By selecting a single district hospital, the patients in this pilot study come from a limited geographical referral area, which controls, to a large extent, for the socioeconomic differences associated with risk of disease, accessibility to health resources and inequalities in receipt of treatment which might have accounted for these differences.
These low survival rates may not be surprising considering that patients are disadvantaged regarding almost all the known prognostic factors, such as stage at diagnosis, histological grade and aggressiveness of the disease, availability and accessibility to appropriate treatment modalities and probably age at diagnosis.
Ethnic variations in hospitalisation may reflect differing disease incidence, accessibility of both primary and hospital inpatient and outpatient care, and healthcare seeking behaviour.
This finding may reflect increasing knowledge and awareness of the disease; appropriate accessibility to health services; and good compliance to treatment and clinical follow-up by the higher education groups (6, 12).
This is because morbidity data rely on patient's threshold to seek medical help from the primary health care centers; this threshold is determined by the patient, his family, and the surrounding society's perception and attitude to the disease, and accessibility to health institutions [ 54].
Water, in general, emerged as a recurring theme in our research and was discussed in the context of contamination, disease risk, and accessibility.
Topics that gain prominence in low income countries are "Disease burden" and "Accessibility".
The selection of patients admitted to a tertiary care hospital in India is biased as a result of factors such as severity of disease, gender and accessibility.
Earlier studies have found factors affecting service utilisation ranged from cultural and socio-demographic factors, physical accessibility, disease patterns to perception of quality of services and confidence in care [ 29].
This is likely to reflect a combination of factors: improved trial design, increased numbers of patients receiving a genetic diagnosis of mitochondrial disease and increased accessibility of clinical trials to patients.
