Summary of doctoral thesis medicine research on some related factors to dao women health care services in socio cultural aspects in bach thong district, bac kan province

Therefore, analyzing the impact of cultural and social factors to health services of Dao in general and of Dao women in particular are necessary to contribute solutions in protection and

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BACKGROUND

Health of women and children are the top concerns of countries around the world including Vietnam In Vietnam, women health care have remarkablly achieved results, many indicators related to reproductive health care has reached and exceeded objectives However, economic, cultural, social development in mountainous areas are still much lower than other areas affected to the healthcare services for people Besides factors such as low educational level, low living standards, traffic difficulties there are cultural elements such as backward customs, worship the Ghost when sickness that would affect health services utilization and approach, especially ethnic minorities including Dao ethnic Therefore, analyzing the impact of cultural and social factors to health services of Dao in general and of Dao women in particular are necessary to contribute solutions in protection and health care for ethnic minority women

In Vietnam, many related rerearchs have been conducted However, systematic researches concerning health services for Dao people in general and for Dao women in particular on socio-cultural aspects have not been carried out Due to reasons above, we choose Bac Kan province (province has large number of Dao ethnic that only behind

Tay ethnic) to research topic: "Research on some related factors to Dao

women health care services in socio-cultural aspects in Bach Thong district, Bac Kan province"

Study objectives

1 To describe and analyze the needs, supply and utilization status of health care services to Dao women on cultural, ethnic and social aspects in some communes in Bach Thong district, Bac Kan province

2 To analyze some related factors concering to supply and utilization for the existing mother health care services in local areas

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NEW CONTRIBUTIONS OF THESIS

1 The first research in Viet Nam studied systematicly and depthly

analyzied about some socio-cultural aspects relating to the supply and

utilization of reproductive health care services of Dao women

2 The first time using the combination of classic research Methods, Qualitative Research (PRA) and evaluation methods based on five indicators by chart CBM logic, along with samples of cases tracked consecutive 12 months to identify the factors related to health care Dao woman, as prerequisite for strengthening the activities of health services for Dao women on some cultural – society aspects

IMPLICATION OF THE THESIS

1 Identified the needs, supply and utilization status of Dao women

health care services A base from which the proposed activities strengthen health services in the province

2 Analyzed the factors related to supply and use health services of Dao women Among them, cultural - society factors have much influence to women health Local activities to enhance health services reached some initial results based on the identification of factors related above, a base for operations orientation strengthening health services for Dao ethnic in particular and for ethnic minorities in general

LAYOUT OF THE THESIS

Thesis includes 105 pages

pages

107 deferences were used in the thesis (84 in Vietnamese, 23 in English), 37 tables, 7 graphs, 29 photos, 4 pictrures

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Chapter 1 OVERVIEW OF DOCUMENTS 1.1 Cultural definition

Culture is a broad concept with many connotations different interpretation, involving all aspects of material life and the human

spirit In 2002, UNESCO has offered this definition of culture: "Culture

should be addressed as a set of characteristics in mind, physical, and emotional knowledge of a society or group in society and it contains, in addition to the literature and the arts, both living and modes of living together, value systems, traditions and beliefs "

In summary, organic cultural attachment to people, we can understand

an aspect of culture that is the custom, customs, habits, lifestyles of the people are formed, survive and development of human life The elements

of culture include nine basic content: language, food, accommodation, clothing, beliefs, rituals, folk art, folk knowledge and the different traditions (funeral, marriage, the new house, healing, family )

1 2 Some culture charecteristics of Dao ethnic related to the health

1.2.1 Language

Voice of the Mongolian - Daolanguage group, the number of people fluent in the language of literature is not much Due to the nature of language, in the process of communicating health officials face many difficulties because of language barrier

1.2.2 Housing

Houses of the Dao is mainly a ground House has a low roof, small windows, always low humidity, lack of air and low light The vast majority of households do not use the bathroom and toilet

1.2.3 Eating, drinking

After delivery, women having a personal food, food is mainly meat, pork and chicken are cooked with herb drugs Dao people drink tea and some leaves have an aromatic cool, easy to drink and used to treat diseases More common type of drinking is alcohol made from yeast leaves

1.2.4 The practice of reproductive and take care children

In the past, when women who have children often have to delivery themself, umbilical cord is cut with sharp bamboo In recent years, the birth of the Dao have been many changes, obstetric complications, mortality in infants have been minimized, Dao population increased significantly

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1.2.5 Beliefs related to illness

The Dao people concept that when the spirt is full in the human body that mean they are very well If the spirit in any position is absence, it will cause sickness To avoid negative consequences, it must invite the sorcerer to call spirit or ransom to come back

1.2.6 Customs and habits: Worship the Ghost, delivery at home

has been remained

1.2.7 Some intolerance: When pregnant, women diet of hard

working, a couple living diet, diet food rancid During pregnancy they

do not talk out, diet in eating so it is easy to decline their health, affecting the development of the fetus

1.2.8 Knowledge in folk medicine: Dao people know to process

alot of type of traditional medicine, such as cooking drugs, alcohol drugs, pure drug, broken bone drugs Among them, the outstanding was bath drug for women postpartum, it helped women to recover health quickly, it was accepted by the community

1.3 Health situation, reproductive health of women

Incidence of diseases in women are generally higher than men, overall rates of 2.5 disease / person, women with diseases of the reproductive system, urology higher than three times men

1.4 Women in access and use of health services

Approaching health service depends on four basic groups of factors: distance from home to medical facilities, economy, health care, culture

- society The relationship between access and use health care: If the

"supplier" lack the necessary resources, will lead to efficient resource utilization is low If the "demand" does not demand the right, not to accept, do not use the health which the "supplier" ready to offer, this leads to waste of resources and effective community health care services is limited

1.5 Management system of primary health care - assessment tools to approach and use of health services

CBM - Community Based Monitoring - a method of assessing access and use of health services The main goal of CBM is to determine health care needs have been met or not, how to meet, the cause of obstructing the use of health services and the existence of the health services provider through indicators: availability, approach, using, use enough and use effectively

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Chapter 2 OBJECTS AND METHODS OF STUDY 2.1 Objects, places and time study

- Married Dao women from 15 to 49 years old in Don Phong and Duong Phong commune, Bach Thong district, Bac Kan province

- Research time: 2 years, from 01/2008 to 12/2009

2.2 Research methodology

- Research description: cross-sectional survey combines quantitative, qualitative (PRA) and track 12 months was conducted on the whole number of married Dao women from 15 – 49 years old to describe specific of ethnic Dao and some specific cultural - social; reality provides and uses health care

- Research analysis: Evaluating the health care through five logic indicators (availability, access, use, enough use, efficient use), paper cases (with check list) to discover trends range of services, the problem exists, assessing the quality of health service

- Sample size and choosing a sample: Select the form intent The sample size includes all married Dao women who are 15 to 49 years old, including 329 women, in which 80 women with children under 5 years old and / or are pregnant

2.3 Research technique

-The variables of population, demographic, housing, water source, distance from home to medical station; medical personnel, facilities, medicines and equipment were recorded by survey techniques (surveys

329 married Dao woman from 15 - 49 years old; 60 health staffs who are working in 17 medical stations belong to Bach Thong district), observed (photos)

-The variables of characteristics cultural - society relating to health

of Dao woman are collected by using PRA techniques: mapping (2), ranking (1); life story (1), seasoning(1), matrix (1), in-depth interviews (5), discussion groups (3)

-The variables of knowledge, skills of its medical staff are evaluated through the methods of paper case combining the check list

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- The variable about tend to health services (5 indicators logic) are evaluated by CBM chart and track 12 consecutive months

2.4 Evaluation criteria about indicators research

Index performance evaluation of active primary care: The evaluation criteria recognized by national standard for commune health

Index performance evaluation of reproductive health care for the period 2001 - 2010: folowing The decision of No 136/2000/QD - TT of the Prime Minister on 28th November 2000

Index performance evaluation the knowledge of health staff on reproductive health: excelent = 9 - 10 points; good = 7 - 8 points; average = 5 - 6 points, bad = 1 - 4 points, a basic error = 0 points Five logical indicators: According to the formula prescribed by the Ministry of Health, including:

* Monitor the health care of pregnant women before delivery: + The rate of available: (number of days reporting period - Number of

days unavailable) x 100 / number of days reporting period) The number of days unavailable in iron, albumin urine test paper (or solution to test), antenatal care and blood pressure check during the next report from the monitoring book The number of days not available are the total number of days without one or more of the things mentioned above

+ The rate of approaching: (the access number x 100) / Total

population People approach the total population live in villages where time travel to the clinic by conventional means available shall not exceed one hour and each month receive health care of pregnant women at foreign stations at least once time if more than an hour away

+ The rate of utilization: (number of women have prenatal care x 100) /

estimated number of women giving birth As the proportion of pregnant women were examined at least 1 time before birth during the reporting period

+ The rate of full utilization: (number of antenatal care enough x

100) / estimated number of women giving birth As the proportion of pregnant women for antenatal care at least 3 times before they give birth during the reporting period

+ The rate of effective utilization: (number of well-maintained x

100) / estimated number of women giving birth Number of good care

is the number of prenatal care are three times at three gestation, were vaccinated against tetanus two times and received the iron before birth during the reporting period

+ The rate of access: Folloing the formula above

+ The rate of utilization: (number of women delivered by medical

staffs x 100) / number of women giving birth (estimated) If having exactly number of delivered women, not the estimated number of women giving birth

+ The rate of full utilization: (The care enough x 100) / estimated

number of women giving birth Number of care enough are the number of women who have at least 3 times antenatal care, giving birth by health care staffs and received postnatal care (at least 2 times within 42 days after birth)

+ The rate of effective utilization: (number of well-care x 100) /

estimated number of women giving birth Number of good care is the number of women who have at least 3 times examination in 3 periods

of pregnancy, giving birth by health care staffs, received postnatal care (at least 2 times within 42 days after birth) and give birth in medical station with the support of the means of delivered (the clean package delivered and the set of delivered tools) during the reporting period

* How to read CBM charts

The vertical axis indicates the rate of the factors related to health issues The horizontal axis indicates the factors that are related closely Diagram is drawn when the results of the target factors, the availability, access, use, full utilization and effective utilization has been made in tracking together If the path of the chart tend to decline that means have some problems in public health care and this matters should be resolved More and more declining level that means have more and more health care problems in community and priority needs to be resolved Level of decline of the chart decreases means that activity

medical progress

2.5 Data processing method

Research data is processed and analyzed by using statistical software SPSS The qualitative research data are presented as methods for qualitative and complement the results of quantitative research

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Chapter 3 RESULTS OF STUDY 3.1 Some cultural - social charateristics of the Dao people in Bach Thong district, Bac Kan province

Table 3.2 Characteristics of married Dao women aged 15 to 49 in

two research communes in 2009 Characteristics of Dao women Number

Table 3.4 Characteristics of house, water source and stable of Dao

people in two research communes Housing, water source, stable Number

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Comments: House is mainly a temporary (60.5%) Stream water is

mainly water source of the Dao (54.1%) Most of barns near the house

so that it is very unhygienic

Table 3.6 Characteristics of distance, time and vehicles to the

nearest health facility

Min = 2 Max = 30 Mean = 7.84

The time from home to CHC by

ussually used vehicles

Comments: Having 76.29% of households take more than an hour to

the nearest CHCs by ussually used vehicles

* The result of depth interviews, life story to understand the

concept of Dao people in health, disease, customs that related to childbirth, Mr Ban Van K (Priest), Ms Ban Thi K (village leader) ,

Ms Trieu Thi H said that: Dao people concept that disease was made

by Ghost so that they attach much important to worship When sicknes, they both worship at home and go to the health care When Dao women giving birth, they are cared carefully with traditional herbs, typically is bathherb for women after giving birth The habit of Dao people is to reserve medicine at home When sickness, they take the traditional medicine theirself or self-purchase model medicine If their health are not better, they go to medical facilities later

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3.2 Supply status of health services at basic health system Table 3.7 Human resource of 17 CHCs in Bach Thong district in 2009

Total of health staffs of 17 medical stations 65 100

The rate of commune with midwifery 10 58.82

Midwifery / women aged 15-49 (10/1659) 0.6

Comments: The rate of doctors in CHCs is still low (47.05%),

midwives are about 58.82%

Table 3.9 Infrastructure, drugs and equipment at 17 CHCs in 2009

Sufficient Insufficient No have Index

Comments: Most CHCs lack functional departments and requred

instruments About 47,06% CHCs have no dental instruments; 76,47% without ENT instruments; no eye examination instruments (88,24%) Not enought sufficient drugs (47,1%) About 82,4% have no pharmacy

Table 3.10 Obstetric equipments at 17 CHCs in Bach Thong

district in 2009 Sufficient Insufficient No have Index

1.Facilities, instruments

O & G department 4 23.53 10 58.82 3 17.65 Gynecology table 10 58.82 4 23.53 3 17.65 Tools of antenatal 7 41.18 10 58.82 0

Tools of delivered 8 47.06 6 35.29 3 17.65 Tools of family planning 7 41.18 6 35.29 4 23.53

Comments: Most of CHCs lack O&G treament rooms About 17.65

% stations do not have any tool to use; 23.53% stations do not have family planning tools; 17.65% have no oxytocin and iron The rate of stations lack iron is 52.94% About 70.59% missing sheets for antenatal care and 100% do not test albumin urine

Comment: Knowledge of health staffs about obstetric care is still

limitted, have no scored well, bad on knowledge is 15%

Table 3.12 Antenatal care skills of health workers (n = 60)

Average 13 21.67 4 6.67 11 18.33 28 46.67 Not good 7 11.67 2 3.33 8 13.33 17 28.33

Comment: Skills of health staffs about antenatal care are very weak, have

no good ratings The rate of not good practice are very high (28.33%)

3.3 Disease patterns, healthcare needs and how to treat when sick Table 3.13 Situation of sickness of Dao’families in the two weeks

before survey at two communes