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      Utilization of a mobile medical van for delivering pediatric care in the bateys of the Dominican Republic

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          Abstract

          Background

          Bateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region.

          Aims

          This study evaluated an existing mobile medical system. The primary goal was to describe the population served, diseases treated, and resources utilized. A secondary goal was to determine qualitatively an optimal infrastructure for sustainable health care delivery within the bateys.

          Methods

          Information on basic demographic data, diagnosis, chronicity of disease, and medications dispensed was collected on all pediatric patients seen in conjunction with an existing mobile medical system over a 3-month period in the DR. Health statistics for the region were collected and interviews were conducted with health care workers (HCWs) and community members on existing and optimal health care infrastructure.

          Results

          Five hundred eighty-four pediatric patients were evaluated and treated. Median age was 5 years (range 2 weeks to 20 years), and 53.7% of patients seen were 5 years of age or younger. The mean number of complaints per patient was 2.8 (range 0 to 6). Thirty-six percent (373) of all diagnoses were for acute complaints, and 64% (657) were chronic medical problems. The most common pediatric illnesses diagnosed clinically were gastrointestinal parasitic infection (56.6%), skin/fungal infection (46.2%), upper respiratory tract infections (URIs) (22.8%), previously undiagnosed asthma and allergies (8.2%), and symptomatic anemia (7.2%). Thirty HCWs and community members were interviewed, and all cited the need for similar resources: a community clinic and hospital referral site, health promoters within each community, and the initiation of pediatric training for community HCWs.

          Conclusion

          A mobile medical system is a sustainable, efficient mechanism for delivering acute and preventive care in the Haitian bateys of the Dominican Republic. The majority of patients served were 8 years of age or younger with multiple presenting symptoms. A pediatric protocol for identifying the most appropriate drugs and supplies for mobile units in the DR can be created based upon diseases evaluated. Qualitative data from HCWs and community members identified the need for an integrative health care delivery infrastructure and community health promoters versed in pediatric care who can aid in education of batey members and monitor chronic and acute illnesses. We are planning follow-up visits to implement these programs.

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          Most cited references7

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          A population-based survey of eczema prevalence in the United States.

          Eczema and atopic dermatitis (AD) are recognized as major health problems worldwide. Prevalence estimates are as high as one-third of the population, depending on the country studied, the age range of the subjects, and the diagnostic criteria used. National estimates of prevalence for the US population are lacking. To examine the public health problem posed by eczema, AD, and eczematous conditions in the United States by analyzing disease and symptom prevalence, estimating the number of undiagnosed cases, and assessing comorbidities. A self-administered questionnaire was sent to a sample of households (N = 60,000) representative of the US population. A designated member responded with information on symptoms, diagnoses, and impact for affected household members; 42,249 households (70%) responded, representing 116,202 individuals. Empirical eczema was defined by itching/scratching and red/inflamed rash or excessive dryness/scaling. Empirical AD was defined by itching/scratching and red/inflamed rash, excessive dryness/scaling, skinfold location, early onset, symptoms lasting or 14 days, or a physician diagnosis of asthma or of allergic rhinitis or hay fever. Of the population studied, 17.1% reported at least one of four eczematous symptoms; empirically defined eczema was found in 10.7%, and empirically defined AD was found in 6%. Prevalence decreased with increasing income. Approximately two-thirds of individuals with an empirical diagnosis of eczema or AD had moderate to severe symptoms, one-third had sleep disturbances, and one-quarter had chronic unremitting symptoms. Just over one-third (37.1%) of those with symptoms reported a physician diagnosis. Peak onset for empirical AD occurred in the group of subjects aged
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            A national survey of mobile crisis services and their evaluation.

            Although mobile crisis services have been widely accepted as an effective approach to emergency service delivery, no systematic studies have documented the prevalence or effectiveness of these services. This survey gathered national data on the use and evaluation of mobile crisis services. In 1993 mental health agencies in 50 states, the District of Columbia, and U.S. territories were surveyed. Repeated follow-up was done to ensure a 100 percent response. A total of 39 states have implemented mobile crisis services, dispatching teams to a range of settings. Although respondents reported that use of mobile crisis services is associated with favorable outcomes for patients and families and with lower hospitalization rates, the survey found that few service systems collect evaluative data on the effectiveness of these services. The claims of efficacy made for mobile crisis services, which have led to their widespread dissemination, are based on little or no empirical evidence. More rigorous evaluation of new and existing modes of service delivery is needed. The need for such evaluation will increase in the climate promulgated by managed care, in which greater emphasis is placed on cost-effectiveness.
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              Costs, effects and cost-effectiveness analysis of a mobile maternal health care service in West Kiang, The Gambia

              The costs, effects and cost-effectiveness of a new mobile maternal care service offered in The Gambia at a government-run health centre in Karantaba were compared with the usual pattern of maternal care offered (at Ngayen Sanjal). Routinely collected data were supplemented by research on time allocation of staff by activity, use of drugs, medical consumables and vehicles, out-of-pocket payments by patients and a range of effectiveness indicators. To account for a differential effect on hospital referrals, maternity care at the main referral hospital was assessed. In 1991, the annual total cost of maternity care at Karantaba was US$64 800 compared with US$25 300 at Ngayen Sanjal. The largest proportion of this difference was attributed to training. Whilst average cost/attendance was higher at Karantaba, the marginal cost of expanding the service to other villages was lower than the marginal cost at Ngayen Sanjal. Incremental cost-effectiveness of the mobile service at Karantaba was calculated according to best and worst case scenarios which showed that the extra cost/extra death averted per year ranged between US$459 and US$2134. Using discounted life years gained reduced the figures to US$42.9 and US$206.3. Various suggestions are offered for reducing the cost of the new service, and a number of methodological points are raised for discussion.
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                Author and article information

                Contributors
                +1-832-8241364 , +1-832-8255424 , hlcrouse@texaschildrenshospital.org,
                Journal
                Int J Emerg Med
                International Journal of Emergency Medicine
                Springer-Verlag (London )
                1865-1372
                1865-1380
                21 August 2010
                21 August 2010
                December 2010
                : 3
                : 4
                : 227-232
                Affiliations
                [1 ]Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
                [2 ]Department of General Pediatrics, Harvard University, Boston Children’s Hospital, Boston, MA USA
                [3 ]Texas Children’s Hospital, 6621 Fannin St. MC 1-1481, Houston, TX 77030-2399 USA
                Article
                198
                10.1007/s12245-010-0198-4
                3047868
                21373288
                4475a275-81b7-459a-8bbc-b034ead21dfa
                © Springer-Verlag London Ltd 2010
                History
                : 3 December 2009
                : 31 May 2010
                Categories
                Original Research Article
                Custom metadata
                © Springer-Verlag London Ltd 2010

                Emergency medicine & Trauma
                dominican republic,disease prevalence,pediatric emergency medicine,pediatrics,mobile medical system,international health,developing country

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