Panel Discussion

Maternal and child health improved in urban setting

Access to healthcare
-

Transportation
o Public transport
Busses and trains available for use of public compared to
rural area
Hospitals are situated in busy, easy to reach areas and are
located in the route of public transport
o Easy access no geographical barrier
In cities, roads are developed and highways are available
Easy to reach hospital
No barriers like in rural setting where people have to
walk through forests, rivers and hills to reach
healthcare
Easy to receive ambulance services

According to The New England Journal of Medicine

http://www.nejm.org/doi/full/10.1056/NEJM199802193380806
-

Availability of healthcare services

o More hospitals available
There are more hospitals, public and private, available in
urban settings
Hospitals are better equipped compared to the small district
hospitals with only primary healthcare equipment
Staffing
More doctors, specialists and nurses
o Specialists more readily available compared to
rural where only 2-3 times a week
o Emergency cases are quickly and better attended
to in urban setting
Availability of more medicine and of more potency
First line, second line and third line drugs more
available in urban places
Quality of healthcare that can be delivered is better in urban
setting
Better and wider diagnostic facilities

More treatment options available

Better advocating of lifestyle modifications. Eg:
rehabilitation & quit smoking/ weight loss programs
Cater to more people more effectively
o Midwife practice in rural setting shows higher mortality rate
unfpa, chapter 2 conditions of life in urban areas
In rural areas, they prefer traditional birth attendance who
have poor healthcare and delivery training
In Malaysia, midwife practice is still existent, especially in
villages and rural settings
Deliveries are performed without proper monitoring of
mothers and babys vitals and with the absence of
anesthesia
Caeserian section procedures not available as an alternative
Higher chances of occurrences of perinatal infections
According to The Lancet (Prof. Michael Marmot)
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)616906/fulltext
Patient Empowerment
-

Practice of preventive medicine more in urban

o Investigative procedures to prevent births of babies with congenital
disorders like Down syndrome, Thalassemia, or even vertically
transmitted Dz like HIV - Amniocentesis, chorionic villus sampling
o Media, campaigns, advocated by doctors
Folate deficiency, other nutrients failure of growth
development
Rural setting less availability of supplements
Rural setting sees higher occurrences of
malnourishment & nutrient deficiency Dz
HIV infected mother can still carry and deliver a healthy
child if prevention is taken via drug therapy better
observed in urban setting
Family planning,
In traditional there is poor family planning many
children cannot provide optimally for all the children
o Housing, sanitation, nutrition, cognitive
stimulation

o Leading to stunted development and higher

mortality rate
o Antenatal classes
Very rare in rural
Educate parents to prepare for pregnancy, delivery and the
after-effects
Taught proper nutrition and to abstain from negative habits
(smoking, alcohol, substance abuse which lead to Fetal
Alcoholic Syndrome, withdrawal syndromes in babies,
deformities)
Encourage more open exchange between husband-wife
concerning reproductive health improve future support for
mother and child by involvement of male figure in family
o Vaccination programs
Widely available in urban setting and better enforced
Mothers in rural setting are Immunocompromised due to
environment
High risk occupation, low living standards, poor
sanitation (water)
Higher rates of bacterial and parasitic infection
According to the American Journal of Preventive Medicine
http://www.sciencedirect.com/science/article/pii/S0749379702006554

Literacy, education, socioeconomic status

o Better patient compliance to treatment
Patients have better understanding of their condition, its
severity and the importance of adhering to treatment - Eg:
dose? Regularity?
Patients are more aware of their condition better able to
provide information regarding their symptoms and disease
progress helpful in treatment and management
o Higher baseline levels of health
Better food, hygiene, medicine availability
Higher awareness of the importance of exercise
Passing down of vertically transmitted diseases such as HIV in
high poverty places rural and countries
o Higher income
o Better able to provide for mother and child

According to the Journal of Association of American Medical Colleges

http://journals.lww.com/academicmedicine/Abstract/2004/12000/Health_Disp
arities_Based_on_Socioeconomic.4.aspx