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Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery
INTRODUCTION: There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this s...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583072/ https://www.ncbi.nlm.nih.gov/pubmed/33093032 http://dx.doi.org/10.1136/bmjopen-2020-038470 |
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author | Ensor, Tim Virk, Amrit Aruparayil, Noel |
author_facet | Ensor, Tim Virk, Amrit Aruparayil, Noel |
author_sort | Ensor, Tim |
collection | PubMed |
description | INTRODUCTION: There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India. METHODS: The study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken. RESULTS: Surgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity. CONCLUSION: In low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated. |
format | Online Article Text |
id | pubmed-7583072 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-75830722020-10-28 Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery Ensor, Tim Virk, Amrit Aruparayil, Noel BMJ Open Global Health INTRODUCTION: There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India. METHODS: The study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken. RESULTS: Surgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity. CONCLUSION: In low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated. BMJ Publishing Group 2020-10-22 /pmc/articles/PMC7583072/ /pubmed/33093032 http://dx.doi.org/10.1136/bmjopen-2020-038470 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Global Health Ensor, Tim Virk, Amrit Aruparayil, Noel Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title | Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title_full | Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title_fullStr | Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title_full_unstemmed | Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title_short | Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery |
title_sort | factors influencing use of essential surgical services in north-east india: a cross-sectional study of obstetric and gynaecological surgery |
topic | Global Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583072/ https://www.ncbi.nlm.nih.gov/pubmed/33093032 http://dx.doi.org/10.1136/bmjopen-2020-038470 |
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