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Devanbu VGC, R N, A S, Kumar N. Situational Analysis of Healthcare Delivery and User Perspectives of Mobile Diagnostics (mDiagnostics) in Chennai, Tamil Nadu, India: A Mixed-Method Study. Cureus 2023; 15:e45808. [PMID: 37876401 PMCID: PMC10591228 DOI: 10.7759/cureus.45808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Situational analysis of exciting infrastructure including mobile health services is crucial for comprehensive healthcare delivery. The concept of mDiagnostics has gained traction as it addresses the challenges of accessibility, affordability, and availability of healthcare services in remote regions. Purpose The study was to do a situational analysis of the availability of medical diagnostic facilities and identify the challenges and barriers faced in the implementation and utilisation of mDiagnostics. Material and methods The present study was a mixed mixed-method study conducted in rural and urban areas of Chennai, Tamil Nadu, India. A total of 1,489 households were included. Situational analysis of existing healthcare facilities and the availability of Ayushman Bharat Health Account (ABHA) numbers for study participants in both urban and rural areas was assessed. In-depth interviews on user perspective, affordability, awareness of existing health services, and perception of the utility of mobile lab services and focus group discussions with healthcare professionals, community members, and key stakeholders were carried out. Thematic analysis for qualitative data, proportion, and means were calculated for the quantitative component. Result Out of 1,489 households included, 711 were from rural areas, and 778 were from urban areas. The distance traveled from their residence to both the lab and health facility was less than 5 km in urban areas, while it is more than 5 km in rural areas. The mean expenditure in availing healthcare services is above five thousand rupees per annum in nearly half of the rural households (46%) and 60% of urban. The analyses of interviews explored the availability, acceptability, and affordability under seven thematic areas for situational analysis of healthcare facilities, and a focused group discussion was held to explore the community member's barrier to healthcare services. Conclusion The study reveals a comprehensive understanding of healthcare delivery access disparities between rural and urban areas in Tamil Nadu. The findings highlighted the potential benefits of mobile lab initiatives in improving healthcare access and early disease detection in underserved rural communities.
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Affiliation(s)
| | - Narendranath R
- Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, IND
| | - Sanjutha A
- Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, IND
| | - Neeta Kumar
- Social Health Implementation, Indian Council of Medical Research (ICMR), New Delhi, IND
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Thapa DK, Acharya K, Karki A, Cleary M. Health facility readiness to provide antenatal care (ANC) and non-communicable disease (NCD) services in Nepal and Bangladesh: Analysis of facility-based surveys. PLoS One 2023; 18:e0281357. [PMID: 36913361 PMCID: PMC10010536 DOI: 10.1371/journal.pone.0281357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Antenatal care (ANC) visits provide an important opportunity for diagnostic, preventive, and curative services for non-communicable diseases (NCDs) during pregnancy. There is an identified need for an integrated, system-wide approach to provide both ANC and NCD services to improve maternal and child health outcomes in the short and long term. OBJECTIVE This study assessed the readiness of health facilities to provide ANC and NCD services in Nepal and Bangladesh, identified as low-and middle-income countries. METHOD The study used data from national health facility surveys in Nepal (n = 1565) and Bangladesh (n = 512) assessing recent service provision under the Demographic and Health Survey programs. Using the WHO's service availability and readiness assessment framework, the service readiness index was calculated across four domains: staff and guidelines, equipment, diagnostic, and medicines and commodities. Availability and readiness are presented as frequency and percentages, while factors associated with readiness were examined using binary logistic regression. RESULTS Of the facilities, 71% in Nepal, and 34% in Bangladesh reported offering both ANC and NCD services. The proportion of facilities which showed readiness for providing ANC and NCD services was 24% in Nepal and 16% in Bangladesh. Gaps in readiness were observed in the availability of trained staff, guidelines, basic equipment, diagnostics, and medicines. Facilities managed by the private sector or a Non-Governmental Organization, located in an urban area, with management systems to support the delivery of quality services were positively associated with readiness to provide both ANC and NCD services. CONCLUSION There is a need to strengthen the health workforce by ensuring skilled personnel, having policy, guidelines and standards, and that diagnostics, medicines, and commodities are available/provided in health facilities. Management and administrative systems are also required, including supervision and staff training, to enable health services to provide integrated care at an acceptable level of quality.
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Affiliation(s)
- Deependra K. Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
- * E-mail:
| | | | - Anjalina Karki
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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Venkatesh U, Grover A, Vignitha B, Ghai G, Malhotra S, Kishore J, Jaswal N, Yashwanth RD, Durga R, Goel S, Kishore S. Urban-rural disparities in blood pressure and lifestyle risk factors of hypertension among Indian individuals. J Family Med Prim Care 2022; 11:5746-5756. [PMID: 36505536 PMCID: PMC9730999 DOI: 10.4103/jfmpc.jfmpc_573_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aims to assess the urban-rural difference in prevalence of hypertension (HT) and to explore the disparities in lifestyle risk factors of HT among urban and rural individuals aged 15-49 years in India. Study Design The cross-sectional data collected as a part of the fourth round of National Family Health Survey (NFHS-4) was analysed in this observational study. NFHS-4 was conducted between January 2015 and December 2016 amongst men aged 15-54 years and women aged 15-49 years. In order to maintain uniformity, age group of 15-49 years was considered. Descriptive analyses were performed for sociodemographic and lifestyle factors. Binary logistic regression was conducted to assess the predictors of HT in men and women in urban and rural settings. The presence of HT was considered as the outcome variable. Results The overall age adjusted prevalence of HT was 17.2% and was greater in urban (18.3%) than in rural population (15.5%). The age adjusted prevalence was also higher in males (18.2%) as compared to females (16.1%). Age and wealth were associated with HT in both urban and rural population. Education and dietary habits played a role in all except rural men. Alcohol consumption, diabetic status and marital status were significantly associated with HT in both urban and rural women. Occupation was associated with HT only in urban women. Conclusions The study has shown higher HT prevalence in urban areas despite higher prevalence of lifestyle risk factors in rural settings. This calls for more robust screening and health education in the entire population, especially in rural areas.
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Affiliation(s)
- U. Venkatesh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Ashoo Grover
- Scientist F, Division of Non Communicable Disease, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - B. Vignitha
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Glory Ghai
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jugal Kishore
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nidhi Jaswal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - R Durga
- Department of Paediatric and Prevention Dentistry, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Adjunct Clinical Associate Professor, Public Health Master’s Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. Honorary Professor, Faculty of Human and Health Sciences, Swansea University, United Kingdom. E-mail:
| | - Surekha Kishore
- Executive Director, All India Institute of Medical Sciences, Gorakhpur, India
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Irani F, Coquoz E, von Wolff M, Bitterlich N, Stute P. Awareness of non-communicable diseases in women: a cross-sectional study. Arch Gynecol Obstet 2022; 306:801-810. [PMID: 35426002 PMCID: PMC9411077 DOI: 10.1007/s00404-022-06546-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.
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Affiliation(s)
- Fiona Irani
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Eloïse Coquoz
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | | | - Petra Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.
- Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital Inselspital, Friedbuehlstrasse 19, 3010, Bern, Switzerland.
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Wu J, Duan W, Jiao Y, Liu S, Zheng L, Sun Y, Sun Z. The Association of Stage 1 Hypertension, Defined by the 2017 ACC/AHA Guidelines, With Cardiovascular Events Among Rural Women in Liaoning Province, China. Front Cardiovasc Med 2021; 8:710500. [PMID: 34458337 PMCID: PMC8387632 DOI: 10.3389/fcvm.2021.710500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines redefined blood pressure levels 130-139/80-89 mmHg as stage 1 hypertension. However, the association of stage 1 hypertension with cardiovascular disease (CVD) and its age-specific differences among the rural women in Liaoning province remains unclear. It needs to be quantified in considering guideline adoption in China. Methods: In total, 19,374 women aged ≥35 years with complete data and no cardiovascular disease at baseline were followed in a rural community-based prospective cohort study of Liaoning province, China. Follow-up for the new cases of CVD was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2008–December 31, 2017). Adjusted Cox proportional hazards models were applied to estimate the Hazard Ratios (HR) and 95% Confidence Intervals (CI) with the normal blood pressure as a reference. Results: During the median follow-up period of 12.5 years, 1,419 subjects suffered all-cause death, 748 developed CVD, 1,224 participants suffered stroke and 241 had Myocardial Infarction (MI). Compared with normal BP, Stage 1 hypertension had a HR (95% CI) of 1.694 (1.202–2.387) in CVD mortality, 1.575 (1.244–1.994) in the incidence of stroke. The results obtained that the risk of CVD mortality and incidence of stroke was significantly associated with stage 1 hypertension in rural women aged ≥45 years after adjusting for other potential factors. However, in participants aged 35–44 years, stage 1 hypertension was not associated with an increased risk of cardiovascular disease. Conclusions: The newly defined stage 1 hypertension is associated with an increased risk of CVD mortality and also incidence of stroke in the rural women aged ≥45 years population of Liaoning province. This study can be a good reference for health policy makers and clinicians workers to make evidence-based decisions toward lowering burden of cardiovascular disease more efficient, timely measures on prevention and control of stage 1 hypertension in China.
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Affiliation(s)
- Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weili Duan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - SiTong Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - LiQiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YingXian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - ZhaoQing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
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Basu P, Tripathi R, Mehrotra R, Ray K, Srivastava A, Srivastava A. Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context. Cancer Causes Control 2021; 32:429-440. [PMID: 33528692 DOI: 10.1007/s10552-021-01399-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
Breast cancer is the most frequently diagnosed cancer among women in both transitioned and transitioning countries and has become a major women's health problem. Although recent advances in our understanding of the biological nature of cancer, improved awareness coupled with better early detection facilities, use of chemotherapy, hormone therapy, and targeted therapy have significantly improved survival from cancer, there are many gaps in providing individual-centric, holistic care. Integrative medicine refers to the use of traditional medicine alongside conventional preventive or therapeutic interventions (allopathic medicine) as a comprehensive, individual-centered, evidence-based care. The three pillars of complementary medicine (lifestyle modifications, mind-body practices, and use of natural products) have the potential for cancer prevention and improving quality-of-life and even treatment response in cancer patients when combined with conventional oncology care. Therefore, continued research into integrative therapies is required to extend the benefits to a broader patient population and improve outcomes in breast and other common cancers. In the present review article, the possible role of integrative medicine across the breast cancer care continuum has been discussed along with the concept of integrating complementary practices into mainstream health delivery. We have focused on breast cancer as a model cancer that is well amenable to prevention, early detection and stage appropriate treatment. However, our observations are pertinent for other common cancers, for which there are several opportunities for improving the continuum of care, especially in developing countries like India.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | | | - Ravi Mehrotra
- ICMR-India Cancer Research Consortium, New Delhi, India
| | | | - Anurag Srivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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