mexico City. This overlay was then used to identify those hospitals that may be threatened by the occurrence of a large or major seismic event. We analyzed the public and private hospitals considered as main health facilities. Our results indicate that more than 50% of the hospitals are highly exposed to seismic hazards. Besides, in most of these health facilities we identified the lack of preventive measures and preparedness to reduce their vulnerability. For proper interpretation, our results are also presented in a Geographical Information System (GIS) that provides elements to support government plans to mitigate the impact of future earthquakes.

Urban lymphatic filariasis.

PubMed

Simonsen, Paul E; Mwakitalu, Mbutolwe E

2013-01-01

Lymphatic filariasis (LF) is a disabling and disfiguring disease resulting from a mosquito-borne parasitic infection. It is a major public health problem in many countries with a warm climate. Research and control activities have mainly focused on LF in rural areas where it also has its major impact. However, with rapid and unplanned growth of cities in the developing world, there is a need also to consider LF transmission and control in urban settings. Here, we review currently available knowledge on urban LF and the environmental and socio-economic basis for its occurrence. Among the three parasite species causing LF in humans, only Wuchereria bancrofti has been documented to have a significant potential for urban transmission. This is primarily because one of its vectors, Culex quinquefasciatus, thrives and proliferates excessively in crowded city areas with poor sanitary, sewerage and drainage facilities. For this reason, urban LF also often shows a marked focality in distribution, with most cases clustered in areas inhabited by the less privileged city populations. More knowledge on urban LF is needed, in particular on its socio-economic and human behavioural context, on the potential for transmission in regions where other LF vector species predominate, and on rapid methods for identification and mapping of risk areas, to provide a strong evidence base for its control.

Integrating Urban Infrastructure and Health System Impact Modeling for Disasters and Mass-Casualty Events

NASA Astrophysics Data System (ADS)

Balbus, J. M.; Kirsch, T.; Mitrani-Reiser, J.

2017-12-01

Over recent decades, natural disasters and mass-casualty events in United States have repeatedly revealed the serious consequences of health care facility vulnerability and the subsequent ability to deliver care for the affected people. Advances in predictive modeling and vulnerability assessment for health care facility failure, integrated infrastructure, and extreme weather events have now enabled a more rigorous scientific approach to evaluating health care system vulnerability and assessing impacts of natural and human disasters as well as the value of specific interventions. Concurrent advances in computing capacity also allow, for the first time, full integration of these multiple individual models, along with the modeling of population behaviors and mass casualty responses during a disaster. A team of federal and academic investigators led by the National Center for Disaster Medicine and Public Health (NCDMPH) is develoing a platform for integrating extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, health care facility-specific vulnerability and failure assessments, and health system/patient flow responses. The integration of these models is intended to develop much greater understanding of critical tipping points in the vulnerability of health systems during natural and human disasters and build an evidence base for specific interventions. Development of such a modeling platform will greatly facilitate the assessment of potential concurrent or sequential catastrophic events, such as a terrorism act following a severe heat wave or hurricane. This presentation will highlight the development of this modeling platform as well as applications not just for the US health system, but also for international science-based disaster risk reduction efforts, such as the Sendai Framework and the WHO SMART hospital project.

A case study of potential human health impacts from petroleum coke transfer facilities.

PubMed

Dourson, Michael L; Chinkin, Lyle R; MacIntosh, David L; Finn, Jennifer A; Brown, Kathleen W; Reid, Stephen B; Martinez, Jeanelle M

2016-11-01

Petroleum coke or "petcoke" is a solid material created during petroleum refinement and is distributed via transfer facilities that may be located in densely populated areas. The health impacts from petcoke exposure to residents living in proximity to such facilities were evaluated for a petcoke transfer facilities located in Chicago, Illinois. Site-specific, margin of safety (MOS) and margin of exposure (MOE) analyses were conducted using estimated airborne and dermal exposures. The exposure assessment was based on a combined measurement and modeling program that included multiyear on-site air monitoring, air dispersion modeling, and analyses of soil and surfaces in residential areas adjacent to two petcoke transfer facilities located in industrial areas. Airborne particulate matter less than 10 microns (PM 10 ) were used as a marker for petcoke. Based on daily fence line monitoring, the average daily PM 10 concentration at the KCBX Terminals measured on-site was 32 μg/m 3 , with 89% of 24-hr average PM 10 concentrations below 50 μg/m 3 and 99% below 100 μg/m 3 . A dispersion model estimated that the emission sources at the KCBX Terminals produced peak PM 10 levels attributed to the petcoke facility at the most highly impacted residence of 11 μg/m 3 on an annual average basis and 54 μg/m 3 on 24-hr average basis. Chemical indicators of petcoke in soil and surface samples collected from residential neighborhoods adjacent to the facilities were equivalent to levels in corresponding samples collected at reference locations elsewhere in Chicago, a finding that is consistent with limited potential for off-site exposure indicated by the fence line monitoring and air dispersion modeling. The MOE based upon dispersion model estimates ranged from 800 to 900 for potential inhalation, the primary route of concern for particulate matter. This indicates a low likelihood of adverse health effects in the surrounding community. Implications: Handling of petroleum coke at bulk material transfer facilities has been identified as a concern for the public health of surrounding populations. The current assessment, based on measurements and modeling of two facilities located in a densely populated urban area, indicates that petcoke transport and accumulation in off-site locations is minimal. In addition, estimated human exposures, if any, are well below levels that could be anticipated to produce adverse health effects in the general population.

Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities.

PubMed

Alford-Teaster, Jennifer; Lange, Jane M; Hubbard, Rebecca A; Lee, Christoph I; Haas, Jennifer S; Shi, Xun; Carlos, Heather A; Henderson, Louise; Hill, Deirdre; Tosteson, Anna N A; Onega, Tracy

2016-02-18

Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access--which is a critical component of health care planning and equity almost everywhere. We analyzed one mammogram from each of 646,553 women participating in the US based Breast Cancer Surveillance Consortium for years 2005-2012. We geocoded each record to street level address data in order to calculate travel time to the closest and to the actually used mammography facility. Travel time between the closest and the actual facility used was explored by woman-level and facility characteristics. Only 35% of women in the study population used their closest facility, but nearly three-quarters of women not using their closest facility used a facility within 5 min of the closest facility. Individuals that by-passed the closest facility tended to live in an urban core, within higher income neighborhoods, or in areas where the average travel times to work was longer. Those living in small towns or isolated rural areas had longer closer and actual median drive times. Since the majority of US women accessed a facility within a few minutes of their closest facility this suggests that distance to the closest facility may serve as an adequate proxy for utilization studies of geographically abundant services like mammography in areas where the transportation networks are well established.

Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements

PubMed Central

2013-01-01

Background The loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri–urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. Methods The study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate. Results HWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work. Conclusions The OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention. PMID:23919539

The roles of community health workers in management of non-communicable diseases in an urban township

PubMed Central

Puoane, Thandi; Schneider, Helen; Levitt, Naomi S.; Steyn, Krisela

2014-01-01

Background Community health workers (CHWs) are increasingly being recognised as a crucial part of the health workforce in South Africa and other parts of the world. CHWs have taken on a variety of roles, including community empowerment, provision of services and linking communities with health facilities. Their roles are better understood in the areas of maternal and child health and infectious diseases (HIV infection, malaria and tuberculosis). Aim This study seeks to explore the current roles of CHWs working with non-communicable diseases (NCDs). Setting The study was conducted in an urban township in Cape Town, South Africa. Method A qualitative naturalistic research design utilising observations and in-depth interviews with CHWs and their supervisors working in Khayelitsha was used. Results CHWs have multiple roles in the care of NCDs. They act as health educators, advisors, rehabilitation workers and support group facilitators. They further screen for complications of illness and assist community members to navigate the health system. These roles are shaped both by expectations of the health system and in response to community needs. Conclusion This study indicates the complexities of the roles of CHWs working with NCDs. Understanding the actual roles of CHWs provides insights into not only the competencies required to enable them to fulfil their daily functions, but also the type of training required to fill the present gaps. PMID:26245419

Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements.

PubMed

George, Gavin; Atujuna, Millicent; Gow, Jeff

2013-08-06

The loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. The study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate. HWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work. The OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention.

HEALTH CARE EXPENDITURE OF HOUSEHOLDS IN MAGWAY, MYANMAR

PubMed Central

KHAING, INN KYNN; MALIK, AMONOV; OO, MYO; HAMAJIMA, NOBUYUKI

2015-01-01

ABSTRACT Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73–16.26) for hospitalization and 1.08 (95% CI 0.36–3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential. PMID:25797985

78 FR 25184 - Federal Housing Administration (FHA): Section 232 Healthcare Facility Insurance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-30

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Parts 5, 200, 207, and 232 [Docket No. FR-5465... Residential Care Facilities, Office of Healthcare Programs, Office of Housing, Department of Housing and Urban Development, 451 7th Street SW., Room 6264, Washington, DC 20410-8000; telephone number 202-708- 0599 (this is...

Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda.

PubMed

Abongomera, George; Chiwaula, Levison; Revill, Paul; Mabugu, Travor; Tumwesige, Edward; Nkhata, Misheck; Cataldo, Fabian; van Oosterhout, J; Colebunders, Robert; Chan, Adrienne K; Kityo, Cissy; Gilks, Charles; Hakim, James; Seeley, Janet; Gibb, Diana M; Ford, Deborah

2018-01-01

The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda. We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time. © The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing.

PubMed

Wayne, Peter M; Gagnon, Margaret M; Macklin, Eric A; Travison, Thomas G; Manor, Bradley; Lachman, Margie; Thomas, Cindy P; Lipsitz, Lewis A

2017-09-01

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S. Copyright © 2017 Elsevier Inc. All rights reserved.

Response of Urban Systems to Climate Change in Europe: Heat Stress Exposure and the Effect on Human Health

NASA Astrophysics Data System (ADS)

Stevens, Catherine; Thomas, Bart; Grommen, Mart

2015-04-01

Climate change is driven by global processes such as the global ocean circulation and its variability over time leading to changing weather patterns on regional scales as well as changes in the severity and occurrence of extreme events such as heavy rain- and windstorms, floods, drought, heat waves, etc. The summer 2003 European heat wave was the hottest summer on record in Europe over the past centuries leading to health crises in several countries like France and caused up to 70.000 excess deaths over four months in Central and Western Europe. The main risks induced by global climate change in urbanised areas are considered to be overheating and resulting health effects, increased exposure to flood events, increased damage losses from extreme weather conditions but also shortages in the provision of life-sustaining services. Moreover, the cities themselves create specific or inherent risks and urban adaptation is often very demanding. As most of Europe's inhabitants live in cities, it is of particular relevance to examine the impact of climate variability on urban areas and their populations. The present study focusses on the identification of heat stress variables related to human health and the extraction of this information by processing daily temperature statistics of local urban climate simulations over multiple timeframes of 20 years and three different European cities based on recent, near future and far future global climate predictions. The analyses have been conducted in the framework of the NACLIM FP7 project funded by the European Commission involving local stakeholders such as the cities of Antwerp (Belgium), Berlin (Germany) and Almada (Portugal) represented by different climate and urban characteristics. Apart from the urban-rural temperature increment (urban heat island effect), additional heat stress parameters such as the average number of heat wave days together with their duration and intensities have been covered during this research. In a subsequent step, the heat stress variables are superposed on relevant socio-economic datasets targeting total population and its distribution per age class as well as vulnerable institutions such as hospitals, schools, rest homes and child/day care facilities in order to generate heat stress exposure maps for each use case city and various climate, urban planning and mitigation scenarios. The specifications and requirements for the various scenarios have been consolidated in close collaboration with the local stakeholders during dedicated end-users workshops. The results of this study will allow urban planners and policy makers facing the challenges of climate change and develop sound strategies for evolving towards sustainable and climate resilient cities.

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2015. Final rule.

PubMed

2014-08-05

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015. This final rule also contains a revision to policies related to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). This final rule includes a discussion of a provision related to the Affordable Care Act involving Civil Money Penalties. Finally, this final rule discusses the SNF therapy payment research currently underway within CMS, observed trends related to therapy utilization among SNF providers, and the agency's commitment to accelerating health information exchange in SNFs.

24 CFR 598.515 - Alaska and Hawaii.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Alaska and Hawaii. 598.515 Section 598.515 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS Special Rules § 598...

24 CFR 598.515 - Alaska and Hawaii.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Alaska and Hawaii. 598.515 Section 598.515 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS Special Rules § 598...

24 CFR 598.515 - Alaska and Hawaii.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Alaska and Hawaii. 598.515 Section 598.515 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS Special Rules § 598...

24 CFR 598.515 - Alaska and Hawaii.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Alaska and Hawaii. 598.515 Section 598.515 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES: ROUND TWO AND THREE DESIGNATIONS Special Rules § 598...

24 CFR 573.8 - Environmental procedures and standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Environmental procedures and standards. 573.8 Section 573.8 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES LOAN GUARANTEE RECOVERY FUND § 573.8 Environmental...

24 CFR 573.8 - Environmental procedures and standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Environmental procedures and standards. 573.8 Section 573.8 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES LOAN GUARANTEE RECOVERY FUND § 573.8 Environmental...

24 CFR 573.8 - Environmental procedures and standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Environmental procedures and standards. 573.8 Section 573.8 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES LOAN GUARANTEE RECOVERY FUND § 573.8 Environmental...

24 CFR 594.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Definitions. 594.3 Section 594.3 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES JOHN HEINZ...

Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi.

PubMed

Kundrick, Avery; Huang, Zhuojie; Carran, Spencer; Kagoli, Matthew; Grais, Rebecca Freeman; Hurtado, Northan; Ferrari, Matthew

2018-06-15

Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (R E ) in the context of the 2010 measles epidemic in Malawi. Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, R E , at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated R E ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern. Furthermore, the spatial scale at which each metric is calculated impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns. These methods may be used to allocate effort for prophylactic campaigns or to prioritize response for outbreak response vaccination.

Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis.

PubMed

Chuma, Jane; Gilson, Lucy; Molyneux, Catherine

2007-05-01

Ill-health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in-depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi-sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro-finance schemes that enable small amounts of credit to be accessed with minimal interest rates.

Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care.

PubMed

Kuria, Ng'endo; Reid, Anthony; Owiti, Philip; Tweya, Hannock; Kibet, Caleb Kipkurui; Mbau, Lilian; Manzi, Marcel; Murunga, Victor; Namusonge, Tecla; Kibachio, Joseph

2018-05-19

To determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya. Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than six months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the Chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication. 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance to appointments of 63%. Compliance was high in the health facilities and walkway clinics but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to anti-hypertensive medication than patients at the health facility (OR 1.97, 95%CI 1.25-3.10). Walkway clinics outperformed health facilities and weekend clinics. Use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania.

PubMed

Juma, Omar Ali; Enumah, Zachary Obinna; Wheatley, Hannah; Rafiq, Mohamed Yunus; Shekalaghe, Seif; Ali, Ali; Mgonia, Shishira; Abdulla, Salim

2016-10-19

Malnutrition has long been associated with poverty, poor diet and inadequate access to health care, and it remains a key global health issue that both stems from and contributes to ill-health, with 50 % of childhood deaths due to underlying undernutrition. The purpose of this study was to determine the prevalence of malnutrition among children under-five seen at Bagamoyo District Hospital (BDH) and three rural health facilities ranging between 25 and 55 km from Bagamoyo: Kiwangwa, Fukayosi, and Yombo. A total of 63,237 children under-five presenting to Bagamoyo District Hospital and the three rural health facilities participated in the study. Anthropometric measures of age, height/length and weight and measurements of mid-upper arm circumference were obtained and compared with reference anthropometric indices to assess nutritional status for patients presenting to the hospital and health facilities. Overall proportion of stunting, underweight and wasting was 8.37, 5.74 and 1.41 % respectively. Boys were significantly more stunted, under weight and wasted than girls (p-value < 0.05). Children aged 24-59 months were more underweight than 6-23 months (p-value = <0.0001). But, there was no statistical significance difference between the age groups for stunting and wasting. Children from rural areas experienced increased rates of stunting, underweight and wasting than children in urban areas (p-value < 0.05). The results of this study concur with other studies that malnutrition remains a problem within Tanzania; however our data suggests that the population presenting to BDH and rural health facilities presented with decreased rates of malnutrition compared to the general population. Hospital and facility attending populations of under-five children in and around Bagamoyo suffer moderately high rates of malnutrition. Current nutrition programs focus on education for at risk children and referral to regional hospitals for malnourished children. Even though the general population has even greater malnutrition than the population presenting at the hospital, in areas of high malnutrition, hospital-based interventions should also be considered as centralized locations for reaching thousands of malnourished children under-five.

Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study.

PubMed

Lorent, Natalie; Choun, Kimcheng; Malhotra, Shelly; Koeut, Pichenda; Thai, Sopheak; Khun, Kim Eam; Colebunders, Robert; Lynen, Lut

2015-01-01

While community-based active case finding (ACF) for tuberculosis (TB) holds promise for increasing early case detection among hard-to-reach populations, limited data exist on the acceptability of active screening. We aimed to identify barriers and explore facilitators on the pathway from diagnosis to care among TB patients and health providers. Mixed-methods study. We administered a survey questionnaire to, and performed in-depth interviews with, TB patients identified through ACF from poor urban settlements in Phnom Penh, Cambodia. Additionally, we conducted focus group discussions and in-depth interviews with community and public health providers involved in ACF, respectively. Acceptance of home TB screening was strong among key stakeholders due to perceived reductions in access barriers and in direct and indirect patient costs. Privacy and stigma were not an issue. To build trust and facilitate communication, the participation of community representatives alongside health workers was preferred. Most health providers saw ACF as complementary to existing TB services; however, additional workload as a result of ACF was perceived as straining operating capacity at public sector sites. Proximity to a health facility and disease severity were the strongest determinants of prompt care-seeking. The main reasons reported for delays in treatment-seeking were non-acceptance of diagnosis, high indirect costs related to lost income/productivity and transportation expenses, and anticipated side-effects from TB drugs. TB patients and health providers considered home-based ACF complementary to facility-based TB screening. Strong engagement with community representatives was believed critical in gaining access to high risk communities. The main barriers to prompt treatment uptake in ACF were refusal of diagnosis, high indirect costs, and anticipated treatment side-effects. A patient-centred approach and community involvement were essential in mitigating barriers to care in marginalised communities.

Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study

PubMed Central

Malhotra, Shelly; Koeut, Pichenda; Thai, Sopheak; Khun, Kim Eam; Colebunders, Robert; Lynen, Lut

2015-01-01

Background While community-based active case finding (ACF) for tuberculosis (TB) holds promise for increasing early case detection among hard-to-reach populations, limited data exist on the acceptability of active screening. We aimed to identify barriers and explore facilitators on the pathway from diagnosis to care among TB patients and health providers. Methods Mixed-methods study. We administered a survey questionnaire to, and performed in-depth interviews with, TB patients identified through ACF from poor urban settlements in Phnom Penh, Cambodia. Additionally, we conducted focus group discussions and in-depth interviews with community and public health providers involved in ACF, respectively. Results Acceptance of home TB screening was strong among key stakeholders due to perceived reductions in access barriers and in direct and indirect patient costs. Privacy and stigma were not an issue. To build trust and facilitate communication, the participation of community representatives alongside health workers was preferred. Most health providers saw ACF as complementary to existing TB services; however, additional workload as a result of ACF was perceived as straining operating capacity at public sector sites. Proximity to a health facility and disease severity were the strongest determinants of prompt care-seeking. The main reasons reported for delays in treatment-seeking were non-acceptance of diagnosis, high indirect costs related to lost income/productivity and transportation expenses, and anticipated side-effects from TB drugs. Conclusions TB patients and health providers considered home-based ACF complementary to facility-based TB screening. Strong engagement with community representatives was believed critical in gaining access to high risk communities. The main barriers to prompt treatment uptake in ACF were refusal of diagnosis, high indirect costs, and anticipated treatment side-effects. A patient-centred approach and community involvement were essential in mitigating barriers to care in marginalised communities. PMID:26222545

Analysis of hepatitis B vaccination behavior and vaccination willingness among migrant workers from rural China based on protection motivation theory

PubMed Central

Liu, Rugang; Li, Youwei; Wangen, Knut R.; Maitland, Elizabeth; Nicholas, Stephen; Wang, Jian

2016-01-01

ABSTRACT Introduction: With China's accelerating urbanization, migrant workers comprise up to 40% of the urban population of China's largest cities. More mobile than non-migrant urban dwellers, migrants are more likely to contract and spread hepatitis B (HB) than non-migrants. Due to the mandatory system of household registration (hukou), migrants are less likely to be covered by national HB immunization programs and also to have more limited access to public health services where they work than non-migrants. Migrants form a significant sub-group in all Chinese cities posing unique public policy vaccination challenges. Objective: Using protection motivation theory (PMT), we developed and measured HB cognitive variables and analyze the factors affecting HB vaccination behavior and willingness to vaccinate by migrant workers. We propose public policy interventions to increase HB vaccination rates of migrant workers. Methods: We developed a questionnaire to collect information on the HB vaccination characteristics of 1684 respondents from 6 provinces and Beijing. Exploratory factor analysis was used to create PMT variables and a binary logistic regression model was used to analyze the factors affecting migrant workers' HB vaccination behavior and willingness to vaccinate. Results: Vulnerability and response-efficacy were significant PMT cognition factors determining HB vaccination behavior. The HB vaccination rate for migrants decreased with increasing age and was smaller for the primary education than the high education group. The vaccination rate of the medical insurance group was significantly greater than the non-insured group, and the vaccination probability was significantly higher for the self-rated good health compared to the self-rated poor health group. Geographical birth location mattered: the vaccination rate for Beijing city and Ningxia province migrants were higher than for Hebei province and the vaccination rate was lower for migrants born far from health facilities compared to those located middle-near distances from health facilities. We also studied vaccination willingness for the unvaccinated group. For this group, vulnerability and self-efficacy cognition factors were significant factors determining HB vaccination willingness. The probability of willingness to vaccinate for the 46+ age group was significantly smaller than the 16–25 age group and the willingness to vaccinate was lower in Jiangsu and Hainan province than in Hebei province. Conclusion: Increased knowledge of HB cognition is an effective way for improving HB vaccination behavior and HB vaccination willingness of migrant workers. We also found that health intervention policies should focus on older migrants (age 46+), without medical insurance, with poorer self-reported health status and poor health services accessibility. PMID:27078191

Analysis of hepatitis B vaccination behavior and vaccination willingness among migrant workers from rural China based on protection motivation theory.

PubMed

Liu, Rugang; Li, Youwei; Wangen, Knut R; Maitland, Elizabeth; Nicholas, Stephen; Wang, Jian

2016-05-03

With China's accelerating urbanization, migrant workers comprise up to 40% of the urban population of China's largest cities. More mobile than non-migrant urban dwellers, migrants are more likely to contract and spread hepatitis B (HB) than non-migrants. Due to the mandatory system of household registration (hukou), migrants are less likely to be covered by national HB immunization programs and also to have more limited access to public health services where they work than non-migrants. Migrants form a significant sub-group in all Chinese cities posing unique public policy vaccination challenges. Using protection motivation theory (PMT), we developed and measured HB cognitive variables and analyze the factors affecting HB vaccination behavior and willingness to vaccinate by migrant workers. We propose public policy interventions to increase HB vaccination rates of migrant workers. We developed a questionnaire to collect information on the HB vaccination characteristics of 1684 respondents from 6 provinces and Beijing. Exploratory factor analysis was used to create PMT variables and a binary logistic regression model was used to analyze the factors affecting migrant workers' HB vaccination behavior and willingness to vaccinate. Vulnerability and response-efficacy were significant PMT cognition factors determining HB vaccination behavior. The HB vaccination rate for migrants decreased with increasing age and was smaller for the primary education than the high education group. The vaccination rate of the medical insurance group was significantly greater than the non-insured group, and the vaccination probability was significantly higher for the self-rated good health compared to the self-rated poor health group. Geographical birth location mattered: the vaccination rate for Beijing city and Ningxia province migrants were higher than for Hebei province and the vaccination rate was lower for migrants born far from health facilities compared to those located middle-near distances from health facilities. We also studied vaccination willingness for the unvaccinated group. For this group, vulnerability and self-efficacy cognition factors were significant factors determining HB vaccination willingness. The probability of willingness to vaccinate for the 46+ age group was significantly smaller than the 16-25 age group and the willingness to vaccinate was lower in Jiangsu and Hainan province than in Hebei province. Increased knowledge of HB cognition is an effective way for improving HB vaccination behavior and HB vaccination willingness of migrant workers. We also found that health intervention policies should focus on older migrants (age 46+), without medical insurance, with poorer self-reported health status and poor health services accessibility.

Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland - Appraisals by parents of children requiring medical attention.

PubMed

Kołłątaj, Barbara; Kołłątaj, Witold; Wrzołek, Katarzyna; Karwat, Irena Dorota; Klatka, Maria

2017-03-31

 Introduction. The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as 'the European Health Consumer Index', Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. The materials for this study consisted of 540 parents of children aged 6-16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved.

Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria.

PubMed

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.

Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria

PubMed Central

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

Objective There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. Methods The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. Results The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. Conclusion The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms. PMID:22815828

PARCS: A Safety Net Community-Based Fitness Center for Low-Income Adults

PubMed Central

Keith, NiCole; de Groot, Mary; Mi, Deming; Alexander, Kisha; Kaiser, Stephanie

2015-01-01

Background Physical activity (PA) and fitness are critical to maintaining health and avoiding chronic disease. Limited access to fitness facilities in low-income urban areas has been identified as a contributor to low PA participation and poor fitness. Objectives This research describes community-based fitness centers established for adults living in low-income, urban communities and characterizes a sample of its members. Methods The community identified a need for physical fitness opportunities to improve residents’ health. Three community high schools were host sites. Resources were combined to renovate and staff facilities, acquire equipment, and refer patients to exercise. The study sample included 170 members ≥ age 18yr who completed demographic, exercise self-efficacy, and quality of life surveys and a fitness evaluation. Neighborhood-level U.S. Census data were obtained for comparison. Results The community-based fitness centers resulted from university, public school, and hospital partnerships offering safe, accessible, and affordable exercise opportunities. The study sample mean BMI was 35 ± 7.6 (Class II obesity), mean age was 50yr ± 12.5, 66% were black, 72% were female, 66% completed some college or greater, and 71% had an annual household income < $25K and supported 2.2 dependents. Participants had moderate confidence for exercise participation and low fitness levels. When compared to census data, participants were representative of their communities. Conclusion This observational study reveals a need for affordable fitness centers for low-income adults. We demonstrate a model where communities and organizations strategically leverage resources to address disparities in physical fitness and health. PMID:27346764

Impact of the raising immunizations safely and effectively (RISE) program on healthcare worker influenza immunization rates in long term care settings.

PubMed

Nace, David A; Handler, Steven M; Hoffman, Erika L; Perera, Subashan

2012-11-01

National influenza immunization rates for healthcare workers (HCW) in long-term care (LTC) remain unacceptably low. This poses a serious public health threat to residents. Prior work has suggested high staff turnover rates as a contributing factor to low immunization rates. There is a critical need to identify and deploy successful models of HCW influenza immunization programs to LTC facilities. This report describes one potential model that has been successfully initiated in a network of LTC facilities. All facilities served by a single regional LTC pharmacy were invited to participate in a HCW influenza immunization program. This voluntary immunization program began in 2005 and continues to the present. As part of the program, the pharmacy promoted organizational change by assuming oversight and control of HCW immunization policies and processes for all facilities. Primary and secondary outcomes are the number of facilities reaching HCW influenza immunization rates of 60% and 80%. Fourteen of the 16 LTC facilities participated. Facilities were diverse and included both nursing and assisted living facilities; unionized and nonunionized facilities; and urban, suburban, and rural facilities. The pharmacy provided educational and communication materials, centralized data collection using a standardized definition for HCW immunization rates, and facility feedback. All 14 LTC facilities achieved the primary goal of 60% and nearly two thirds reached the secondary goal of 80%. Twenty percent reached the new Healthy People 2020 goal of 90%. It is possible for LTC facilities to improve HCW immunization rates using a pharmacy based, voluntary HCW influenza immunization approach. Such an approach may help attenuate the negative influence of staff turnover on HCW immunizations. Attainment of the new Health People 2020 goals still remains a challenge and may require mandatory programs. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Characteristics of joint use agreements in school districts in the United States: findings from the School Health Policies and Practices Study, 2012.

PubMed

Everett Jones, Sherry; Wendel, Arthur M

2015-04-16

Joint use or shared use of public school facilities provides community access to facilities for varied purposes. We examined a nationally representative sample of school districts in the United States to identify characteristics associated with having a formal joint use agreement (JUA) and with the kinds of uses to which JUAs apply. We analyzed data from the 2012 School Health Policies and Practices Study. The response rate for the module containing questions about formal JUAs was 60.1% (N = 630). We used multivariate logistic regression models to examine the adjusted odds of having a formal JUA and χ(2) analyses to examine differences in district characteristics associated with the uses of the JUA. Among the 61.6% of school districts with a formal JUA, more than 80% had an agreement for the use of indoor and outdoor recreation facilities; other uses also were identified. JUAs were more common in urban than rural areas, in large than small school districts, and in the West compared with the Midwest, South, and Northeast. In many districts, school facilities appear to be an untapped resource for community members. Formal JUAs provide an opportunity for shared use while addressing issues of liability, cost, and logistics.

Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants.

PubMed

Zulkifli, S N; U, K M; Yusof, K; Lin, W Y

1994-01-01

This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study.

PubMed

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Sharma, Saket; Allen, Elizabeth; Shankar, Anuraj H; Zodpey, Sanjay

2016-08-26

Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. Urban poor community in the Southeast district of Delhi, India. We randomly sampled 1849 children aged 1-3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria-pertussis-tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers' recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities. CTRI/2011/091/000095. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

24 CFR 573.11 - Record access and recordkeeping.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Record access and recordkeeping. 573.11 Section 573.11 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES LOAN GUARANTEE RECOVERY FUND § 573.11 Record access and...

24 CFR 582.310 - Resident rent.

Code of Federal Regulations, 2010 CFR

2010-04-01

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24 CFR 582.310 - Resident rent.

Code of Federal Regulations, 2014 CFR

2014-04-01

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24 CFR 582.310 - Resident rent.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Resident rent. 582.310 Section 582.310 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES SHELTER PLUS...

24 CFR 599.5 - Data used for eligibility determinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Data used for eligibility determinations. 599.5 Section 599.5 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES RENEWAL COMMUNITIES General Provisions § 599.5 Data...

24 CFR 594.7 - Other threshold requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

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24 CFR 594.7 - Other threshold requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Other threshold requirements. 594.7 Section 594.7 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES JOH...

24 CFR 594.7 - Other threshold requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

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24 CFR 594.7 - Other threshold requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

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Development of Inspection and Investigation Techniques to Prepare Debris Flow in Urban Areas

NASA Astrophysics Data System (ADS)

Seong, Joo-Hyun; Jung, Min-Hyeong; Park, Kyung-Han; An, Jai-Wook; Kim, Jiseong

2017-04-01

Due to the urban development, various facilities are located in mountainous areas near the city, and the damage to the occurrence of the debris flow is increasing in the urban area. However, quantitative inspection and investigation techniques are not sufficient for preparing debris flow in the urban area around the world. Therefore, in this study, we developed the debris flow inspection and investigation techniques, which are suitable for urban characteristics, regarding the soil hazard prevention and restoration in urban area. First, the inspection and investigation system is divided into the daily occurrence and the occurrence of the soil hazard event, and the inspection / investigation flow chart were developed based on the kind of inspection and correspondence required for each situation. The types of inspections applied in this study were determined as daily inspection, regular inspections, special emergency inspection, damage emergency inspection and In-depth safety inspection. The management agency, term of inspection, objects to be inspected, and contents of inspection work were presented according to type of each inspection. The daily inspection routinely checks for signs of collapse and conditions of facilities in urban areas which show vulnerability for soil hazard and that are conducted from the management agency. In the case of regular inspection, an expert for soil hazards regularly conducts detailed visual surveys on mountainous areas, steep slopes, prevention facilities and adjacent facilities in vulnerable areas. On the other hand, it was decided that the emergency inspection is carried out in the event of the occurrence of vulnerable element or soil hazards. Acknowledgement This study was conducted with the research iund support by the constructiontechnology research project of the Ministry of Land, Infrastructure and Transport (project number 16SCIP-B069989-04)

What is the cost of providing outpatient HIV counseling and testing and antiretroviral therapy services in selected public health facilities in Nigeria?

PubMed

Aliyu, Husaina Bello; Chuku, Nkata Nwani; Kola-Jebutu, Abimbola; Abubakar, Zubaida; Torpey, Kwasi; Chabikuli, Otto Nzapfurundi

2012-10-01

Limited data on actual cost of providing HIV/AIDS services in Nigeria makes planning difficult. A study was conducted in 9 public health facilities supported by the Global HIV/AIDS Initiative Nigeria. The objective was to determine the cost of outpatient HIV Testing and Counseling (HTC) and antiretroviral therapy (ART) services per patient. Two tertiary and 7 secondary facilities were purposively selected across the six geopolitical regions. Facilities were distributed in urban and rural settings. Utilization and cost data for a 12-month period (January to December 2010) were analyzed. Cost elements included consumables, human resources, infrastructure, trainings, facility management, and Global HIV/AIDS Initiative Nigeria technical support. Total costs were apportioned based on percentage utilization by services, and unit costs were derived by dividing resource inputs by service outputs. Data were analyzed using Microsoft Excel 2003. A sensitivity analysis was also conducted for key assumptions. Mean costs for HTC and ART were US $7.4 and US $209.0, respectively. Costs were higher in Northern facilities (US $6.9, US $250.8), compared with Southern ones (US $6.7, US $194.7); and in tertiary facilities ($18.5, $338.4), compared with secondary ones ($6.3, $204.9). Major cost drivers for HTC and ART were human resources--ranging from 62% to 50%, and ARV drugs--ranging from 54% to 31%, respectively. Governments' ability to negotiate lower priced antiretroviral drugs will be central to reducing the cost of ART. Additionally, use of lower cadre staff to provide HTC will reduce costs and improves efficiency.

The human resource for health situation in Zambia: deficit and maldistribution

PubMed Central

2011-01-01

Introduction Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care. Population and methods We used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them. Results The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers). The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces. This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763. In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other. The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus. Discussion and Conclusions This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity. PMID:22182366

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-Sectional Study.

PubMed

Fuhrimann, Samuel; Winkler, Mirko S; Kabatereine, Narcis B; Tukahebwa, Edridah M; Halage, Abdulla A; Rutebemberwa, Elizeus; Medlicott, Kate; Schindler, Christian; Utzinger, Jürg; Cissé, Guéladio

2016-03-01

There are health risks associated with wastewater and fecal sludge management and use, but little is known about the magnitude, particularly in rapidly growing urban settings of low- and middle-income countries. We assessed the point-prevalence and risk factors of intestinal parasite infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda. A cross-sectional survey was carried out in September and October 2013, enrolling 915 adults from five distinct population groups: workers maintaining wastewater facilities; workers managing fecal sludge; urban farmers; slum dwellers at risk of flooding; and slum dwellers without risk of flooding. Stool samples were subjected to the Kato-Katz method and a formalin-ether concentration technique for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine self-reported signs and symptoms, and risk factors for intestinal parasite infections. Univariate and multivariate analyses, adjusted for sex, age, education, socioeconomic status, water, sanitation, and hygiene behaviors, were conducted to estimate the risk of infection with intestinal parasites and self-reported health outcomes, stratified by population group. The highest point-prevalence of intestinal parasite infections was found in urban farmers (75.9%), whereas lowest point-prevalence was found in workers managing fecal sludge (35.8%). Hookworm was the predominant helminth species (27.8%). In urban farmers, the prevalence of Trichuris trichiura, Schistosoma mansoni, Ascaris lumbricoides, and Entamoeba histolytica/E. dispar was 15% and above. For all investigated parasites, we found significantly higher odds of infection among urban farmers compared to the other groups (adjusted odds ratios ranging between 1.6 and 12.9). In general, female participants had significantly lower odds of infection with soil-transmitted helminths and S. mansoni compared to males. Higher educational attainment was negatively associated with the risk of intestinal protozoa infections, while socioeconomic status did not emerge as a significant risk factor for any tested health outcome. Urban farmers are particularly vulnerable to infections with soil-transmitted helminths, S. mansoni, and intestinal protozoa. Hence, our findings call for public health protection measures for urban farmers and marginalized communities, going hand-in-hand with integrated sanitation safety planning at city level.

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-Sectional Study

PubMed Central

Fuhrimann, Samuel; Winkler, Mirko S.; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Halage, Abdulla A.; Rutebemberwa, Elizeus; Medlicott, Kate; Schindler, Christian; Utzinger, Jürg; Cissé, Guéladio

2016-01-01

Background There are health risks associated with wastewater and fecal sludge management and use, but little is known about the magnitude, particularly in rapidly growing urban settings of low- and middle-income countries. We assessed the point-prevalence and risk factors of intestinal parasite infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda. Methodology A cross-sectional survey was carried out in September and October 2013, enrolling 915 adults from five distinct population groups: workers maintaining wastewater facilities; workers managing fecal sludge; urban farmers; slum dwellers at risk of flooding; and slum dwellers without risk of flooding. Stool samples were subjected to the Kato-Katz method and a formalin-ether concentration technique for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine self-reported signs and symptoms, and risk factors for intestinal parasite infections. Univariate and multivariate analyses, adjusted for sex, age, education, socioeconomic status, water, sanitation, and hygiene behaviors, were conducted to estimate the risk of infection with intestinal parasites and self-reported health outcomes, stratified by population group. Principal Findings The highest point-prevalence of intestinal parasite infections was found in urban farmers (75.9%), whereas lowest point-prevalence was found in workers managing fecal sludge (35.8%). Hookworm was the predominant helminth species (27.8%). In urban farmers, the prevalence of Trichuris trichiura, Schistosoma mansoni, Ascaris lumbricoides, and Entamoeba histolytica/E. dispar was 15% and above. For all investigated parasites, we found significantly higher odds of infection among urban farmers compared to the other groups (adjusted odds ratios ranging between 1.6 and 12.9). In general, female participants had significantly lower odds of infection with soil-transmitted helminths and S. mansoni compared to males. Higher educational attainment was negatively associated with the risk of intestinal protozoa infections, while socioeconomic status did not emerge as a significant risk factor for any tested health outcome. Conclusions/Significance Urban farmers are particularly vulnerable to infections with soil-transmitted helminths, S. mansoni, and intestinal protozoa. Hence, our findings call for public health protection measures for urban farmers and marginalized communities, going hand-in-hand with integrated sanitation safety planning at city level. PMID:26938060

Urbanization and health in developing countries: a systematic review.

PubMed

Eckert, Sophie; Kohler, Stefan

2014-01-01

Future population growth will take place predominantly in cities of the developing world. The impact of urbanization on health is discussed controversially. We review recent research on urban-rural and intra-urban health differences in developing countries and investigate whether a health advantage was found for urban areas. We systematically searched the databases JSTOR, PubMed, ScienceDirect and SSRN for studies that compare health status in urban and rural areas. The studies had to examine selected World Health Organization health indicators. Eleven studies of the association between urbanization and the selected health indicators in developing countries met our selection criteria. Urbanization was associated with a lower risk of undernutrition but a higher risk of overweight in children. A lower total fertility rate and lower odds of giving birth were found for urban areas. The association between urbanization and life expectancy was positive but insignificant. Common risk factors for chronic diseases were more prevalent in urban areas. Urban-rural differences in mortality from communicable diseases depended on the disease studied. Several health outcomes were correlated with urbanization in developing countries. Urbanization may improve some health problems developing countries face and worsen others. Therefore, urbanization itself should not be embraced as a solution to health problems but should be accompanied by an informed and reactive health policy. Copyright © 2013 Longwoods Publishing.

Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study.

PubMed

Jolivet, R Rima; Uttekar, Bella Vasant; O'Connor, Meaghan; Lakhwani, Kanchan; Sharma, Jigyasa; Wegner, Mary Nell

2018-04-03

Making high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in India. We adapted a "generic" model of group antenatal care developed through a systematic scoping review of the existing evidence on group ANC in LMICs for use in an urban setting in India, after looking at local, national and global guidelines to tailor the model content. We demonstrated one session of the model to physicians, auxiliary nurse midwives, administrators, pregnant women, and support persons from three different types of health facilities in Vadodara, India and used qualitative methods to gather and analyze feedback from participants on the perceived feasibility and acceptability of the model. Providers and recipients of care expressed support and enthusiasm for the model and offered specific feedback on its components: physical assessment, active learning, and social support. In general, after witnessing a demonstration of the model, both groups of participants-providers and beneficiaries-saw group ANC as a vehicle for delivering more comprehensive ANC services, improving experiences of care, empowering women to become more active partners and participants in their care, and potentially addressing some current health system challenges. This study suggests that introducing group ANC would be feasible and acceptable to stakeholders from various care delivery settings, including an urban primary health clinic, a community-based mother and child health center, and a private hospital, in urban India.

Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian)

PubMed Central

2014-01-01

Background The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio-demographic contexts, based type of tasks shifted. The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them. Methods This was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies. Results The study found that there were tasks to be shifted and motivation strategies that were common to all three contexts. Common tasks were promotive, preventive, and simple curative services. Common motivation strategies were supportive supervision, means of identification, equitable allocation of resources, training, compensation, recognition, and evidence based community dialogue. Further, in the nomadic and peri-urban sites, community health workers had assumed curative services beyond the range provided for in the Kenyan task shifting policy. This was explained to be influenced by lack of access to care due to distance to health facilities, population movement, and scarcity of health providers in the nomadic setting and the harsh economic realities in peri-urban set up. Therefore, their motivation strategies included training on curative skills, technical support, and resources for curative care. Data collection was viewed as an important task in the rural site, but was not recognized as priority in nomadic and peri-urban sites, where they sought monetary compensation for data collection. Conclusions The study concluded that inclusion of curative tasks for community health workers, particularly in nomadic contexts, is inevitable but raises the need for accreditation of their training and regulation of their tasks. PMID:25079588

Design and Construction of an Urban Runoff Research Facility

PubMed Central

Wherley, Benjamin G.; White, Richard H.; McInnes, Kevin J.; Fontanier, Charles H.; Thomas, James C.; Aitkenhead-Peterson, Jacqueline A.; Kelly, Steven T.

2014-01-01

As the urban population increases, so does the area of irrigated urban landscape. Summer water use in urban areas can be 2-3x winter base line water use due to increased demand for landscape irrigation. Improper irrigation practices and large rainfall events can result in runoff from urban landscapes which has potential to carry nutrients and sediments into local streams and lakes where they may contribute to eutrophication. A 1,000 m2 facility was constructed which consists of 24 individual 33.6 m2 field plots, each equipped for measuring total runoff volumes with time and collection of runoff subsamples at selected intervals for quantification of chemical constituents in the runoff water from simulated urban landscapes. Runoff volumes from the first and second trials had coefficient of variability (CV) values of 38.2 and 28.7%, respectively. CV values for runoff pH, EC, and Na concentration for both trials were all under 10%. Concentrations of DOC, TDN, DON, PO4-P, K+, Mg2+, and Ca2+ had CV values less than 50% in both trials. Overall, the results of testing performed after sod installation at the facility indicated good uniformity between plots for runoff volumes and chemical constituents. The large plot size is sufficient to include much of the natural variability and therefore provides better simulation of urban landscape ecosystems. PMID:25146420

Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia.

PubMed

Koni, Phillip; Chishinga, Nathaniel; Nyirenda, Lameck; Kasonde, Prisca; Nsakanya, Richard; Welsh, Michael

2015-01-01

The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation. Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata. 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20-1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24-1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings. QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation.

Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia

PubMed Central

Koni, Phillip; Chishinga, Nathaniel; Nyirenda, Lameck; Kasonde, Prisca; Nsakanya, Richard; Welsh, Michael

2015-01-01

Introduction The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation. Methods Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata. Results 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20–1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24–1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29–7.86) and in both rural and urban settings. Conclusions QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation. PMID:26098555

Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania.

PubMed

Pfeiffer, Constanze; Mwaipopo, Rosemarie

2013-02-28

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health.

Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania

PubMed Central

2013-01-01

Background Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women’s health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Methods Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. Results The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Conclusions Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health. PMID:23448583

Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu.

PubMed

Gopalakrishnan, Sekharan; Ganeshkumar, Parasuraman; Katta, Ajitha

2013-01-01

Studying drug use pattern among medical practitioners is of vital importance in the present scenario where irrational drug use and development of drug resistance is becoming rampant. To assess, the pattern of prescribing practices among the general practitioners in a defined rural and urban area of Tamil Nadu. A community based descriptive study was conducted to collect 600 prescriptions from the catchment areas of rural and urban health training centers of a medical college using prescribing indicators as per the WHO "How to investigate drug use in health facilities" tool. This prescription study revealed that multivitamins (19.5%), antibiotics (19.3%), drugs for gastro-intestinal tract (GIT) (18%), analgesic non-steroidal anti-inflammatory drugs/ (NSAID's) (15.1%), and antihistaminic (12.5%) were prescribed frequently. Among the antibiotics, amoxicillin (49.2%) was the most commonly prescribed followed by gentamicin (31.7%). Percentage of prescriptions with an antibiotic was 55% and nearly 62% of the practitioners prescribed drugs by their generic names. As a practice of poly-pharmacy, it was observed that the average number of drugs prescribed in urban and rural area was nearly 5 and 4, respectively. Nearly 80% of the urban and rural practitioners were prescribing at least one injection. Study of the quality of prescriptions revealed that there was poor legibility, high usage of abbreviations, inadequate details of the drugs, and absence of signature by practitioners in the prescriptions. This study clearly highlights the practice of poly-pharmacy, low usage of generic drugs, injudicious usage of antibiotics and injections and low usage of drugs prescribed from essential drugs list.

24 CFR 597.1 - Applicability and scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... procedures applicable to urban Empowerment Zones and Enterprise Communities, authorized under subchapter U of... Empowerment Zones, Enterprise Communities and Rural Development Investment Areas. (b) This part contains...

24 CFR 597.1 - Applicability and scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... procedures applicable to urban Empowerment Zones and Enterprise Communities, authorized under subchapter U of... Empowerment Zones, Enterprise Communities and Rural Development Investment Areas. (b) This part contains...

24 CFR 597.1 - Applicability and scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... procedures applicable to urban Empowerment Zones and Enterprise Communities, authorized under subchapter U of... Empowerment Zones, Enterprise Communities and Rural Development Investment Areas. (b) This part contains...

Estimates of Urban Roadway Congestion, 1990: Interim Report

DOT National Transportation Integrated Search

1993-03-01

This research report is the fifth year continuation of a six year research effort focused on quantifying urban mobility. This study contains the facility information for 50 urban areas throughout the country. The database used for this research conta...

24 CFR 597.1 - Applicability and scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... procedures applicable to urban Empowerment Zones and Enterprise Communities, authorized under subchapter U of... Empowerment Zones, Enterprise Communities and Rural Development Investment Areas. (b) This part contains...

24 CFR 597.1 - Applicability and scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES URBAN EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES: ROUND ONE... procedures applicable to urban Empowerment Zones and Enterprise Communities, authorized under subchapter U of... Empowerment Zones, Enterprise Communities and Rural Development Investment Areas. (b) This part contains...

Breast cancer stage at diagnosis and geographic access to mammography screening (New Hampshire, 1998–2004)

PubMed Central

Celaya, MO; Berke, EM; Onega, TL; Gui, J; Riddle, BL; Cherala, SS; Rees, JR

2017-01-01

Introduction Early detection of breast cancer by screening mammography aims to increase treatment options and decrease mortality. Recent studies have shown inconsistent results in their investigations of the possible association between travel distance to mammography and stage of breast cancer at diagnosis. Objective The purpose of the study was to investigate whether geographic access to mammography screening is associated with the stage at breast cancer diagnosis. Methods Using the state’s population-based cancer registry, all female residents of New Hampshire aged ≥40 years who were diagnosed with breast cancer during 1998–2004 were identified. The factors associated with early stage (stages 0 to 2) or later stage (stages 3 and 4) diagnosis of breast cancer were compared, with emphasis on the distance a woman lived from the closest mammography screening facility, and residence in rural and urban locations. Results A total of 5966 New Hampshire women were diagnosed with breast cancer during 1998–2004. Their mean driving distance to the nearest mammography facility was 8.85km (range 0–44.26; 5.5 miles, range 0–27.5), with a mean estimated travel time of 8.9 min (range 0.0–42.2). The distribution of travel distance (and travel time) was substantially skewed to the right: 56% of patients lived within 8 km (5 miles) of a mammography facility, and 65% had a travel time of less than 10 min. There was no significant association between later stage of breast cancer and travel time to the nearest mammography facility. Using 3 categories of rural/urban residence based on Rural Urban Commuting Area classification, no significant association between rural residence and stage of diagnosis was found. New Hampshire women were more likely to be diagnosed with breast cancer at later stages if they lacked private health insurance (p<0.001), were not married (p<0.001), were older (p<0.001), and there was a borderline association with diagnosis during non-winter months (p=0.074). Conclusions Most women living in New Hampshire have good geographical access to mammography, and no indication was found that travel time or travel distance to mammography significantly affected stage at breast cancer diagnosis. Health insurance, age and marital status were the major factors associated with later stage breast cancer. The study contributes to an ongoing debate over geographic access to screening mammography in different states, which have given contradictory results. These inconsistencies in the rural health literature highlight a need to understand the complexity of defining rural and urban residence; to characterize more precisely the issues that contribute to good preventive care in different rural communities; and to appreciate the efforts already made in some rural states to provide good geographic access to preventive care. In New Hampshire, specific subgroups such as the uninsured and the elderly remain at greatest risk of being diagnosed with later stage breast cancer and may benefit from targeted interventions to improve early detection. PMID:20438282

Should I stay or should I go?: consistency and switching of delivery locations among new mothers in 39 Sub-Saharan African and South/Southeast Asian countries

PubMed Central

Benova, Lenka; Macleod, David; Radovich, Emma; Lynch, Caroline A; Campbell, Oona M R

2017-01-01

Abstract The objective of this article is to assess the extent and determinants of switching delivery location between women’s first and second deliveries. We used Demographic and Health Survey data from 39 low- and middle-income countries on delivery locations from >30 000 women who had their first two deliveries in the 5-year survey recall period. Each delivery was characterized as occurring at home or in a health facility, facilities were classified as public- or private-sector. The extent of switching was estimated for each country, region and overall. Multivariable logistic regression models assessed determinants of switching (home to facility or facility to home), using four dimensions (perceived/biological need, socioeconomic characteristics, utilization of care and availability of care). Overall, 49.0% of first and 44.5% of second deliveries occurred in health facilities. Among women who had their first delivery at home, 11.8% used a facility for their second (7.0% public-sector and 4.8% private-sector). Among women who had their first delivery in a facility, 21.6% switched to a home location for their second. The extent of switching varied by country; but the overall net effect was either non-existent (n = 20) or away from facilities (n = 17) in all but two countries—Cambodia and Burkina Faso. Four factors were associated with switching to a facility after a home delivery: higher education, urban residence, non-poor household status and multiple gestation. Majority of women consistently used the same delivery location for their first two deliveries. We found some evidence that where switching occurred, women were being lost from facility care during this important transition, and that all four included dimensions were important determinants of women’s pattern of delivery care use. The relative importance of these factors should be understood in each specific context to improve retention in and provision of quality intrapartum care for women and their newborns. PMID:28981668

Should I stay or should I go?: consistency and switching of delivery locations among new mothers in 39 Sub-Saharan African and South/Southeast Asian countries.

PubMed

Benova, Lenka; Macleod, David; Radovich, Emma; Lynch, Caroline A; Campbell, Oona M R

2017-11-01

The objective of this article is to assess the extent and determinants of switching delivery location between women's first and second deliveries. We used Demographic and Health Survey data from 39 low- and middle-income countries on delivery locations from >30 000 women who had their first two deliveries in the 5-year survey recall period. Each delivery was characterized as occurring at home or in a health facility, facilities were classified as public- or private-sector. The extent of switching was estimated for each country, region and overall. Multivariable logistic regression models assessed determinants of switching (home to facility or facility to home), using four dimensions (perceived/biological need, socioeconomic characteristics, utilization of care and availability of care). Overall, 49.0% of first and 44.5% of second deliveries occurred in health facilities. Among women who had their first delivery at home, 11.8% used a facility for their second (7.0% public-sector and 4.8% private-sector). Among women who had their first delivery in a facility, 21.6% switched to a home location for their second. The extent of switching varied by country; but the overall net effect was either non-existent (n = 20) or away from facilities (n = 17) in all but two countries-Cambodia and Burkina Faso. Four factors were associated with switching to a facility after a home delivery: higher education, urban residence, non-poor household status and multiple gestation. Majority of women consistently used the same delivery location for their first two deliveries. We found some evidence that where switching occurred, women were being lost from facility care during this important transition, and that all four included dimensions were important determinants of women's pattern of delivery care use. The relative importance of these factors should be understood in each specific context to improve retention in and provision of quality intrapartum care for women and their newborns. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story.

PubMed

Anastasi, Erin; Ekanem, Ekanem; Hill, Olivia; Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin; Bernasconi, Andrea

2017-01-01

Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894-1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations-as in the urban slums of Lagos.

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story

PubMed Central

Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin

2017-01-01

Introduction Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. Materials and methods The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Results Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894–1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. Discussion The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations—as in the urban slums of Lagos. PMID:28489890

Bringing stillbirths out of the shadows in Latin America.

PubMed

de Jesús, Guilherme; Flenady, Vicki

2018-06-07

In the BJOG stillbirth themed issue, Pingray et al (BJOG, 2018) report on stillbirth rates across countries in Latin America, and examined its relationship with socioeconomic and health coverage. Although pooled estimated stillbirth rate (SBR) for Latin America is considerably lower than worldwide estimate (8.1 vs 18.4 per 1.000 births), the authors found a wide variation in country-level stillbirth rates with indicators of socioeconomic and health coverage being key drivers. Gross domestic product (GDP) per capita and women's schooling have a strong inverse relationship with stillbirths. Birth at a health facility, urban population and fertility rate were also important factors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

What capacity exists to provide essential inpatient care to small and sick newborns in a high mortality urban setting? - A cross-sectional study in Nairobi City County, Kenya

PubMed Central

Gathara, David; Abuya, Nancy; Mwachiro, Jacintah; Ochola, Sam; Ayisi, Robert; English, Mike

2018-01-01

Introduction Appropriate demand for, and supply of, high quality essential neonatal care is key to improving newborn survival but evaluating such provision has received limited attention in low- and middle-income countries. Moreover, specific local data are needed to support healthcare planning for this vulnerable population. Methods We conducted health facility assessments between July 2015-April 2016, with retrospective review of admission events between 1st July 2014 and 30th June 2015, and used estimates of population-based incidence of neonatal conditions in Nairobi to explore access and evaluate readiness of public, private not-for-profit (mission), and private-for-profit (private) sector facilities providing 24/7 inpatient neonatal care in Nairobi City County. Results In total, 33 (4 public, 6 mission, and 23 private) facilities providing 24/7 inpatient neonatal care in Nairobi City County were identified, 31 were studied in detail. Four public sector facilities, including the only three facilities in which services were free, accounted for 71% (8,630/12,202) of all neonatal admissions. Large facilities (>900 annual admissions) with adequate infrastructure tended to have high bed occupancy (over 100% in two facilities), high mortality (15%), and high patient to nurse ratios (7–15 patients per nurse). Twenty-one smaller, predominantly private, facilities were judged insufficiently resourced to provide adequate care. In many of these, nurses provided newborn and maternity care simultaneously using resources shared across settings, newborn care experience was likely to be limited (<50 cases per year), there was often no resident clinician, and sick babies were often referred onwards. Results suggest 44% (9,764/21,966) of Nairobi’s small and sick newborns may not access any of the identified facilities and a further 9% (2,026/21,966) access facilities judged to be inadequately equipped. Conclusion Over 50% of Nairobi’s sick newborns may not access a facility with adequate resources to provide essential care. A very high proportion of care accessed is provided by four public and one low cost mission facility; these face major challenges of high patient acuity (high mortality), high patient to nurse ratios, and often overcrowding. Reducing high neonatal mortality in this urban, predominantly poor, population will require effective long-term, multi-sectoral planning and investment. PMID:29702700

41 CFR Appendix to Part 102 - 83-Memorandum of Understanding Between the Department Of Housing And Urban Development And the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... communities, relocation, urban renewal, model cities, rehabilitation loans and grants, neighborhood facilities... Understanding Between the Department Of Housing And Urban Development And the General Services Administration... Department Of Housing And Urban Development And the General Services Administration Concerning Low- And...

Hydrological impacts of urbanization at the catchment scale

NASA Astrophysics Data System (ADS)

Oudin, Ludovic; Salavati, Bahar; Furusho-Percot, Carina; Ribstein, Pierre; Saadi, Mohamed

2018-04-01

The impacts of urbanization on floods, droughts and the overall river regime have been largely investigated in the past few decades, but the quantification and the prediction of such impacts still remain a challenge in hydrology. We gathered a sample of 142 catchments that have a documented increase in urban areas over the hydrometeorological record period in the United States. The changes in river flow regimes due to urban spread were differentiated from climate variability using the GR4J conceptual hydrological model. High, low and mean flows were impacted at a threshold of a 10% total impervious area. Moreover, the historical evolution of urban landscape spatial patterns was used to further detail the urbanization process in terms of extent and fragmentation of urban areas throughout the catchment and to help interpret the divergent impacts observed in streamflow behaviors. Regression analysis pointed out the importance of major wastewater treatment facilities that might overpass the effects of imperviousness, and therefore further research should either take them explicitly into account or select a wastewater facility-free catchment sample to clearly evaluate the impacts of urban landscape on low flows.

24 CFR 982.613 - Group home: Rent and voucher housing assistance payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SECTION 8 TENANT BASED ASSISTANCE: HOUSING CHOICE VOUCHER PROGRAM... facilities for food preparation and service, are common facilities or private facilities. (c) Payment...

Effect of Free Maternal Health Care Program on Health-seeking Behaviour of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study.

PubMed

Edu, Betta Chimaobim; Agan, Thomas U; Monjok, Emmanuel; Makowiecka, Krystyna

2017-06-15

Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

PubMed

Kiani, Behzad; Bagheri, Nasser; Tara, Ahmad; Hoseini, Benyamin; Tabesh, Hamed; Tara, Mahmood

2017-11-07

Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.

Identifying built environmental patterns using cluster analysis and GIS: Relationships with walking, cycling and body mass index in French adults

PubMed Central

2012-01-01

Background Socio-ecological models suggest that both individual and neighborhood characteristics contribute to facilitating health-enhancing behaviors such as physical activity. Few European studies have explored relationships between local built environmental characteristics, recreational walking and cycling and weight status in adults. The aim of this study was to identify built environmental patterns in a French urban context and to assess associations with recreational walking and cycling behaviors as performed by middle-aged adult residents. Methods We used a two-step procedure based on cluster analysis to identify built environmental patterns in the region surrounding Paris, France, using measures derived from Geographic Information Systems databases on green spaces, proximity facilities (destinations) and cycle paths. Individual data were obtained from participants in the SU.VI.MAX cohort; 1,309 participants residing in the Ile-de-France in 2007 were included in this analysis. Associations between built environment patterns, leisure walking/cycling data (h/week) and measured weight status were assessed using multinomial logistic regression with adjustment for individual and neighborhood characteristics. Results Based on accessibility to green spaces, proximity facilities and availability of cycle paths, seven built environmental patterns were identified. The geographic distribution of built environmental patterns in the Ile-de-France showed that a pattern characterized by poor spatial accessibility to green spaces and proximity facilities and an absence of cycle paths was found only in neighborhoods in the outer suburbs, whereas patterns characterized by better spatial accessibility to green spaces, proximity facilities and cycle paths were more evenly distributed across the region. Compared to the reference pattern (poor accessibility to green areas and facilities, absence of cycle paths), subjects residing in neighborhoods characterized by high accessibility to green areas and local facilities and by a high density of cycle paths were more likely to walk/cycle, after adjustment for individual and neighborhood sociodemographic characteristics (OR = 2.5 95%CI 1.4-4.6). Body mass index did not differ across patterns. Conclusions Built environmental patterns were associated with walking and cycling among French adults. These analyses may be useful in determining urban and public health policies aimed at promoting a healthy lifestyle. PMID:22620266

The 1999 Urban Mobility Report: Information for Urban America

DOT National Transportation Integrated Search

1999-01-01

The mobility provided by the nation's transportation system is the subject of discussion and debate every day. This report provides data on the performance of some elements of that transport system in 68 urban areas. The travel, demographic, facility...

Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India

PubMed Central

Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Background Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. Methods We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. Result There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients’ medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Conclusions Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions. PMID:25188582