RESUMEN
Breast cancer (BC) has become the most common cancer in urban women. Unfortunately, most women are not aware of BC symptoms/signs, prevention, and management. In resource-limited countries like India where we do not have structured screening/awareness programs, a majority of women present with locally advanced BC. The aim of our study is to identify the present status of awareness about BC prevention, early detection, symptoms, and management in urban and rural Indian women (medical, paramedical, and nonmedical) and to assess whether education and socioeconomic strata have any role in better awareness about BC or not. We did a prospective cross-sectional observation study among the medical, paramedical, and nonmedical women in the northern part of India. We designed a questionnaire keeping in mind the three domains about BC-knowledge (questions 1-25 include risk factors, genetics, lifestyle changes, hormones, associated cancers, and modes of presentation like lump, nipple/skin changes), breast self-examination (questions 25-37), and attitude to prevention and early detection (questions 38-44). We also asked how many do breast self-examination (BSE) and what they think are the three main factors responsible for late presentation and the three main ways to increase BC awareness. The Likert scale was used for objective assessment. We analyzed the whole data using SPSS software version 15. A total of 220 women out of 270 completed the questionnaire. Out of 220 women, 26.4% were medical, 20.9% paramedical, and 52.7% nonmedical. Most women were educated (82.7%) and married (65%). 59.5% women resided in urban areas and the rest (40.5%) were from rural areas. We found that there was relatively more knowledge in the medical group; however, the skills of BSE and attitude to prevention and early detection in all the three subgroups and among rural and urban women were suboptimal and not different significantly. The three main factors responsible for delayed presentation were shyness and not knowing BSE, ignorance about BC symptoms, and social stigma of cancer along with financial constraints. The three main ways to improve BC awareness suggested were to have more advertisements on television and social media, roadside campaigns and in colleges along with group discussions and debates, and at grassroots level to involve Anganwadi workers and nurses to create more awareness in villages. There was less breast cancer knowledge and awareness among the nonmedical women compared to those among the medical and paramedical, the skills of BSE and attitude to prevention and early detection were suboptimal in all the three groups. Rural or urban dwellings did not make much difference in BC knowledge, skills of BSE, and attitude to prevention. More awareness regarding breast cancer symptoms with early detection and BSE need to be addressed with more information dissemination via social media, campaigns, and involvement of paramedics and social workers.
RESUMEN
BACKGROUND: Cost data are useful in health planning, budgeting and for assessing the efficiency of services. However, such data are not easily available from developing countries. We therefore estimated the cost incurred for the year 1991-92 on a primary health centre in northern India, which is affiliated to an academic institution. METHODS: The total costs incurred included the capital costs for land, building, furniture, vehicles and equipment as well as the recurrent costs for salaries, drugs and vaccines, diesel and maintenance. Except for land, where the 'opportunity cost' was calculated, the current market rates were considered for all other factors. A discount rate of 10% was used in the study. RESULTS: A total of Rs 777,015 (US $24,282) was incurred on the primary health centre in the study year, 80% being recurrent costs. Salaries constituted 62% of the total costs. A sum of Rs 30 (US $0.94) per head per year on primary health care was being incurred. CONCLUSION: Salaries constitute the bulk of the cost incurred on health. Approximately Rs 28 (40%) of the Rs 69 spent per head per year on health services by the Government of India is incurred on providing primary health care services.
PIP: Primary health care in India is provided by a chain of primary health centers (PHC) which are staffed by a medical officer and para-professional health workers. The multipurpose workers (MPW) deliver health services such as immunization and antenatal care. Each male and female worker team serves a population of approximately 5000, while the PHC serves a population of approximately 30,000. The MPWs are supervised by two health assistants, one male and one female, while the medical officer supervises the workers and provides curative services. The authors report findings from their study of the cost of providing health care through the Chhainsa PHC of the Comprehensive Rural Health Services Project in Ballabgarh, Haryana, during 1991-92. Such data are useful in health planning, budgeting, and assessing the efficiency of services. The authors note that Chhainsa PHC caters to a population of 25,762 and that it is not a prototype of others in the country as it is run by a medical college, the All India Institute of Medical Sciences. Capital costs were assessed for land, building, furniture, vehicles, and equipment, as well as the recurrent costs for salaries, drugs, and vaccine, diesel, and maintenance. Current market costs were considered for all factors except land for which the opportunity cost was calculated. A 10% discount rate was used in the study. The analysis found that Rs 777,015 was incurred on the primary health center in the study year, 80% being recurrent costs. Salaries constituted 62% of total costs, drugs and equipment 10% of recurrent costs, and vaccines and other family welfare items 4% of the total annual costs. Salaries therefore consume the bulk of expenditures for health. It costs Rs 30 per head per year to run the PHC. This per head estimate is probably high compared to other PHCs in India. So, out of Rs 69 per capita currently spent on health in India, approximately 44% appears to be spent on primary health care.