Mối liên quan giữa Bệnh không lây với dịch vụ sức khỏe và các rào cản do xã hội ở người trung niên_ NCD related health services use and barrier differences by social locations of middle aged people in lao PDR

Mối liên quan giữa Bệnh không lây với dịch vụ sức khỏe và các rào cản do xã hội ở người trung niên_ NCD related health services use and barrier differences by social locations of middle aged people in lao PDR BackgroundNoncommunicable diseases (NCD) are on the rise to become one of the major cause of morbidity and mortality of the people in Lao PDR. Due to NCD’s deep impacts on economic and social burden, the importance of prevention and management of NCDs has been acknowledged widely. Limited researches on the need of NCD related health service use, the status of health service utilization, and barriers of service use. This study analyzed the need, the use, and the barriers of NCD related health services in relation of respondents’ social location. AimsTo examine the need of NCD related health service useTo find out the methods and quantity of health service utilizationTo understand the barriers of needed health service useTo investigate the differences of health service use by “social location”, such as gender, age, financial status, and residential place.

NCD related Health Services

Use and Barrier Differences

by Social Locations of

Mid-dle Aged people in Lao PDR

Gunjeong Lee, Ph.D.

Department of Global Health and Nursing, Ewha Womans University,

Seoul, Korea

Gunjeong Lee, Kongmany Chaleunvong, Younhee Kang, Minah Kang,

Harris Hyun-soo Kim, Kyungok Yi, Yuri Kim, Yookyung Choi, Minjin Koo

Background

 Non-communicable diseases (NCD) are on the rise

to become one of the major cause of morbidity

and mortality of the people in Lao PDR

 Due to NCD’s deep impacts on economic and

so-cial burden, the importance of prevention and

management of NCDs has been acknowledged

widely

 Limited researches on the need of NCD related

health service use, the status of health service lization, and barriers of service use

uti- This study analyzed the need, the use, and the

bar-riers of NCD related health services in relation of respondents’ social location

Background

1 To examine the need of NCD related health service

4 To investigate the differences of health service use

by “social location”, such as gender, age, financial status, and residential place

Aims

 Survey Study

 Research Object : Middle aged people (40-59 years old)

 Period : May 2th – June 3th, 2015

 Randomly selected 25 urban villages in 2 district from Vientiane Capital and 25 rural villages in 2

district from Vientiane Province

 Random selected 20 households from each

vil-lage’s household list

 Interviewed one member who is 40-59 years old  N=997 completed

 removed 17 due to inappropriate or incomplete answers

 Final N=979

Methods

 Variables for this study

(Angina, Myocardial infarction,

Usual place for treatment

Variable N Store Drug Clinic Hospital

nity Health Center

Commu-Village Health Volun- teer

No Place

To go Others

value

Experience of difficulty in getting

2 Reasons of Difficulty to get medical

care

Health Service Use (during last

1yr)

Health Service (N=979, % ) Total (N=250 NCD

)

No NCD (N=68 2)

Don’t know (N=4 7)

valu e

unteer 26 2.66% 3.2% 2.6% 0.0% 0.456Traditional healer 77 7.87% 12.8% 6.6% 0.0% 0.001

Dental care 179 18.32% 18.8% 19.0% 6.4% 0.095

Significant differences by subgroup analyses, more use on

• In-patient : Age(50-59 years old)

• Emergency room : Sex(Female), Area(Urban)

• Out-patient experiences b: Sex(Female)

• Community health center services : Area(Rural)

• Village health care volunteer(or worker) : Sex(Female), Age(40-49 years old), Area(Rural)

• Traditional healer : Area(Rural)

• Dental care : Sex(Female), Area(Urban)

Drug store use during last month

Frequency of Drug

store Use (N=979) Total (n=250) NCD (n=682) No NCD

Don’t know (n=47)

value

Medical insurance

All (N=979) (n=250) NCD

No NCD (n=68 2)

Don’t know (n=47)

value

Received Information about?

404 (41.27%) 340 (34.73%) 331 (33.81%)

Information about NCD

Total N=979 100%

NCD (n=250) No NCD (n=50)

Don’t know (n=47)

P -value

Medical check up

(n=250 )

No NCD (n=682 )

Don’t know (n=47)

value

P<0.00 1

No medical check

Logistic regression analysis

on Getting Regular Medical check up

Among NCD Among Non NCD

Independent variable OR (95% CI)

p-value OR (95% CI) p-valueMale 1.56 (0.79-3.06) 0.192 1.29 (0.93-1.78) 0.124 age 0.98 (0.93-1.04) 0.571 0.99 (0.14-2.05) 0.692 rural 0.51 (0.24-1.05) 0.067 0.89 (0.64-1.23) 0.473

Total

NCD (n=250)

No NCD (n=682)

Don’t know (n=47)

valu e

0.02 1

Difficulty in getting medical care

Logistic regression analysis

on difficulty in getting medical care

Among NCD Among Non NCD

p-Male 0.38 (1.43-0.99) 0.047 0.84

(0.44-1.61) 0.606age 1.00 (0.94-1.08) 0.886 0.96 (0.92-

1.01) 0.139rural 1.53 (0.65-3.57) 0.328 1.96 (0.99-3.85) 0.052

Hmong-mien 0.51 (0.63-3.57) 0.548 2.93

(1.23-7.01) 0.015Less than primary school 0.63 (0.19-2.13) 0.456 1.59 (0.61-

4.15) 0.340Illiteracy 2.31 (0.64-8.32) 0.199 0.72 (0.24-

2.19) 0.570

Unhealthy 1.39 (0.59-3.25) 0.449 3.76

(2.03-6.95) 0.000

Unemployed 0.98 (3.46-2.76) 0.964 1.49 (0.70-3.12) 0.296

 There were significant differences of NCD

diag-nose rate between sex group, age group, ethnic group, education level, literacy or not and health status

 NCD diagnosis, sex, age, ethnic group, education

level and literacy made significant differences

on usual treatment place

 The highest two main reason on difficulty in

get-ting medical care were ‘cost’ and

‘trans-portation’

 NCD diagnosis made an significant differences on

health service use in last 1 year such as in-patient experience, emergency room use, out-patient

experience, community health care center use

and traditional healer use

Results

 NCD diagnosis made an significant differences on

Drug store use in last 30 days Also, area and

health status made such significant

differ-ences

 NCD diagnosis made an significant differences on

Information about NCD

 Hmong mien, the more illiterate, the more

un-healthy and the more unemployed, the higher the rate of ‘no medical check up’

 Male, Hmong mien, the more unhealthy and the

more unemployed, the higher the rate of rience of difficulty in getting medical care’

Results

Conclusion

 By this survey, the gaps of medical service need

and health service use are not big

 However, more researches are needed on the

meaning of medical diagnosis, health service use, medical check-up, due to the low level of using

medical facilities and knowledge on NCDs

 There are significant differences on NCD related

health service use and barriers by social

loca-tions Therefore political intervention is needed

to improve health service accessibility and ability for the group with unmet health service need

afford- Ali, M K., Rabadán-Diehl, C., Flanigan, J., Blanchard, C., Narayan, K M V., & Engelgau, M (2013) Systems and Capacity to

Ad-dress Noncommunicable Diseases in Low- and Middle-Income Countries Science Translational Medicine, 5(181), 181cm184 doi: 10.1126/scitranslmed.3005121.

 Atienza, A., & King, A (2002) Community-based health intervention trials: an overview of methodological issues Epidemiol

Rev, 24(1), 72 - 79

 Beaglehole, R., Bonita, R., Alleyne, G., Horton, R., Li, L., Lincoln, P., Nishtar, S (2011) UN High-Level Meeting on

Non-Communi-cable Diseases: addressing four questions Lancet, 378(9789), 449 - 455

 Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., Casswell, S (2011) Priority actions for the

non-commu-nicable disease crisis Lancet, 377(9775), 1438 - 1447

 Chongsuvivatwong, V., Phua, K., Yap, M., Pocock, N., Hashim, J., Chhem, R., Lopez, A (2011) Health and health-care systems

in Southeast Asia: diversity and transitions Lancet, 377(9763), 429 – 437

 Chu, Vang et al.(2010), Report on STEPS Survey on Non Communicable Diseases Risk Factors in Vientiane Capital city, Lao PDR,

WHO.

 Dans, A., Ng, N., Varghese, C., Tai, E., Firestone, R., & Bonita, R (2011) The rise of chronic non-communicable diseases in

South-east Asia: time for action Lancet, 377(9766), 680 - 689

 Health in Southeast Asia (2011), The rise of chronic non-communicable diseases in southeast Asia: time for action.

 Loo KW, Gan SH: The burden of stroke in the Lao People's Democratic Republic International Journal of Stroke 2013,

8(4):273-275.

 Miranda, J., Kinra, S., Casas, J., Davey Smith, G., & Ebrahim, S (2008) Non-communicable diseases in low- and middle-income

countries: context, determinants and health policy Trop Med Int Health, 13(10), 1225 - 1234

 Morgan, D (1998) Practical strategies for combining qualitative and quantitative methods: applications to health research Qual

Health Res, 8(3), 362 - 376

 WHO(2011), Country Cooperation Strategy for the Lao People’s Democratic Republic.

 WHO(2013), Lao People’s Democratic Republic: health Profile.

 WHO(2014), NCD country profile: Lao PDR.

References

Q & A Thank you.