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  • The study by Mijiti and colleagues also illustrates that bes

    2019-05-13

    The study by Mijiti and colleagues also illustrates that, besides medical factors, social determinants of health—poverty, education, geography, customs, etc—also play an important role in tuberculosis control. Owing to the low socioeconomic status and poor social health environment, tuberculosis mainly affects poor and vulnerable populations, namely people who live in the western region, poor rural areas, the urban migrant population, and elderly people. Moreover, Mijiti and colleagues\' finding that the lowest patient diagnosis rate was in the groups with the highest pulmonary tuberculosis prevalence indicates that poor access to health services is also an important factor influencing tuberculosis control. Populations in the ethnic minority areas face challenges such as language barriers, lack of health information, and living too far from medical institutions, which all affect or delay the detection and treatment of tuberculosis. Thus, balancing socioeconomic development, improving the social health environment, promoting education, and changing unhealthy lifestyles are all beneficial for tuberculosis control. In addition, in the ethnic minority areas, specific health education materials and purchase Rapalink-1 such as using story-telling and role-playing for education rather than just distributing brochures should be developed for health education on tuberculosis. In terms of cost, tuberculosis is a catastrophic illness. Due to the continuous economic burden, many patients are unable to adhere to treatment. With the deepening of health reform, China\'s medical insurance initiative has almost reached full coverage: government subsidies for the scheme have reached CH¥420 per capita, and the basic annual per capita government subsidies for public health services has reached ¥45. However, the high out-of-pocket payment is still a catastrophic expenditure for tuberculosis patients, especially for those from poor families. If the government does not provide more support, many patients will have to terminate treatment when they can no longer afford the payment. This will not only result in impoverishment, but will also lead to further spread of tuberculosis epidemics. Therefore, if completely free tuberculosis diagnostics and treatment can be provided, it will not only help solve the ongoing economic burden of tuberculosis, but also contribute to tuberculosis control, especially in poor populations.
    Access to surgery remains inequitable worldwide, with 5 billion people lacking safe and affordable surgical and anaesthesia care when needed. Commission on Global Surgery was convened in 2013 to assess the state of surgery around the world, provide recommendations for improving access, and propose indicators for assessing national surgical systems. A key safety indicator is the perioperative mortality rate (POMR). This is defined by the Commission as the number of all-cause deaths before discharge in patients who have undergone a procedure in an operating theatre, divided by the total number of procedures, and presented as a percentage. While the surgical literature is replete with mortality data at a health facility level, the collection of nationally representative data is more challenging and is less frequently reported. However, recent work has shown that many countries already collect national data on deaths after surgery, including several middle-income countries. Whereas POMR is just emerging, the maternal mortality ratio (MMR) is an established population health indicator. Both are ratio indicators with numerators and denominators that are commonly recorded, making them seemingly straightforward to monitor. Yet MMR has faced numerous challenges through its evolution, creating a cautionary tale and revealing what is needed for POMR to succeed. In particular, problems with MMR have included underreported and misclassified maternal deaths, unreliable civil registration systems, use of different data sources in various settings over time, and changes in definition of maternal mortality. Broadly, the challenges in measuring MMR have been categorised as the definitional challenge and the challenge of finding deaths. Variable data availability and reporting errors have made medical cause and time of death difficult to establish, especially in regions where most deaths occur outside of hospital due to women\'s lack of access to care. Methodological concerns have resulted in at least 18 empirical measurement tools to use depending on country and facility context.