In low-income settings, for example, value questions surrounding birth spacing, distance from clinical facility, absence from work, or using scarce family resources to purchase antibiotics, are important value-trade-offs made everyday by mothers and parents living in rural areas often in poverty [ 82].
Compared with the stringent checks on seclusion used in mental health facilities, the absence of similar protections leaves detainees vulnerable and without recourse.
Issues such as lack of protocols for diabetic complication evaluation and monitoring, little or non-existent referral systems, inadequate health facilities, and absence of multidisciplinary diabetic care teams also make diabetes care difficult [ 101].
This in part is due to inadequate quality of care resulting from dependence on under-trained personnel for most of the clinical work in most of our health facilities, and absence of or insufficient laboratory diagnostic services, particularly in the primary health care units (Mangesho et al. in preparation).
1. Patients with relapsed cancer since they would have had previous exposure to CVL 2. Age > 18 years at cancer diagnosis since majority are treated at the adult facilities 3. Absence of CVL 4. Diagnosis of CVL-dysfunction prior to study enrollment 5. Patients on anticoagulation therapy or prophylaxis 6.
Our findings are similar to those in a study carried out in Oji River, Enugu state where reasons for non or under utilization of health facilities were absence of a medical doctor (84.1%), poor staff attitude (47.6%) and long distance (39.6%) [ 13].
The assumption that a distance of 5 km is a walking distance and as such a facility 5 km away is accessible may need to be further examined, since the study showed that communities are not able to access health facilities due to absence of roads and absence of transport.
Of facility characteristics, distance travelled, facility working hours, absence of specialty clinics, waiting time, waiting area structure and confidentiality measures, were the negative factors most impacting patients' satisfaction.
Providers, especially in profit-oriented facilities, noted an absence of records or up-to-date registers.
The long distance to the health facilities and the absence of public transport in remote communities is a major obstacle to the use of professional delivery services.
