Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

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.

Predictors of antenatal health service utilization among left-behind wives of male outmigrants:Evidence from Patna District,India

Objective:To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care(ANC)services utilization.Methods:A cross-sectional survey was conducted in rural regions of the Patna district,India.The sample size(n=328)was estimated using Cochran’s formula.Five parameters of the social support system were identified(autonomy,spousal support,family support,social circle support,and government support).The score for each was calculated as a composite score using multiple variables;these served as independent variables.The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.Results:The regression results showed that four out of five social parameters had a significant effect on ANC behavior.Spousal support was the strongest predictor(standardized regression coefficient β=0.57,OR 1.16,95%CI 1.08-1.79,P=0.007).Government support was found to be the second strongest predictor(β=0.40,OR 1.49,95%CI 1.04-2.14,P=0.027),followed by family support(β=0.31,OR 1.36,95%CI 1.23-2.57,P=0.034)and autonomy(β=0.11,OR 1.32,95%CI 1.11-2.26,P=0.030).The social circle support was found to be non-significant in predicting ANC behavior(P>0.05).Conclusions:The policymakers could focus on the identified predictors to strengthen and modify the existing policies for leftbehind wives of male outmigrants.The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net.One strategy we suggest is to launch an awareness campaign focusing on husbands(male outmigrants)and family members.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Public satisfaction with the quality of First Health Facility Services in Indonesia: Does sociodemographic matter?

Objective:To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.

Ontological Model for Cohesive Smart Health Services Management

Health care has become an essential social-economic concern for all stakeholders(e.g.,patients,doctors,hospitals etc.),health needs,private care and the elderly class of society.The massive increase in the usage of health care Internet of things(IoT)applications has great technological evolvement in human life.There are various smart health care services like remote patient monitoring,diagnostic,disease-specific remote treatments and telemedicine.These applications are available in a split fashion and provide solutions for variant diseases,medical resources and remote service management.The main objective of this research is to provide a management platform where all these services work as a single unit to facilitate the users.The ontological model of integrated healthcare services is proposed by getting requirements from various existing healthcare services.There were 26 smart health care services and 26 smart health care services to classify the knowledge-based ontological model.The proposed ontological model is derived from different classes,relationships,and constraints to integrate health care services.This model is developed using Protégébased on each interrelated/correlated health care service having different values.Semantic querying SPARQL protocol and RDF query language(SPARQL)were used for knowledge acquisition.The Pellet Reasoner is used to check the validity and relations coherency of the proposed ontology model.Comparative to other smart health care services integration systems,the proposed ontological model provides more cohesiveness.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

The Management of Mental Health, and Service Networks in Italy

Madness has attracted and frightened for centuries,and talking about this means discussing how this diversity was built and managed in different social contexts and historical periods.Not all societies have had,and still have,the same relationship with madness.It is only with the affirmation of the Modern State,and of Capitalism,that the idea of“normality”indispensable to be able to conceive diversity as something dangerously distant and different from the norm takes over.In our post-modern society,people with mental illness in Italy can resort to specialists and social-health services.But the heterogeneous answers given after the approval of law 180 appear to be increasingly diversified.In this research,much attention will be paid to how the social and health services,located in different areas of Italy(Messina,Rome,Trento)face the current growing risk of social,housing and economic isolation of these fragile subjects.The aim of the research is to explore the possibility of a new relationship between the social-health service and the local community.On the one hand,research investigates what the contribution of the services could be.On the other what the spaces of protagonism and participation of the community could be in inclusion process account.In order to better understand the differences between these two dimensions,a qualitative research approach was chosen through the conduct of in-depth interviews.In this way it was possible to investigate:(1)the partial representations characteristic of the single individual,family members,operators and stackholders in general;(2)the services around the topic dealt with is articulated.From the first results of the research it emerges that the territory can no longer be considered as an abstract entity,but becomes the social space within which the construction of a new community welfare can and must take place.

Exploring the association of paid sick leave with healthcare utilization and health outcomes in the United States:a rapid evidence review

Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.

Research progress on the health status and community management service needs of mobile elderly people

The health status of the floating elderly population and the need of community management services are complex and important problems.Owing to the change of living environment and the insecure medical care,the mobile elderly people have more health and psy-chological problems compared to the rest of the elderly population.Therefore,the community should take a variety of measures to meet their needs and help them to better adapt to the new living environment,and maintain their physical and mental health.This paper aims to summarize recent studies on the physical and emotional health problems of mobile elderly people and related community management service needs.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Chronic Diseases, Health Status and Health Service Utilization among Koreans

This study described the self-reported chronic diseases and health status and examined the factors that are associated with effective health service utilization. Descriptive and logistic regression analysis was performed to determine the factors significantly associated with self-rated health, in-patient and out-patient utilization. Self-rated health status was ranked lower among rural residents, lower-income families, married persons, and those with chronic diseases. Chronic diseases such as hypertension, arthritis, melancholy, and diabetes were common and they are associated with poor health of Koreans. The presence of chronic diseases was significant in predicting the likelihood of poor health while socio-economic factors, rather than health-related need factors, had more predictive power of the use of health services. This study provides a unique contribution to the knowledge base of the Korean population. The study findings show that Koreans in poor health status were married, living in rural areas, having chronic diseases and lower income, with a high likelihood of health care utilization among employed individuals, which could significantly help in the public health policy required to address this issue.

Enhancing pediatric asthma management through multifaceted health education

BACKGROUND Pediatric asthma is a significant public health issue that impacts the quality of life of children globally.Traditional management approaches focus on symptom control and medication adherence but often overlook the comprehensive educational needs of patients and their families.A multifaceted health education approach may offer a more holistic strategy in managing pediatric asthma,especially in outpatient settings.AIM To evaluate the efficacy of a comprehensive health education strategy in improving disease management,medication adherence,and quality of life among children with asthma in outpatient settings.METHODS In total,100 pediatric patients with severe asthma were enrolled from January 2021 to November 2022 and randomly allocated to a control group(n=50)or an observation group(n=50).The control group received standard nursing care,including basic nursing interventions and health education upon admission.In contrast,the observation group was exposed to a broad spectrum of health education methodologies,including internet-based hospital systems,social media channels,one-on-one verbal education,informational brochures,slide present ations,telephone check-ins,animated videos,and illustrated health education manuals.Data on asthma management knowledge,symptom control,quality of life[St.George’s Respiratory Questionnaire(SGRQ)],treatment adherence,and nursing satisfaction were collected and analyzed.RESULTS The scores of the observation group in knowledge areas,such as medication,home care,disease understanding,symptom management,prevention strategies,and nutritional guidance,were significantly higher than those of the control group(P<0.05).In addition,the observation group exhibited greater symptom control,improved quality of life based on their SGRQ scores,and higher treatment adherence post-intervention(P<0.05).Nursing satisfaction was also rated higher in the observation group across all evaluated areas(P<0.05).CONCLUSION Implementing a diversified health education approach in pediatric asthma management significantly enhances disease understanding,symptom management,and treatment adherence,leading to improved quality of life for affected children.These findings underscore the importance of multifaceted clinical health education in augmenting disease awareness and facilitating continuous improvements in asthma control rates,highlighting the potential benefits of incorporating comprehensive educational strategies into pediatric asthma care protocols.

Gender differences in mental health service utilization among respondents reporting depression in a national health survey

This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Reproductive Health Service Utilization and Social Determinants among Married Female Rural-to-urban Migrants in Two Metropolises,China

Reproductive health（RH） education and services of female migrants in China have become an important health issue.This research aimed to investigate the RH knowledge and utilization among married female migrants,and to explore the influencing factors from the perspectives of population and sociology.We conducted a cross-section survey in Shenzhen and Wuhan,China,using the purposive sampling method.A total of 1021 rural-to-urban married migrants were recruited,with 997 valid survey results obtained.A face-to-face structured questionnaire survey was used,with primary focus on knowledge of fertility,contraception,family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome（STD/AIDs）,and RH service utilization.The results showed that the RH service utilization（38.0%） was at a low level in married migrants and the accessibility of RH service was poor.Females who migrated to（OR=0.32） Wuhan obtained fewer RH consultations than those in Shenzhen.The workers with high school education received additional RH consultations and checkup services than those with other background education,apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers（P〈0.05）.We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China.RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.