Assessing Barriers to Mental Healthcare Interventions for Deaf People in Ghana

While mental health issues are increasingly gaining attention in Ghana, little is known about the situation among deaf people. This study assessed the mental health care needs of deaf people in Ghana. A descriptive design, consisting of interviews and focus group discussions, was used to collect data from 97 participants. Findings indicated that participants had limited knowledge on mental health issues. Mental health stigma, inaccessible mental health information and exclusion from mental health programmes were the major barriers hindering access to mental health care services. This study bridges the knowledge gap and provides evidence for the implementation of deaf-friendly services.

Universal Health Coverage in Somalia: Charting the Path to Equitable Healthcare Financing and Governance

Somalia is a country facing numerous challenges in achieving universal health coverage (UHC) and ensuring adequate healthcare financing, This article explores the complexities and obstacles that Somalia must overcome in its pursuit of UHC, the paper begins by providing an overview of the current healthcare landscape in Somalia, highlighting the lack of infrastructure, political instability, and limited financial resources that hinder the establishment of a comprehensive and equitable healthcare system. It then examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while emphasizing the need for a more sustainable, domestically financed solution. Drawing on a range of data sources and case studies, the article proposes a multi-faceted approach to strengthen healthcare governance, improve resource allocation, and foster local capacity building, the study delves into the unique obstacles that Somalia faces, including a lack of infrastructure, political instability, and limited financial resources, which hinder the establishment of a comprehensive and equitable healthcare system. The paper also examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while highlighting the need for a more sustainable, domestically financed solution. The findings underscore the importance of political commitment, international cooperation, and innovative financing mechanisms in advancing towards UHC in Somalia, providing valuable insights for other low resource, conflict affected settings.

The effect of self-employment on health, access to care, and health behavior

The focus of this paper is to investigate the role self-employment conceptualized as a lifestyle factor on health, access to health care, and health behaviors. We analyze rich data on 13,435 working adults in the US, who are either selfemployed or salaried workers. Outcomes include physical and mental health perception, validated indexes of physical and mental health, and medical conditions;access-to-care measures such as a barrier to obtaining necessary health care;and health behaviors such as smoking, physical activity and body mass index. Instrumental variables methods are used to correct for selection into self-employment. We find that self-employment is positively associated with perceived physical health, and is negatively associated with having diabetes, high blood pressure, high cholesterol and arthritis. No mental health outcome is significantly associated with self-employment. There is no significant difference between self-employed and wage-earning individuals with regard to access to care. Self-employed individuals are less likely to smoke, and are more likely to participate in physical activity and have normal-weight. We conclude that despite lack of health insurance, self-employed persons in the US are as healthy as wage-earners, do not experience a greater barrier to access to care, and are more likely to engage in healthy behavior.

Physical Accessibility for Disabled People: Analysis of Toilet Facilities in Primary Health Care Units

Background: Accessibility enables the effective participation of disabled persons in public and private areas and the use of urban equipment and street furniture. Objective: This study aimed to analyze the physical accessibility of toilet facilities in urban and rural primary health care units. Methods: It was a quantitative descriptive study conducted in 157 Primary Health Care Units of 16 municipalities in the Baturité Massif region, Ceará, Brazil. The study took place from August 2014 to May 2015, with a checklist type form, designed from the Technical Standard 9050 of the Brazilian National Standards Organization, specifying the ideal access conditions established by law to allow mobility of persons with physical disabilities. Data were processed through the Statistical Package for the Social Sciences software and organized into tables. Results: Toilets designed for physically disabled people were accessible as the location and signs (59.9%), identified with symbols for males and females (57.3%);however, the doorway width was smaller than needed to accommodate a wheelchair (77.7%). Inside the bathroom, only the forward approach was possible (59.9%). Grab bars positioned on the side and rear walls were inadequate or nonexistent (67.6%);toilet seats (91.1%) and toilet paper dispensers (96.2%) were mostly in inaccessible heights;flush controls in appropriate height (59.2%) and activated by light pressure (58%). Sinks without pedestal (51%), but higher than recommended (80.3%) and without single handle faucets (95.6%). It was verified that the toilets of basic health units located in urban areas had better accessibility conditions compared to those in rural areas. Conclusion: Results showed that the analyzed units presented physical inaccessibility in some toilet facilities, making it difficult or even impossible the accessibility for the disabled. The inclusion of accessibility features in health services for this clientele provides equal opportunities and social inclusion.

Integration of Location-Allocation and Accessibility Models in GIS to Improve Urban Planning for Health Services in Al-Madinah Al-Munawwarah, Saudi Arabia

In this study, accessibility and location-allocation models have been integrated into GIS to improve spatial planning and environmental sustainability of health services in Al-Madinah Al-Munawwarah. This integration provides a planning framework in order to check the efficiency of the spatial allocation of health services and to generate alternatives either by proposing an active service or to improve an existing one. To achieve these objectives, the accessibility to the service area was analyzed within the analysis of health services networks, which are divided into eight types: public hospitals, specialized hospitals, health units, healthcare centers, infirmaries, clinic complexes, the Red Crescent Center, and ambulance facilities, with time intervals of (5 minutes - 10 minutes - 15 minutes) to access coverage ranges, and the location-allocation model was used based on the maximum coverage model within a response time not exceeding 15 minutes, The results of the study revealed the poor distribution of health services Al-Madinah Al-Munawwarah suffers from weak accessibility to health services coverage areas and is unable to meet the needs of its population at present. The current need for health services reached twenty-four locations, including two public hospitals, three specialized hospitals, two health centers, three ambulance facilities, four infirmaries, three clinic complexes, four health units, and three Red Crescent centers.

Enriching online access to health information for the public: Efforts from a medical library in China

Purpose: Disseminating medical and health information is a mission of a public medical library. This paper describes a practice of a medical library in providing online access to health information for the general public.Design/methodology/approach: A four-step workflow is developed to integrate and disseminate heterogeneous health information from medical associations. First, a raw data repository is developed to manage the original submissions from information providers.Second, each document in the raw data repository is represented in a standardized XML schema. Third, the medical terms are identified and manually annotated, enriching the semantics of health information. Lastly, all the semantically enriched XML documents are converted to HTMLs for online dissemination.Findings: A health information website, CHealth, was developed for Chinese speakers. It provides free online access for all without any login or IP constrains. CHealth is available at www.chealth.org.cn.Research limitations: The current workflow is time-consuming and labor-intensive due to the lack of information submission/exchange standard and commonly agreed-on consumer health terminology in Chinese.Originality/value: In this work, the target audience of the medical library has been extended from traditional academic/professional to the general public. Methodologies in library sciences have been combined with those in consumer health informatics in CHealth development.

Assessment of the Accessibility of Users in Primary Health Care

Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.

Structural Accessibility of Gynecological Nursing Clinics for Users with Motor Disabilities in Basic Health Units

A quantitative descriptive study aimed to evaluate the physical structure accessibility of gynecological nursing clinics and their bathrooms in basic health units for users with motor disabilities. A checklist tool/instrument was applied for analyzing 16 items in the bathroom and four in the nursing clinic. 157 basic health units were evaluated. In the nursing clinic, counters and tables (79.6%) were accessible, but stretchers (93%), seats (93.6%) and doors (87.3%) were inaccessible;moreover, 17.8% of the units examined proved totally inaccessible. In the bathroom, the items with the best evaluation were the height of the toilet flusher (47%) with operation by slight pressure (44.6%) and the wall-mounted sink (42.7%). Bathroom doors and turning area/space for wheelchairs were inaccessible. No bathroom reached full accessibility, and 31.2% were entirely inaccessible. Non-compliance was evident of the standard 9050:2004 of the Brazilian Association of Technical Standards. Raising the awareness of health and engineering professionals is recommended to learn technical accessibility standards and implement them.

Milk Replacer Acidification for Free-Access Feeding: Effects on the Performance and Health of Veal Calves

Objectives of this study were to investigate the effects of milk replacer (MR) acidification for free- access feeding on pre- and post-weaning performance, morbidity and mortality of calves. Calves were randomly assigned to free-access feeding of acidified (ACID, n = 31) or non-acidified (NON, n = 31) MR, and weaned at 42 days. ACIDMR was prepared to pH 4.0 - 4.5 using formic acid. Intakes were measured daily and weights weekly. Samples of ACID and NON MR were analyzed for coliform and aerobic bacterial growth. After weaning, calves transitioned to a grain-fed veal diet, weighed every 2 weeks. At slaughter (approximately 6 months of age), lungs were evaluated for gross pathological changes and dressed carcass weights were obtained. Generalized linear mixed models were constructed to examine the effects of MR acidification. Differences by treatment group for pre- and post-weaning morbidity and mortality were tested using Pearson’s χ2 and Fisher’s exact tests. ACID calves consumed less MR than NON (10.6 vs. 11.7 L/d, P = 0.02). Acidification tended to promote earlier onset of starter ration consumption (32.0 vs. 39.5 d, hazard ratio = 1.5, P = 0.07), but did not affect average daily starter ration or water intakes across the pre-weaning period. ACID and NON calves did not differ for BW at weaning, pre- or post-weaning ADG or dressed carcass weight. ACID MR had less coliform (P < 0.001) and aerobic bacterial growth (P < 0.001) than NON MR, but odds of disease treatment and mortality did not differ. ACID calves tended to have lower odds of pulmonary lesions during post-mortem inspection than NON calves (OR = 0.3, P = 0.07). These results indicate that under free-access feeding conditions, acidification limited bacterial growth and MR intake, but there were no long-term impacts of acidification on calf performance or health. In conclusion, acidification to pH 4.0 - 4.5 will significantly reduce bacterial growth in milk fed to calves.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Health Status and Access to Health Services in Indian Slums

This paper analyzes the state of health and access to health services among the urban poor in India. Analysis is based on data from a primary survey conducted among 2000 households, covering 10,929 individuals from four cities of India. Summary statistics and regressions (using STATA) are used for data analysis. Results show lack of government facilities and services, a very high preference for private health facilities, high expenses especially in private but also in public facilities, and a perception that private facilities are offering high quality services as important concerns. An econometric analysis of the determinants of acute illness indicates the insufficiency of basic amenities like sanitation, garbage disposal and potable water. Together with the lack of availability of government health facilities in the vicinity, these results indicate continued vulnerability of the urban poor, and the need for urgent government action.

Accessibility and availability of health care services to internally displaced persons, in Kitgum and Pader districts, northern Uganda

Introduction: During 1986-2009, an estimated 1.6 million persons were internally displaced from northern and eastern regions of Uganda due to civil war. We investigated accessibility to and availability of health care services for the internally displaced persons in Kitgum and Pader districts, northern Uganda. Methods: This was a cross-sectional study conducted in Kitgum and Pader districts, northern Uganda. We interviewed a total of 1383 respondents comprising 968 (70%) adults and 415 (30%) adolescents;60% were females and 40% males, randomly selected from 35 of 67 (52.2%) internally displaced persons (IDP) camps. We held 27 key informant interviews and 52 focus group discussions. Data were entered in EPI data version 3.02 and analysed using SPSS version 12.00 statistical packages. Findings: Two thirds of the respondents 67.5% lived within 5 km distance of a health facility. The majority 62.9% of respondents mentioned that health related information was readily provided. 43.5% of health providers were always available in a health facility. A quarter 25.1% of health facilities always had drugs available, while 56.9% of the drugs prescribed were always available. Two thirds of the respondents 65.9% were satisfied with the health care services provided. The main reasons for the choice of a health facility were proximity 29.6%, provision of free treatment 24.7% and availability of drugs 17.2%. Main barriers to health care access were due to the lack of financial resources, trained personnel, and inadequate drugs and supplies in the health facilities. Conclusions and Recommendations: The majority of IDPs lived in close proximity to health facilities and obtained health care services from public health facilities. Access to health care was determined mainly by proximity and availability of free services and drugs. Although geographic accessibility to health services was high, lack of finances, information and decision power hindered access to health care services.

Healthcare access and the patterns of maternal health care utilization among poor and non-poor women living in urban areas in Portugal

Introduction: Studies on attitudes and practices are increasingly used but not specifically related to the motivations for the use of reproductive health care among women of fertile age, living in urban areas and in different social contexts. Objectives: The aim of this study was to estimate the associations between the variables of social status (degree of poverty in the studied groups) and the variables of fecundity (representations, tensions, practices and control of fertility) and, in addition, to compare access to health care in the different studied groups, assessing the association between use of maternal health care and poverty in urban areas. Design: A case-control study was conducted in the Municipality of Lisbon, Portugal, with a total sample of 1513 women of fertile age: 499 cases of women considered very poor were selected from the database of beneficiaries of RSI (Social Welfare Payment for Inclusion);1014 controls (two controls for each selected case), divided as 507 poor women selected from the other beneficiaries of Santa Casa da Misericórdia in Lisbon and 507 non-poor women selected from four Health Centers from the Municipality of Lisbon, Portugal. A total of 1054 women answered the questionnaire: 304 cases (response rate of 61%) and 750 (response rate of 74%) controls. The statistical analysis involved descriptive analysis and multinomial logistic regression. Results: The analysis confirms the association between poverty and patterns and representations of fecun dity regarding pregnancy planning. The results of this study thus show the existence of different distributions on several variables and the gradients of poverty. Regarding access to health care, the major impact of poverty on women is limiting access to pharmaceuticals. The incapacity to afford the cost of health care appears as a central aspect of access to health care. Conclusion: A number of factors seem to be associated with poverty in women, such as ethnicity, single motherhood, low household income, low household size, low educational level of women and marital status. The association of poverty with not planning the pregnancy of the last child on one hand and large household size on the other hand points to a vicious circle that sustains poverty and leads to extreme poverty. Limited financial access to health care seems to mediate the association between women’s poverty and low coverage with family planning as well as the lack of access to safe termination of pregnancy.

Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Access to Supportive Health Services for People with Physical Disabilities: A Case of Health Facilities in Singida Rural District, Tanzania

Background: It is estimated that above one billion people (15%) of the world’s populations are living with disabilities. The poor and unfriendly infrastructure at health facilities is the core challenge for people with physical disabilities in accessing healthcare. This study aimed to explore at what extent the existing infrastructure and design of health facilities in Singida rural district, Tanzania supports people with physical disabilities to access healthcare. Methods: A cross sectional health facility-based assessment of all thirty-two functioning health facilities in the district was done between June and December 2020 using observational checklist and key informants’ interviews consist of measurement procedures of the architectural condition of health facilities. Observation checklist was designed based on standard of health facilities in Tanzania, national guideline for safe care standards for dispensaries, health centers and district hospital of 2014 and national guideline for water, sanitation and hygiene in healthcare facilities of 2017. Data were analyzed by SPSS-26 using descriptive statistics to obtain frequencies tables, percentage and figure. Qualitative data were analyzed by using NVivo-12 software. Results: The study revealed that there was no signage, entrance area, parking and toilets designated for people with physical disabilities in all health facilities. There was no special seat, examination table/bed and special weight scale for people with physical disabilities in all facilities. Also, the doors were not wide enough to support wheelchair user to maneuver in all health centers and dispensaries. In addition, door handles were not user friendly for wheelchair users. In fact, only the hospital and health centers had wheelchairs while 27 (96.4%) of all dispensaries had no wheelchairs. Furthermore, ramp and pathways were not available in all dispensaries. All health facilities had stairs but the challenge was most of the staircases had no floor located before the steps. Conclusion: The study revealed that the infrastructures in most healthcare facilities pose challenges to people with physical disabilities when they access healthcare services. These findings call for need of improving health facilities’ infrastructure to accommodate people with physical disabilities and this should be given a priority.

China to Create an Access System for the Reproductive Health Industry Based on Quality Accreditation

Zhang Weiqing, director of the National Population and Family Planning Commission (NPFPC), disclosed at the inaugural meeting of the China Reproductive Health Industry Association (CRIA), held on March 26, 2007, that China will create an inspection system, a quality accreditation system, and an industry access system for better population structure and family planning.……

Accessibility Analysis of Healthcare Delivery System within Enugu Urban Area Using Geographic Information System

The problem of accessibility of health institution, with respect to the available facility to serve the entire population leaving in an area, can be solved using GIS. This paper presents an analysis on accessibility of healthcare facilities in Enugu urban area in a GIS environment. This was achieved through acquisition of a base map of Enugu State showing geographic extent of Enugu Urban, determining the geometric positions of health institutions in Enugu urban using handheld GPS, Creation of a spatial database of existing healthcare facilities and demonstrating through various analyses the potentials of GIS in measurement of accessibility to healthcare facilities in Enugu urban Area. The analysis includes network analysis, used to determine the closeness of a facility and shortest route to these healthcare facilities. ARCGIS 9.3 was the main software used. This was supported by Geocal for coordinate conversion and Microsoft office packages. The result of the study showed the spatial distribution of health institutions, closest facilities in case of emergency and route to those health institutions within Enugu urban Area. It was noticed that most of the healthcare facilities were located within Enugu North local government area (LGA). Other settlements and LGAs had fewer healthcare facilities. Areas deprived of healthcare facility were also identified. Routes and closest facilities to those deprived areas were identified in the settlements/area. The analysis showed the efficacy of GIS in determining accessibility of healthcare institutions in Enugu urban area. The study is thus, recommended as a spatial decision support system for decisions regarding spatial accessibility of healthcare facilities in an urban area.

In Bangla There Is No Word for Vagina —Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries

Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.

Double Tragedy: Examining the Effects of Mental Health Stigma on Help Seeking Behaviour among Deaf People in Ghana

Background: Globally, mental health is recognized as one of the major public health issues, and mental health stigma is one of the main barriers to mental healthcare. While several studies have been conducted on the stigma associated with mental health, very little is known about the mental health stigma experienced by deaf persons with mental health conditions in Ghana. This study examines the experiences of double stigmatization by deaf people with mental health conditions in Ghana. Methodology: A descriptive, mixed method data collection was used for seventy-nine (79) participants. The paper presents findings from the only qualitative component of the study. Results: The findings from the study showed that deaf people with mental illness experienced double stigma, namely being stigmatized for being deaf and for having mental illness. This hindered access to mental health services for deaf people with mental health condition. Conclusion: Deaf people with mental health conditions experience double stigmatization which discourages them from seeking professional psychiatric care. This implies that efforts to reduce mental health stigma and create awareness on deafness should be improved upon. It is recommended that, in view of the impact of stigma on the provision and use of mental health care services, strategies to improve access to mental health care, should seriously consider concerns about stigma.

医疗服务可及性对老年人生活满意度的影响

提升老年人生活满意度是积极应对人口老龄化的重要举措。使用2014年和2018年中国老年人健康影响因素跟踪调查(CLHLS)数据,探究医疗服务可及性对老年人生活满意度的影响及其作用机制,结果表明:医疗服务可及性对老年人生活满意度存在积极影响,地理可及性和知识/服务可及性均能显著提升老年人生活满意度;提升医疗服务可及性能够有效改善老年人的健康状况,进而提升老年人的生活满意度。异质性分析表明,医疗服务可及性对有充足经济来源、有家人照料以及有情感支持的老年人生活满意度的影响更大。因此,提升老年人的生活满意度可从以下几方面入手:大力推进医疗服务的可及性与均等化,优化医疗资源的配置;加强健康保健知识的宣传教育,提升医疗服务的利用率;同时加快建设友好型社区,充分发挥家庭、社区的功能,鼓励老年人积极参与社会活动,提升老年人的生活品质。