Context:Life-saving cancer therapy is costly and may result in financial burden for these families. Financial costs for treating childhood cancer care are traditionally assessed based on the amount spent for diagnostic tests, hospitalization, and chemotherapy. The financial costs for travel, accommodation, out-of-pocket expenses for food, phone bills, and loss of income due to reduction or termination of parental employment are hidden nonmedical expenses that are rarely accounted for. Studies on the financial implications of pediatric cancer treatment are based on the Western model of healthcare with good government/state insurance coverage and hence literature on lifestyle implications for families in developing nations with limited resources is still scarce.Aims:The aim of this study is to find out the details of out-of-pocket expenses incurred by the families during their treatment of cancer children and its implications on their quality of life. Settings and Design: This study was conducted in a tertiary care center for pediatric malignancies for over 1-year period.Subjects and Methods:About seventy families whose children were diagnosed with acute leukemia and undergoing treatment at our center were asked to fill a questionnaire detailing their out-of-pocket expenses.Results:Nonmedical expenses accounts for about 46% of their monthly household income of parents from rural areas and 22% of their household income from urban areas. On an average, a family from rural area spends four times the normal amount spent on home for their daily food expenditure. Thirty-eight percent of families have borrowed money from money lenders with an average interest rate of about 12.5% which pushes them to a state of debt for the next few years.Conclusions:Out-of-pocket expenses contribute a significant proportion to the financial burden of the families with childhood malignancies and these invisible expenses should be recognized and provide adequate support to lessen the burden of this economic impact.
Introduction: Exclusive breast feeding practice ranks fi rst among the most effective interventions to improve child health. Present study was undertaken to compare breast feeding practices among urban and rural mothers and the factors infl uencing these practices. Materials and Methods: One year long community based crosssectional study was done at villages namely Vantamuri, Kakati (A and B), Honaga, and Bhutramanahatti; and urban area Khasbag which are the fi eld practice areas of Department of Community Medicine, J. N. M. C., Belgaum. By random sampling, 380 rural mothers and 400 urban mothers having 1-year-old child were selected. Information on sociodemographic variables, breast feeding practices was recorded. Results: In the present study, majority of urban (65.00%) as well as rural mothers (64.21%) were between 20 and 24 years of age and were literates (90.25 and 77.89%, respectively). Majority of the mothers in both urban and rural areas gave prelacteal feeds (54.25 and 57.11%, respectively). Many mothers in both rural and urban areas discarded the colostrum, (14.75% in urban vs 25.79% in rural). Initiation of breast feeding after delivery was delayed by 24.50% of mothers in urban and 33.68% of mothers in rural areas. As many as 67.89% rural mothers practiced demand feeding as opposed to 38.75% urban mothers. Age of the mother, education, socioeconomic status, type of family, place of delivery, and education about benefi ts of breast feeding infl uenced the breast feeding practices. Conclusions: Various inappropriate breast feeding practices are prevalent both in rural as well as urban areas. Elder's advice played an important role in shaping the breast feeding practices. Abstract Access this article onlineWebsite: www.ijmedph.org
Objectives: Early integrated palliative care has shown to improve the quality of life in patients with cancer. During the past decade, pediatric palliative care has become an established area of medical expertise, however due to scant information available regarding the triggers for referral and referral practice very few children receive a formal palliative care consult. Materials and Methods: A retrospective audit of medical case records of pediatric oncology patients over a period of 1 year from September 30, 2019, to September 30, 2020, was conducted. Demographic details, diagnosis, staging, clinical parameters, reason for referral, and palliative care plan were captured in a predesigned pro forma. Results: Among 126 children with cancer, 27 (21.4%) patients were referred to palliative care. Majority 21 (77%) referrals were inpatient consults. Symptom management 17 (44.7%) was the most common trigger for referral followed by referrals for psychosocial support 12 (14.4%). Children with solid tumors 16 (59%) were more often referred than hematological malignancies. Among those needing end of life care, 8 (88.8%) out of 9 families preferred home than hospital. Conclusion: Low incidence of palliative care referral and presence of symptoms as a trigger for palliative care referral suggests gaps in the integrated approach. The study findings prompt a review of palliative care referral criteria and referral practice in a pediatric oncology setting.
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