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Introduction: During menopause, women experience various psychological or physical changes which need adequate attention. Moreover, women don’t seek help for these problems due to their hesitancy, lack of awareness, socio-cultural, financial constraints or as they feel this is a natural-phenomenon. The study aims to explore the postmenopausal experiences faced by women during menopause and to elicit the constraints faced by them in seeking health-care services. Methodology: This was a qualitative study with phenomenological approach conducted among post-menopausal women (≥45 years) from Oct 2022-Jan 2023 with the help of In-Depth-Interview guide in four villages of Bhatar Block, Purba-Bardhaman District. Considering the availability of the study participants, they were selected purposively from the list prepared by ASHA of each village and recruitment done till the point of data-saturation. Inductive thematic-analysis was used to identify codes and themes. Results: During menopause, women experienced physical and psychological changes in the body, changes in social life and for these changes they had to adjust to cope-up. They felt various needs like empathy from hus-bands, children, peers. On the other hand, they did not seek help from health-care services due to their knowledge gap, dissatisfaction from previous-visit, cost-issue and unavailability of resources in health-care delivery system. Conclusion: Majority of the post-menopausal women faced various problems associated with menopause, but very few had sought help. So, health care providers have an important role to generate awareness among post-menopausal women regarding physical and mental changes during this phase.
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Objetivo: Identificar as experiências e discriminações vividas pela população LGBTQIA+ em envelhecimento durante a prestação dos serviços de saúde. Método: Estudo exploratório de abordagem qualitativa, por meio da aplicação de um questionário com informações sociodemográficas e questões sobre experiências anteriores dentro de instituições de saúde e percepção do cuidado recebido. Resultados: Participaram nove pessoas, predominantemente, identificadas como homens cisgêneros; e, apenas um estava com idade entre 65 e 70 anos. Em sua maioria buscam o serviço de saúde duas vezes ao ano motivado principalmente por problemas particulares, do sistema respiratório, hipertensão arterial ou dores persistentes. Indicaram não haver desencorajamento para a procura de serviços e a maioria não relatou experiências de discriminação. Conclusão: A baixa frequência de discriminação pode indicar a dificuldade de caracterizar a exposição e/ou vivências por esta população. Sendo assim, devese buscar entender o que essa população considera discriminação por parte dos serviços de saúde a pessoas LGBTQIA + durante o processo de envelhecimento.
Objective: To identify the experiences and discrimination experienced by the aging LGBTQIA+ population during the provision of health services. Method: Exploratory study with a qualitative approach, through the application of a questionnaire with sociodemographic information and questions about previous experiences within health institutions and perception of care received. Results: Nine people participated, predominantly identified as cisgender men; and, only one was aged between 65 and 70 years. Most seek the health service twice a year motivated mainly by particular problems, the respiratory system, high blood pressure or persistent pain. They indicated that there was no discouragement to seek services and most did not report experiences of discrimination. Conclusion: The low frequency of discrimination may indicate the difficulty of characterizing the exposure and/or experiences of this population. Therefore, one should seek to understand what this population considers discrimination by health services to LGBTQIA+ people during the aging process.
Objetivo: Identificar las experiencias y la discriminación que vive la población LGBTQIA+ envejecida durante la prestación de los servicios de salud. Método: Estudio exploratorio con enfoque cualitativo, mediante la aplicación de un cuestionario con información sociodemográfica y preguntas sobre experiencias previas dentro de las instituciones de salud y percepción de la atención recibida. Resultados: Participaron nueve personas, predominantemente identificadas como hombres cisgénero; y, solo uno tenía entre 65 y 70 años. La mayoría acude al servicio de salud dos veces al año motivada principalmente por problemas particulares, del sistema respiratorio, hipertensión arterial o dolor persistente. Indicaron que no hubo desánimo para buscar servicios y la mayoría no reportó experiencias de discriminación. Conclusión: La baja frecuencia de discriminación puede indicar la dificultad de caracterizar las exposiciones y/o experiencias de esta población. Por lo tanto, se debe buscar comprender lo que esta población considera discriminación por parte de los servicios de salud a las personas LGBTQIA+ durante el proceso de envejecimiento.
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Humans , Sexual and Gender Minorities , Patient Acceptance of Health Care , Population Dynamics , Delivery of Health Care , Health Services AccessibilityABSTRACT
Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh. Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population. Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure. Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.
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Purpose: To present the eye care seeking behavior among rural adults in South India. Methods: This cross?sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door?to?door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression. Results: A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001). Conclusion: The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.
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A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB.
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Background: Adolescent girls are often less informed and less comfortable in accessing reproductive health care and information. Due to taboos and socio-cultural restrictions associated with menstruation and its issues, a culture of silence surrounds it. Every stage of women’s life influences next stage, thus present menstrual health will help the girls to have good reproductive, sexual and maternal health later. Good knowledge and better health care seeking behaviour will help in managing menstruation hygienically and with dignity. Hence the present study was undertaken with the objectives, to assess knowledge about menstruation and to determine health care seeking behaviour for menstrual health among adolescent girls in urban slums.Methods: A cross sectional study was conducted to assess knowledge about menstruation and determine health seeking behaviour for menstrual health among 150 adolescent school girls. Multi stage random sampling with probability proportionate to size sampling technique was used. A pre-tested, semi-structured questionnaire was self administered to assess socio-demographic factors, knowledge and health care seeking behaviour for menstrual health.Results: Among 150 adolescent girls, 102(68.0%) of them had good knowledge. Among girls who had excessive bleeding and irregular menses only half of them sought medical treatment (p<0.05) and though 59.5% had more than one symptoms in a cycle, only 37.3% sought treatment.Conclusions: Health care seeking behaviour for menstrual health among adolescent girls was marginally low, only 34(37.4%) sought treatment.
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Background: Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. Objectives: The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. Methods: A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. Results: The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Conclusions: Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.
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Aims: The western region in Kenya is holoendemic to malaria and experience stable P. falciparum malaria transmission. The use of health care options has a direct influence on the outcome of severe malaria. As such, the current study will assess the health care seeking behavior among caregivers of sick children who had severe malarial anaemia (SMA) inwestern Kenya.Study Design:Cross section study.Place and Duration of Study:The study was conducted at Jaramogi Odinga Oginga Teaching and Referral Hospital (JOOTRH) between September 2014 to July 2015. Methodology: It was open to all children ≤10 years (n=271) admitted and diagnosed with SMA (hemoglobin <5.0 g/dl and any density of P. falciparum. Caregivers were interviewed on the health care options before seeking care at a heath facility, when the childstarted to get sick, if they took child to another health centre/dispensary/private hospital before coming to JOOTRH Results: Majority of the caregivers interviewed, 80.07% (217) had attained Primary education. Majority of the caregivers were in the age category of19-24 75(27.67%) years and 25-29 years 75 Original ResearchArticle (27.67%). 74.90% (203) of their children were below five years and 25.09% (68) were above 5 years. 61.62% (167. Majority of the caregivers gave some remainder drugs before presenting to a heath facility 32.5% (88). A good number bought drugs at drug stores/pharmacies 27.7% (75). None visited a traditional healer. A minority used herbs 10% (27). There were no statistically significant differences between most of the pre-hospitalization measures taken s with regard to patient’s gender and age, and caretaker’s level of education. Caregivers who chose to give herbs to their sick children took longer in deciding to take their children to hospital. This was however statistically significant between those who used herbs and those who bought drugs only (median 4 days vs. 3 days, respectively, p = 0.0063). There was no significant difference in the delay of child admission at JOOTRH between caregivers who had had primary education only and those with a minimum of secondary education (p = 0.9842). Conclusion:Self-medication is a common practice before seeking care at a heath facility. There is need for community awareness for correct and comprehensive information about drawbacks associated with self-medication practices. Since safety continues to be a major issue with the use of herbal remedies, it becomes imperative, therefore, that relevant regulatory authorities put in place to ensure that all herbal medicines are safe and of suitable quality.
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Background: Urinary incontinence (UI) defined by the International Continence Society as the complaint of any involuntary leakage of urine, is a social or hygiene problem. The purpose of this study was to determine how UI affected quality of life (QOL) of women in urban slum in Mumbai and also their health care seeking behavior for the same.Methods: A pre-formed, pre-tested, semi-structured questionnaire was designed for a centre based study, to collect information from 1200 eligible and willing women over a period of 6 months. Of these 361 had complaints of UI how had the UI affected their quality of life and whether they sought health care for treatment of same was studied. Data was entered in Microsoft Excel and analysis was done accordingly.Results: Of the 361 women who had UI, the QOL was affected as in avoiding social interactions 45.15%, avoiding religious functions 49.03%, feeling of emotional upset/distress 59.8% and hampering of domestic work 57.8%. The extra financial burden felt due to UI was only in 7.7% women and only 1.9% complained of sexual life getting affected. Health care services for treatment of UI were sought by only 24.1% of the affected women.Conclusions: That UI affected the QOL of women affected with it in terms of reduced social interactions and attendance at religious programs and the feeling of emotional upset and hampering of domestic works. Subjects felt their financial burden had increased due to UI.
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Objective To study the impacts of medicine and pharmacy separation reform on medical insurance fund and medical care seeking behavior of such patients.Methods The insurance data of patients was collected from year 201 1 to year 2014 at the hospital of the author.The differences of hospitals' revenue from insurance,the use of insurance fund and medical care seeking behavior of patients,before and after the reform were analyzed.Results The results showed that the effect of medicine and pharmacy separation reform in achieving translation;the proportions of drug and per-patient drug expenses were reduced.However,the demand of insurance fund was increased,and the fund used in outpatients began to exceed that used in inpatients after the reform.Totally,the choices of outpatients on doctor's technical titles were influenced by the pricing,as more outpatients tended to choose the intermediate title doctors,and the proportion was increasing.The differences of the choices on the outpatient in superior departments were very small,while those in non-dominant departments were very big,the same as the total patients.Conclusion There are both advantages and disadvantages in impacts of the reform on medical insurance fund conducted in some hospital in Beijing.The advantages included that the hospitals'revenue was not decreased from insurance patients,the use of insurance on paying drugs were reduced by management of proper medication, and out-of-pocket burden of the insurance patients was reduced.Yet the disadvantages contained that because of cheaper drugs and favorable insurance policy on the reform,the outpatients preferred higher level hospitals to buy drugs only,and the reform might lead to the increase of the requirement of insurance fund.
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Background: The persistence of severe intra-partum events as causes of perinatal mortality may be due to the poor care pregnant women receive in labour. The quality and scope of care received in labour varies with the types of health facilities patronized. Objective: To describe the obstetric care-seeking behaviours of pregnant women in Sagamu, Nigeria and relate this to the perinatal outcome. Methods: A cross-sectional survey of parturient at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria was conducted between August 2013 and November 2014. Data were obtained on the demographic and obstetric profile, details of facilities visited during labour and perinatal outcome for analysis. Results: Out of 145 women, 93 (64.1%) received antenatal care at OOUTH. Of the 84 women who were first admitted in labour, 32 (38.1%) presented with emergencies. There were 140 live births and 10 still births; 34/140 (24.3%) of the live births were hospitalized mostly with asphyxia (13/34; 38.2%). One of the 34 hospitalized babies died from asphyxia thus the overall perinatal mortality rate was 73.3/1000 births. Women who presented with emergencies during labour and traversed other health facilities while in labour characteristically had low maternal education, low socioeconomic status and received antenatal care outside OOUTH. Poor perinatal outcome was significantly associated with unbooked status, presentation with emergencies during labour and traversing other health facilities in labour. Conclusion: Quality antenatal care and timely presentation during labour may influence perinatal outcome positively. Research should be focused on strengthening the existing health care structure.
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Background & objectives: Inequity in the use of health care services is an important factor affecting the maternal and child survival. In southern Odisha, India, the health indicators remained below compared to the state and national average. This study identifies various equity issues at individual and community levels that influence women’s choice affecting the utilization of maternal health services in a district in southern Odisha. Methods: A qualitative study was carried out in Gajam district, rural region of south Odisha. Ten in-depth interviews were carried out till data saturation with women having less than one year child and 10 focus group discussions with the average eight women in each group having less than five year old child, community and health care providers separately. A total of 120 respondents were included in the study using in-depth interview and focus group discussions. Results: The important determinants in utilization of health care services by women emerging from the study were transportation and financial constraints. In addition, it was found that divergent aetiological concepts and low perceived hospital benefits of the women and community were equally important determinants. Further, community had different perceptions and interpretations of danger signs influencing the risk approach and health care seeking behaviour. Interpretation & conclusions: Our findings show that to increase the utilization of health care services, the grass root health workers should be made aware of specific social determinants of risk, perceptions and preferences. more attention should be given to the transportation system, and its operational feasibility. The husband of the women and the elders of the family should be considered as an important unit of interjection. A more individualized antenatal consultation could be provided by taking into account women’s perception of risk and their explanatory models.
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Background: For effective malaria control at the community level, information on the treatment practices are essential. However, there is no information on malaria treatment practices in Ibusa community. Thus, this study seeks to assess the prevalence of malaria and health care seeking behaviors in Ibusa community. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Ibusa, Oshimili North Local Government area in Nigeria. The study was untaken between June and November, 2006. Methods: Malaria treatment practices including sources of anti-malarial of the 600 individuals who visited the Fenlab Diagnostic and Research Laboratory Ibusa, Delta State were obtained using a previously validated structured questionnaire. Microscopy was used to establish malaria infection and species identification. Results: The prevalence rate was found to be 73.3% and all were infections of Plasmodium falciparium. The age prevalence showed an undulating pattern however, the prevalence was highest among subjects within age group 20-29 years (31.81%) and least in age group 40-49 years (8.64%). Chi-square analysis showed no significant difference (X2 =13.61, df=5, P=0.183). The prevalence by sex showed higher values in females (60.22%) than males (39.78%), but the difference was not statistically significant at (X2=0.027, df=1, P=0.870). The malaria management practices showed that 20.83% participants buy anti-malarials from shops, 17.33% visit hospitals, while 16.33% employ traditional medicine from local healers. However, some of the subjects employ a combination of approaches. 13.83% get anti-malarials from shops, hospitals and local healers, 10.50% get anti-malarials from shops and hospitals, 9.67% visit local healers and hospitals, while 0.33% do not employ any treatment practices. Conclusion: Given the high prevalence of malaria infection in Ibusa community, proper education of the people on the need to employ proper malaria treatment practice is essential.
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Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.
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Background: Designing health care policies and programmes requires knowledge about health care seeking behaviour, so that appropriate interventions can be implemented. Health care seeking behaviour is influenced by the individual self, diseases, and the availability and accessibility of health services. Dependent on these determinants health care seeking behaviour is a complex outcome of many factors operating at various levels. Aims & Objective: Present study aimed at exploring possible differences in health care seeking behavior in rural and urban Ahmedabad. Material and Methods: A Cross-sectional study was carried out over a period of one year (April 2011-March 2012) in urban and rural area of Ahmedabad district. Total 500 houses from each were surveyed using pre-designed and pre-tested proforma by house to house visits. Head of the family from each household was interviewed. Information regarding morbidity and health seeking behaviour was collected during household survey. Results: Maximum number of respondents belonged to age group 25-39 years in urban (49.8%) and rural (53.8%). Rural people preferred government and trust hospitals (51.1%) more as compared to urban (44.1%). Significant difference was observed in place for treatment of acute illness from faith healers. More rural people (29.2%) took treatment from faith healers than urban (22.8%). Majority of rural people (59.6%) took treatment for chronic illness from private practitioner than urban (51.4%). More urban people (57.4%) were using cash savings for treatment than rural people while borrowing and selling assets for treatment was more in rural people (57.4%) The result was statistically significant. Insurance coverage for illness was significantly low both in urban and rural area. Conclusion: Difference in health seeking behaviour was noticed among urban and rural communities. As far as treatment of chronic illnesses is concerned more infrastructure investments should be made to improve accessibility to government health care facilities, especially in rural areas. There is a need to make the rural people more aware regarding availability of various health insurance schemes.
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Background: Little information is available on triggers and barriers for seeking appropriate healthcare among chest symptomatics (CS) from slum populations in India. Methods: Urban slums in Uttar Pradesh (UP) and Karnataka (KA) were selected based on case detection rate (2008), population size and geographic distribution. A door-to-door survey was conducted in 2010 and CS were identified and interviewed. Action taking patterns were collected and factors influencing these among behavers (CS visiting qualified providers) and non-behavers (CS not taking action or resorting to self-medication) compared. Results: Of 1526 CS in UP and 1515 in KA interviewed, 75% in UP and 58% in KA sought care; of them 79% in UP and 99% in KA visited a qualified provider. More than 80% in both UP and KA underwent recommended tests within a week (mean days: UP-1.8; KA-2.4). Only 16% of respondents in UP and 48% in KA reported that private qualified providers recommended sputum microscopy. Important triggers of visiting a qualified provider were being females; of higher economic status, self-efficacy, suspicion of having TB when suffering from persistent cough and that sputum microscopy should be done to diagnose TB. Additional triggers included knowledge that TB is caused by germs and can affect anyone (UP) and perceptions of quality of care and knowledge that TB is curable (KA). Implications: There is need to carry out targeted area-specific communication in slums to improve appropriate treatmentseeking behaviour and demand creation for DOTS by CS. The study recommends investments to focus on changing private provider behaviour.
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Adult , Aged , Directly Observed Therapy , Female , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care , Population Groups , Poverty Areas , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology , Young AdultABSTRACT
Background: World population ageing is enduring, the proportion of older persons has been rising steadily, from 7 per cent in 1950 to 11 per cent in 2007, with an expected rise to reach 22 percent in 2050. Globally the population of older persons is growing at a rate of 2.6 per cent per year, considerably faster than the population as a whole which is increasing at 1.1 percent annually. The issue of health care-seeking (or medical-care) behaviour is crucial to all society. Objective: To know the Socio-demographic distribution of elderly population in rural area, observe the Health seeking behaviour of the rural elderly and to know the available health care services in rural area of Uttar Pradesh. Materials and Methods: A community based Cross sectional study was conducted from October 2010 to June 2011. Persons aged 60 years and above were selected by multistage random sampling. The minimum Sample size of 400 was calculated using formula 4pq/d2 and finally a total of 411 individuals were studied. The data was analyzed by means, proportions and Chi-square test, p value less than 0.05(p<0.05) at 95% confidence interval, was consider for significant, SPSS Version 12 Statistical Software was used to analyze the data. Results: Out of the 411 elderly persons, 214 (52.1%) were males and 197(47.9%) were females. Mean age for the entire study population was 69.2 years with a standard deviation of 7.8 years. Majority of the elderly population were illiterate (70.1%). Higher proportion of females was illiterate (92.4%) as compared to males (49.5%). Among the 411 elderly persons, 188 (45.7%) sought treatment from private practitioner and private hospital, 133 (32.3%) from non registered practitioner (Quack), only 77 (18.9%) sought treatment from Government hospital and remaining 13 (3.1%) used home remedies or sought help from traditional healers. Conclusion: Majority of the geriatric subjects were in the age group of 60 to 69 years. Awareness must be generated among the elderly regarding the problems related to the ageing, strict implementation of legislation on parents’ care by their children and Promotion of income.
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The outpatient service system at Shanghai Sixth People's Hospital came into use since April 2009.Data from Jan.2010 to Oct.2010 and interviews with employees of department in question showed a rapid growth of outpatient appointments,a poor handling of outpatients absenteeism,and poor integration among the platforms of the appointments.The development of outpatient services depends on behavioral change of both medical workers and consumers.Some measures could be employed to improve outpatient appointment within the current mechanism.
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The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.
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Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities. This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.