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Determinants of Health Care-Seeking Delay among Tuberculosis Patients in Rural Area of Central China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091998. [PMID: 30217043 PMCID: PMC6164791 DOI: 10.3390/ijerph15091998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
Abstract
Background The prevalence of tuberculosis (TB) in low and middle-income countries is a significant public health and social concern. TB is a common infectious disease caused by the Mycobacterium tuberculosis infection, which has a widespread infection rate. Health care-seeking delay maybe one of the most important neglected risk factors for the spread of TB. Objectives The aim of this study was to understand the situation of health care-seeking delay among rural tuberculosis patients in Hubei Province, and explore its risk factors. Methods A total of 1408 rural tuberculosis patients were surveyed using a standard structured questionnaire in three cities of Hubei Province during the past two years. Results For the 1408cases of pulmonary tuberculosis, 39.70% of them were health care-seeking delayed. Logistic regressions indicate that the Han nationality, farming careers, the over 45 min walk to the township’s hospital, and awareness of the national TB free treatment policy, were significantly associated with higher odds of a delay in care seeking. Conclusions The prevalence of health care-seeking delay among tuberculosis patients was high in rural areas. It is essential to take comprehensive targeted interventions to reduce care-seeking delay.
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Sheikh K, Josyula LK, Zhang X, Bigdeli M, Ahmed SM. Governing the mixed health workforce: learning from Asian experiences. BMJ Glob Health 2017; 2:e000267. [PMID: 28589031 PMCID: PMC5435263 DOI: 10.1136/bmjgh-2016-000267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 01/28/2023] Open
Abstract
Examination of the composition of the health workforce in many low and middle-income countries (LMICs) reveals deep-seated heterogeneity that manifests in multiple ways: varying levels of official legitimacy and informality of practice; wide gradation in type of employment and behaviour (public to private) and diverse, sometimes overlapping, systems of knowledge and variably specialised cadres of providers. Coordinating this mixed workforce necessitates an approach to governance that is responsive to the opportunities and challenges presented by this diversity. This article discusses some of these opportunities and challenges for LMICs in general, and illustrates them through three case studies from different Asian country settings.
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Affiliation(s)
- Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - Lakshmi K Josyula
- Previous affiliation: Indian Institute of Public Health, Hyderabad, Public Health Foundation of India; Present affiliation: The George Institute for Global Health, Hyderabad, India
| | - Xiulan Zhang
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Maryam Bigdeli
- Past: Alliance for Health Policy and Systems Research, WHO; Present: Department of Health Systems Governance, Policy and Aid Effectiveness, World Health Organization (WHO), Geneva, Switzerland
| | - Syed Masud Ahmed
- Centre of Excellence for UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Lakshmi JK, Nambiar D, Narayan V, Sathyanarayana TN, Porter J, Sheikh K. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries. Health Policy Plan 2014; 30:1067-77. [PMID: 25171821 DOI: 10.1093/heapol/czu096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/15/2022] Open
Abstract
This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with distinct and unaligned notions of evidence and efficacy, and ethical and operational challenges of the administration of a plural workforce.
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Affiliation(s)
- Josyula K Lakshmi
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Devaki Nambiar
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Venkatesh Narayan
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tamysetty N Sathyanarayana
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - John Porter
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Kabir Sheikh
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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