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1.
BMC Health Serv Res ; 23(1): 387, 2023 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-37087489

RESUMEN

INTRODUCTION: Outpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people's preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual's decision to seek outpatient care in primary healthcare facilities in India's largest state Rajasthan. METHODS: It was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey. ANALYSIS: The focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people's choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services. RESULT: Except for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118-0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076-0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856-33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine. CONCLUSION: The uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.


Asunto(s)
Atención Ambulatoria , Atención Primaria de Salud , Humanos , Estudios Transversales , India/epidemiología , Encuestas y Cuestionarios , Accesibilidad a los Servicios de Salud
2.
Indian Pediatr ; 57(4): 305-309, 2020 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-32038035

RESUMEN

OBJECTIVE: To study the effectiveness of a hypothermia monitoring device in reducing neonatal mortality and increasing Kangaroo Mother Care compliance. DESIGN: Non-randomized controlled trial. SETTING: 3 government Sick Newborn Care Units and 7 Primary Health Centers in Udaipur and Dungarpur districts of Rajasthan for 4 months. The follow-up period was 4 weeks for each baby. PARTICIPANTS: Total 386 neonates were included in the study. 250 (64.76%) new-borns in the study group (BEMPU bracelet) and 136 (35.23%) enrolled in the control group. Clinically stable babies discharged below 2500 grams, whose parents could be reached by phone, and who could visit the facility for 4 weekly follow-ups were eligible for participation. Infants with complications or those leaving against medical advice were not eligible. INTERVENTION: The BEMPU Bracelet is a medical device that provides 4 weeks of continuous hypothermia monitoring for new-borns, and emits an audio-visual alarm when the temperature of the newborn is below 36.5°C. OUTCOME: Neonatal mortality over the 4-week period. RESULTS: Mortality data was obtained for 92% (229 babies) of the study group and 91% of the control group (124 babies) at the end of the 4-week period. The intervention group had a significantly lower mortality rate as compared to the control group (6% vs. 14%, P=0.013). Weight data from 51% of the study group (128 babies) and 32% of the control group (44 babies) did not show a significant difference in weight gain between the groups. CONCLUSIONS: The observed effect on mortality and qualitative feedback on KMC compliance suggest the utility of the device in the community settings.


Asunto(s)
Hipotermia , Método Madre-Canguro , Peso al Nacer , Niño , Humanos , Hipotermia/prevención & control , India/epidemiología , Lactante , Recién Nacido de Bajo Peso , Recién Nacido
3.
Trop Med Health ; 48: 67, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32831577

RESUMEN

Irrespective of how the COVID-19 pandemic evolves over time across the globe, our past experiences with comparable zoonotic diseases demonstrate the significance of having resilient primary healthcare systems to successfully respond to public health emergencies. However, literature corroborates that in low- and middle-income countries, the primary healthcare systems are plagued with significant energy insecurity and inadequate built environment. These gaps in reliable energy and responsive built environment in primary healthcare systems are exacerbated during disruptive public health emergencies such as COVID-19. In this letter, we discuss the way forward to address these gaps and the policy and practical implications thereof.

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