| 1. Peer Reviewed Title: Antiretroviral adherence in rural Zambia: the first year of treatment availability. Author: Birbeck GL; Chomba E; Kvalsund M; Bradbury R; Mang'ombe C; Malama K; Kaile T; Byers PA; Organek N Author: RAAZ Study Team Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):669-74. Abstract: We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | SPOUSE | SOCIAL NETWORKS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | CLINIC VISITS | PARTNER COMMUNICATION | KNOWLEDGE | SEX FACTORS | SPOUSAL SUPPORT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Friends and Relatives | HIV | Behavior | Service Statistics | Program Activities | Programs | Organization and Administration | Interpersonal Relations | Microeconomic Factors | Economic Factors Document Number: 331277 |
2.  Title: [Contraceptive use and incidence of pregnancy among women after HIV testing in Abidjan, Ivory Coast] Pratiques contraceptives et incidence des grossesses chez des femmes apres un Author: Brou H; Viho I; Djohan G; Ekouevi DK; Zanou B; Leroy V; Desgrees-du-Lou A Source: Revue d'Epidemiologie et de Sante Publique. 2009 Mar 20; Abstract: BACKGROUND: Within the framework of programs for the prevention of mother-to-child HIV transmission, women who discover their HIV-infection during their pregnancy receive perinatal interventions in order to reduce the risk of HIV transmission to the child. They also receive family planning counselling and free contraceptives in order to avoid a new pregnancy. In this study, we compared contraceptive use and pregnancy incidence between HIV-positive and HIV-negative women who were offered HIV counselling and testing during a program of prevention of mother-to-child HIV transmission. METHODS: In the Ditrame Plus program in Abidjan, 546 HIV-positive and 393 HIV-negative women were HIV-tested prenatally and followed up 2years after delivery. At each post-partum visit, proportions of contraceptive use were noted, by method. The pregnancy incidence was calculated as the number of pregnancies for 100 women-years at risk. Factors related to the arrival of a new pregnancy were analyzed by Cox model. RESULTS: Between 6 and 24 months post-partum, proportions of women using modern contraception varied from 52 to 65% among HIV-positive women, and from 65 to 75% among HIV-negative women. Pregnancy incidence for 100 women-years at risk was 5.70 (95%CI: 4.17-7.23) and 4.37 (95%CI : 2.83-5.91) (p=0.237) and unwanted pregnancy incidence was 1.07 (95%CI: 0.41-1.73) and 2.39 (95%CI: 1.25-3.53) (p=0.023), respectively among HIV-positive and HIV-negative women. The end of post-partum abstinence, the death of the index child and the end of breastfeeding were positively linked to the arrival of a new pregnancy in the post-partum period. CONCLUSION: Among these women prenatally HIV-tested, family planning counselling and regular follow-up was accompanied by a high rate of contraceptive use after delivery, and consecutively to a low pregnancy incidence irrespective of serostatus. In particular, HIV-positive women had fewer unwanted pregnancies than HIV-negative women. Integration of adequate family planning services in the post-partum follow-up in prevention programs plays an important role in reducing the risk of mother-to-child transmission, by reducing pregnancies among HIV-positive women. Language: French Keywords: COTE D'IVOIRE | RESEARCH REPORT | INCIDENCE | PREGNANCY | WOMEN | HIV TESTING | CONTRACEPTIVE USAGE | CLINIC VISITS | VOLUNTARY COUNSELING AND TESTING | POSTPARTUM | FAMILY PLANNING | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Reproduction | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | Service Statistics | Program Activities | Programs | Organization and Administration | Puerperium | Program Evaluation Document Number: 330856 |
| 3. Peer Reviewed Title: Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda. Author: Castelnuovo B; Babigumira J; Lamorde M; Muwanga A; Kambugu A; Colebunders R Source: International Journal of STD and AIDS. 2009 Feb;20(2):123-4. Abstract: Antiretroviral treatment roll-out programmes in Africa often have difficulties to cope with the increasing number of clients. Based on the findings of a survey carried out in 2005 that showed long waiting times, innovative organizational changes (nurse visits and pharmacy-only refill visits) were introduced in our clinic. In August 2007, the survey was repeated to evaluate the impact of these changes. During both surveys we used the same standardized questionnaire. In 2007, 400 patients visited the clinic on the study day compared to 250 in 2005. The median time spent at the clinic decreased from 157 minutes in 2005 (range 22-426) to 124 minutes (15-314). All the waiting times for different services decreased except the time between the visit to the triage nurse and the doctors' visit. A similar methodology could be used by other health services to evaluate and compare different models of care. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | SURVEYS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | CLINIC VISITS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | CAPACITY BUILDING | TIME FACTORS | ORGANIZATION AND ADMINISTRATION | WAITING AREAS AND QUEUES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Service Statistics | Program Activities | Programs | HIV | AIDS | Program Sustainability | Population Dynamics | Workplace | Employment | Macroeconomic Factors | Economic Factors Document Number: 331091 |
| 4. Title: A survey of mothers' comfort discussing contraception with infant providers at well-child visits. Author: Fagan EB; Rodman E; Sorensen EA; Landis S; Colvin GF Source: Southern Medical Journal. 2009 Mar;102(3):260-4. Abstract: OBJECTIVE: To determine whether mothers feel comfortable with their infants' providers discussing contraception with them at their infants' well-child checks. METHODS: A cross-sectional survey was conducted using a convenience sample of 114 mothers presenting at a community family medicine residency program for well-child visits among infants up to 17 months old. RESULTS: Almost all mothers (87%) felt comfortable talking with their infants' providers about contraception and were likely to accept the advice of their infants' providers to see their own doctors regarding contraception (83%) or to use a prescription from their infants' providers for contraception (75%). CONCLUSION: Many mothers miss or delay their postpartum visits but see their infants' doctor multiple times within the first year. Mothers are comfortable talking with infant providers about contraception. By discussing contraception with mothers at well-child visits, physicians may encourage mothers to use contraception and prevent unintended pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | MOTHERS | INFANT | CLINICS | PHYSICIANS | CLINIC VISITS | CONTRACEPTION | POSTPARTUM | INFORMATION | PROVIDERS WITH CLIENTS | Developed Countries | North America | Americas | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Health Personnel | Service Statistics | Program Activities | Programs | Organization and Administration | Family Planning | Puerperium | Reproduction | Health Services Document Number: 330896 |
| 5. Peer Reviewed Title: Acceptability of intrapartum HIV counselling and testing in Cameroon. Author: Kongnyuy EJ; Mbu ER; Mbopi-Keou FX; Fomulu N; Nana PN; Tebeu PM; Tonye RN; Leke RJ Source: BMC Pregnancy and Childbirth. 2009;9:9. Abstract: BACKGROUND: To assess the acceptability of intrapartum HIV testing and determine the prevalence of HIV among labouring women with unknown HIV status in Cameroon. METHOD: The study was conducted in four hospitals (two referral and two districts hospitals) in Cameroon. Labouring women with unknown HIV status were counselled and those who accepted were tested for HIV. RESULTS: A total of 2413 women were counselled and 2130 (88.3%) accepted to be tested for HIV. Of the 2130 women tested, 214 (10.1%) were HIV positive. Acceptability of HIV testing during labour was negatively associated with maternal age, parity and number of antenatal visits, but positively associated with level of education. HIV sero-status was positively associated with maternal age, parity, number of antenatal visits and level education. CONCLUSION: Acceptability of intrapartum HIV testing is high and the prevalence of HIV is also high among women with unknown HIV sero-status in Cameroon. We recommend an opt-out approach (where women are informed that HIV testing will be routine during labour if HIV status is unknown but each person may decline to be tested) for Cameroon and countries with similar social profiles. Language: English Keywords: CAMEROON | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | VOLUNTARY COUNSELING AND TESTING | CHILDBIRTH | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MATERNAL AGE | PARITY | ANTENATAL CARE | CLINIC VISITS | EDUCATIONAL STATUS | PREVALENCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | HIV Infections | Viral Diseases | Diseases | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Disease Transmission Control | Prevention and Control | Parental Age | Age Factors | Fertility Measurements | Fertility | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Service Statistics | Program Activities | Programs | Organization and Administration | Socioeconomic Status | Socioeconomic Factors | Measurement Document Number: 331239 |
| 6. Peer Reviewed Title: Effect of early exclusive breastfeeding on morbidity among infants born to HIV-negative mothers in Zimbabwe. Author: Koyanagi A; Humphrey JH; Moulton LH; Ntozini R; Mutasa K; Iliff P; Black RE Source: American Journal of Clinical Nutrition. 2009 May;89(5):1375-82. Abstract: BACKGROUND: Early exclusive breastfeeding (EBF) is recommended by the World Health Organization, but EBF rates remain low throughout the world. For infants born to breastfeeding HIV-positive mothers, early EBF is associated with a lower risk of postnatal transmission than is feeding breast milk together with other liquids or foods. No studies conducted in Africa have reported any benefits of EBF for infants born to HIV-negative women. OBJECTIVE: The objective was to compare the rate of sick clinic visits by infants aged 43-182 d according to breastfeeding exclusivity [EBF, predominant breastfeeding (PBF), and mixed breastfeeding (MBF)]. DESIGN: We compared rates of all-cause clinic visits and clinic visits related to diarrhea and lower respiratory tract infection (LRTI) among a cohort of 9207 infants of HIV-negative mothers during 2 age intervals: 43-91 and 92-182 d according to exclusivity of breastfeeding. Breastfeeding exclusivity was defined in 2 ways ("ever since birth" and "previous 7 d") and was assessed at 43 and 91 d. RESULTS: EBF between birth and 3 mo was significantly protective against diarrhea between 3 and 6 mo of age with the "ever since birth" definition [incidence rate ratios (IRRs) of 8.83 (95% CI: 1.07, 65.53) and 8.76 (95% CI: 1.13, 68.09) for PBF and MBF, respectively] and with the "previous 7 d" definition [2.04 (95% CI: 1.11, 3.77) and 2.05 (95% CI: 1.13, 3.72) for PBF and MBF, respectively]. The adverse effect of MBF on LRTI visits was weaker, reaching borderline significance only by the "ever since birth" definition during the 43-91-d interval (IRR: 1.91; 95% CI: 0.99, 3.67). CONCLUSION: Early EBF is associated with a significant reduction in sick clinic visits, especially those due to diarrhea. Language: English Keywords: ZIMBABWE | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | INFANT | BREASTFEEDING, EXCLUSIVE | CHILD SURVIVAL | CLINIC VISITS | DIARRHEA | RESPIRATORY INFECTIONS | TIME FACTORS | PREVALENCE | MOTIVATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Breastfeeding | Infant Nutrition | Nutrition | Health | Survivorship | Length of Life | Mortality | Population Dynamics | Service Statistics | Program Activities | Programs | Organization and Administration | Diseases | Infections | Measurement | Psychological Factors | Behavior Document Number: 341153 |
| 7. Title: [HIV prevalence in sub-Saharan Africa: background of an estimation] Prevalences du VIH en Afrique sub-saharienne: historique d'une estimation. Author: Larmarange J Source: Medecine Sciences. 2009 Jan;25(1):87-92. Abstract: In 2008 UNAIDS global report on AIDS, the number of people living with HIV in sub-Saharan Africa was estimated at 22 millions in 2007 and 20.4 millions in 2001, while in the 2002 report, the same estimation for 2001 was 28.5 millions. Changes in UNAIDS reflects evolutions of data sources and methods used for the estimates. Sentinel surveillance of pregnant women attending antenatal clinics (ANC) was developed in 1980's with the WHO recommendation of unlinked anonymous testing approach. The objective was not to be representative but to monitor trends. In the 1990's, as ANC data were available, they were used by EpiModel, a model developed by WHO for HIV prevalence estimates from 1992 to 2000. In 2002, a new epidemiological model called EPP (Estimation and Projection Package) was developed by the UNAIDS Reference Group on Estimates, Modelling and Projections, which, in countries with a generalised epidemic, is still based on ANC data collected over time. Since 2001, many countries have conducted national population-based surveys (NPS). Their results have often diverged from estimates based on ANC data. This was explained by the under-representation of rural clinics in sentinel surveillance and relative small participation rate in NPS. Since, several studies have shown that the impact of several biases (participation rate, non-household members, serological window of tests...) in NPS remains relatively low. NPS constitute a good indicator of HIV prevalence level. If pregnant women can be locally representative of the general population, at the national scale, it depends of the localization of selected clinics. But ANC provides data over time, which is not the case for NPS. The current approach of UNAIDS consists in estimating HIV prevalence trends from ANC and the level of the epidemics from NPS. But the hypothesis that ANC data are representative of trends still needs to be verified when several NPS will be available for a same country. Language: French Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | CLINIC VISITS | ANTENATAL CARE | Africa | Developing Countries | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 330885 |
| 8. Peer Reviewed Title: Costs of providing care for HIV-infected adults in an urban HIV clinic in Soweto, South Africa. Author: Martinson N; Mohapi L; Bakos D; Gray GE; McIntyre JA; Holmes CB Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Mar 1;50(3):327-30. Abstract: BACKGROUND: As access to antiretroviral therapy (ART) in sub-Saharan Africa expands, estimates of the costs of initiating and maintaining patients on ART are important to program planning, budgeting, and cost-effectiveness analyses. METHODS: Total costs of providing HIV care, including ART, in an urban, nongovernmental, adult clinic in Soweto, South Africa, were estimated from October 2004 through March 2005. Personnel costs were estimated using individuals' work time and salary, and for across-organization services (eg, information technology), a proportion of entire annual costs was applied. Utilization of medications, laboratories, and radiographic tests were estimated by a random sample of patient charts (10%) and applied to the entire cohort. RESULTS: Nine hundred sixty-six adult patients received care during the study period (75% female, median age 34 years, median CD4 count at ART initiation: 109 cells/mm). Seventeen percent were stable on ART at entry, 61% initiated ART, and 22% did not receive ART over the course of the study. Mean cost of the entire program (in US $) was $92,388 per month, and mean per patient cost of care-regardless of ART treatment status-was $98.1 per month. Among adults on ART, costs were lowest for those already on ART ($119.0/month) and highest for those initiating ART ($209.7/month) in the first month and $130.0 the following month. Human resources and antiretrovirals each accounted for one third of overall costs. CONCLUSIONS: The monthly cost of treating HIV-infected patients in an urban South African clinic was highest in the month of initiation and lower for stable patients, with costs driven predominantly by antiretrovirals and personnel. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | URBAN AREAS | CLINIC VISITS | PERSONS LIVING WITH HIV/AIDS | FEES | COST EFFECTIVENESS | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Financial Activities | Economic Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330891 |
| 9. Peer Reviewed Title: Integrating quality postnatal care into PMTCT in Swaziland. Author: Mazia G; Narayanan I; Warren C; Mahdi M; Chibuye P; Walligo A; Mabuza P; Shongwe R; Hainsworth M Source: Global Public Health. 2009;4(3):253-70. Abstract: Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies. Language: English Keywords: SWAZILAND | RESEARCH REPORT | PILOT PROJECTS | PROVIDERS WITH CLIENTS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | PROGRAM EFFECTIVENESS | TRAINING ACTIVITIES | KNOWLEDGE | CLINIC VISITS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Health Services | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Diseases | Primary Health Care | Programs | Organization and Administration | Program Evaluation | Training Programs | Education | Sociocultural Factors | Service Statistics | Program Activities Document Number: 341394 |
| 10. Peer Reviewed Title: Condom use in the year following a sexually transmitted disease clinic visit. Author: Peterman TA; Tian LH; Warner L; Satterwhite CL; Metcalf CA; Malotte KC; Paul SM; Douglas JM Jr Author: RESPECT-2 Study Group Source: International Journal of STD and AIDS. 2009 Jan;20(1):9-13. Abstract: Consistent condom use can prevent sexually transmitted infections (STIs), but few studies have measured how the prevalence of consistent use changes over time. We measured the prevalence and correlates of consistent condom use over the course of a year. We did a secondary analysis of data from an HIV prevention trial in three sexually transmitted disease clinics. We assessed condom use during four three-month intervals for subjects and across their partnerships using unconditional logistic regression. Condom use was also assessed for subjects during all three-month intervals combined. The 2125 subjects reported on 5364 three-month intervals including 7249 partnership intervals. Condoms were always used by 24.1% of subjects and 33.2% of partnerships during a three-month interval. Over the year, 82% used condoms at least once but only 5.1% always used condoms. Always use of condom was more likely for subjects who had sex only once (66.5%) compared with >30 times (6.4%); one-time partnerships (64.1%) compared with main partnerships (22.2%); and in new partnerships (44.0%) compared with partnerships that were not new (24.5%). Although consistent condom use may prevent STIs, condoms were rarely used consistently during the year of follow-up. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | STATISTICAL REGRESSION | COHORT ANALYSIS | CLINIC VISITS | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONTRACEPTIVE PREVALENCE | TIME FACTORS | COITAL FREQUENCY | HIV PREVENTION | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Family Planning Surveys | Family Planning | Data Analysis | Service Statistics | Program Activities | Programs | Organization and Administration | Risk Reduction Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Contraceptive Usage | Contraception | Population Dynamics | Demographic Factors | Population | Sex Behavior | HIV Infections | Viral Diseases Document Number: 330716 |
| 11. Peer Reviewed Title: Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambarene, Gabon. Author: Schwarz NG; Gysels M; Pell C; Gabor J; Schlie M; Issifou S; Lell B; Kremsner PG; Grobusch MP; Pool R Source: Vaccine. 2009 Jul 16; Abstract: The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem at odds with the region's observed low vaccination coverage. Important reasons for MCC non-attendance included distance to the MCC, transport costs, negative experiences at MCCs (such as interactions with unfriendly staff) and mothers' feeling of shame provoked by different, often poverty-associated reasons such as attending the clinic with a dirty or poorly clothed child. Language: English Keywords: GABON | RESEARCH REPORT | MOTHERS | MATERNAL-CHILD HEALTH SERVICES | VACCINATION | USER COMPLIANCE | ATTITUDES | QUESTIONNAIRES | INTERVIEWS | CLINIC VISITS | DISTANCE | TRANSPORTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Immunization | Behavior | Psychological Factors | Data Collection | Research Methodology | Service Statistics | Program Activities | Programs | Organization and Administration | Geographic Factors | Population | Economic Factors Document Number: 342280 |
| 12. Peer Reviewed Title: Trends observed during a decade of paediatric sick visits to peripheral health facilities in rural western Kenya, 1997-2006. Author: Van Hemelrijck MJ; Lindblade KA; Kubaje A; Hamel MJ; Odhiambo F; Phillips-Howard PA; Laserson KF; Slutsker L; Feikin DR Source: Tropical Medicine and International Health. 2009 Jan;14(1):62-9. Abstract: OBJECTIVES: To assess whether longitudinal surveillance in peripheral health facilities could document trends in disease burden, healthcare practice and utilization resulting from large-scale public health interventions made in the decade 1997-2006. METHODS: Data were collected from sick child visits (SCVs) among children <5 years attending 14 outpatient facilities in Asembo, rural western Kenya, during 1997-2006. Changes in proportions, and counts and rates were evaluated using chi-square and Poisson regression respectively. RESULTS: During the decade, 64 394 SCVs were made, yielding an average rate of 0.70 SCVs per child-year. The annual number of SCVs stayed constant during 1997-2003, then increased by 74% between 2003 and 2006 (P < 0.01). The time between symptom onset and SCV shortened from 5.6 days in 1997 to 4.4 days in 2006 (P < 0.01). Malaria and upper respiratory tract infection (URTI) were most commonly diagnosed (69% and 36% of SCVs respectively). Between 2003 and 2006, the proportion of SCVs with a malaria diagnosis fell from 77% to 48%, although the rate of malaria SCVs did not. URTI visits increased in 2004-2006. The most frequently prescribed antimalarials changed three times, lagging 1-2 years behind changes in national policy. Treatment of pneumonia with antibiotics varied by year, ranging from 19% to 89%. CONCLUSION: Surveillance of paediatric SCVs at peripheral health facilities was useful in documenting the timing and penetration of changes in national policies and clinical patterns of drug use for common infections. The surveillance data suggested that improved access to care, rather than disease burden changes, likely led to greater healthcare utilization after 2003. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EPIDEMIOLOGIC METHODS | CHILDREN | RURAL POPULATION | CLINIC VISITS | PNEUMONIA | MALARIA | RESPIRATORY INFECTIONS | PREVALENCE | ANTIMALARIAL DRUGS | ANTIBIOTICS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Pulmonary Effects | Physiology | Biology | Parasitic Diseases | Diseases | Infections | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330262 |
13.  Title: USAID-supported research influences international family planning guidelines. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Brief on Hormonal Contraception) Abstract: The World Health Organization has changed its recommendation on the timing of re-injection for depot medroxyprogesterone acetate (DMPA). The new guidelines encourage health care providers to allow a longer grace period for a woman to return for her next injection of this popular hormonal contraceptive. Language: English Keywords: SOUTH AFRICA | UGANDA | ZIMBABWE | THAILAND | SUMMARY REPORT | WHO | DEPO-PROVERA | TIME FACTORS | CLINIC VISITS | CONTRACEPTION CONTINUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Asia, Southeastern | Asia | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Contraceptive Usage Document Number: 331727 |
| 14. Peer Reviewed Title: Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania. Author: Anders K; Marchant T; Chambo P; Mapunda P; Reyburn H Source: Malaria Journal. 2008 May 9;7:79. Abstract: Intermittent preventive treatment (IPTp) is efficacious in reducing the adverse outcomes associated with pregnancy-associated malaria, however uptake of the recommended two doses is low in Tanzania, and little is known of the timepoint during pregnancy at which it is delivered. This study investigated the timing of delivery of IPTp to pregnant women attending antenatal clinics (ANC), and the potential determinants of timely uptake. Structured interviews were conducted with staff and pregnant women at antenatal clinics in northeast Tanzania, and antenatal consultations were observed. Facility-based and individual factors were analysed for any correlation with timing of IPTp uptake. Almost half the women interviewed first attended ANC during or before the fourth month of gestation, however 86% of these early attendees did not receive IPTp on their first visit. The timing of IPTp delivery complied closely with the national guidelines which stipulate giving the first dose at 20-24 weeks gestation. Uptake of at least one dose of IPTp among women who had reached this gestation age was 67%, although this varied considerably between clinics. At one facility, IPTp was not delivered because SP was out of stock. Early uptake of IPTp was found to be hampered by factors external to health worker performance or women's individual preferences. These include insufficient drug stocks and an apparent lack of information to health workers on the reasoning for continued use of SP for IPTp when it has been replaced as a first-line treatment. In addition, an unexpectedly high proportion of women attend antenatal clinics before 20 weeks of pregnancy. While current policy denies the use of IPTp at this time, there is emerging, but incomplete, evidence that malaria in early pregnancy may contribute considerably to the burden of pregnancy-related malaria. Current policy may thus result in a missed opportunity for maximising the benefit of this intervention, and efforts to encourage earlier attendance at ANC alone are unlikely to improve uptake of IPTp. More evidence is needed to weigh the benefits of early IPTp use against theoretical risks of antifolate drugs in early pregnancy. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | INTERVIEWS | PREGNANT WOMEN | ANTENATAL CARE | GESTATIONAL AGE | CLINIC VISITS | MALARIA PREVENTION | MALARIA | TREATMENT | QUALITY OF HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health | Fetus | Pregnancy | Reproduction | Service Statistics | Program Activities | Programs | Organization and Administration | Parasitic Diseases | Diseases | Medical Procedures | Medicine | Health Services Evaluation | Program Evaluation Document Number: 326735 |
| 15. Peer Reviewed Title: Antenatal care and perinatal outcomes in Kwale district, Kenya. Author: Brown CA; Sohani SB; Khan KS; Lilford RJ; Mukhwana W Source: BMC Pregnancy and Childbirth. 2008 Jan 10;8:2. Abstract: The importance of antenatal care (ANC) for improving perinatal outcomes is well established. However access to ANC in Kenya has hardly changed in the past 20 years. This study aims to identify the determinants of attending ANC and the association between attendance and behavioural and perinatal outcomes (live births and healthy birthweight) for women in the Kwale region of Kenya. A Cohort survey of 1,562 perinatal outcomes (response rate 100%) during 2004-05 in the catchment areas for five Ministry of Health dispensaries in two divisions of the Kwale region. The associations between background and behavioural decisions on ANC attendance and perinatal outcomes were explored using univariate analysis and multivariate logistic regression models with backwards-stepwise elimination. The outputs from these analyses were reported as odds ratios (OR) with 95% confidence intervals (CI). Only 32% (506/1,562) of women reported having any ANC. Women with secondary education or above (adjusted OR 1.83; 95% CI 1.06-3.15) were more likely to attend for ANC, while those living further than 5km from a dispensary were less likely to attend (OR 0.29; 95% CI 0.22-0.39). Paradoxically, however, the number of ANC visits increased with distance from the dispensary (OR 1.46; 95% CI 1.33-1.60). Women attending ANC at least twice were more likely to have a live birth (vs. stillbirth) in both multivariate models. Women attending for two ANC visits (but not more than two) were more likely to have a healthy weight baby (OR 4.39; 95% CI 1.36-14.15). The low attendance for ANC, combined with a positive relationship between attendance and perinatal outcomes for the women in the Kwale region highlight the need for further research to understand reasons for attendance and non-attendance and also for strategies to be put in place to improve attendance for ANC. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | PREGNANT WOMEN | MOTHERS | ANTENATAL CARE | PREGNANCY OUTCOMES | EDUCATIONAL STATUS | CLINIC VISITS | IMPACT | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Service Statistics | Program Activities | Programs | Organization and Administration | Communication Document Number: 323623 |
| 16. Title: Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI). Author: Devi KM; Devi KhS; Singh NB; Singh NN; Singh ID Source: Journal of Communicable Diseases. 2008 Sep;40(3):193-7. Abstract: In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease. Language: English Keywords: INDIA | RESEARCH REPORT | CLIENTS | WOMEN | PERSONS LIVING WITH HIV/AIDS | CLINIC VISITS | SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT INFECTIONS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | Asia, Southern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Service Statistics | Infections | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331012 |
| 17. Peer Reviewed Title: Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia. Author: Krebs DW; Chi BH; Mulenga Y; Morris M; Cantrell RA Source: AIDS Care. 2008 Mar;20(3):311-317. Abstract: Timely adherence to clinical and pharmacy appointments is well correlated with favourable patient outcomes among HIV-infected individuals on antiretroviral therapy. To date, however, there is little work exploring reasons behind missed visits or evaluating programmatic strategies to recall patients. For this study we implemented community-based follow-up of late patients as part of a large-scale programme for HIV care and treatment in Lusaka, Zambia. Through a network of local home-based care organizations, we attempted home visits to recall patients using locator information provided at time of enrolment. Between May and September 2005, home-based caregivers were dispatched to trace 1,343 patients with missed appointments. Of these, 554 (41%) were untraceable because the provided address was invalid, the patient had moved or no one was at the home. Of the remaining 789, 359 (46%) were reported to have died. Only 430 (54% of those traced, 32% overall) were contacted directly and encouraged to return for care. The likelihood of patient return was higher among traced patients in crude analysis (relative risk [RR] = 2.5; 95%CI = 1.9-3.2) and in multivariable analysis controlling for baseline body mass index, sex and CD4+count less than or equal to 50/microL (adjusted RR = 2.3; 95%CI = 1.7-3.2). However, the process was inefficient: one late patient returned for every 18 home visits that were made. Reasons for missed visits were provided in 271 of 430 (63%) of the patients who were successfully traced. Common reasons included feeling too sick to come to the clinic, travelling away from home and being too busy. Despite the availability of free ART in Lusaka, patients face significant barriers to attending scheduled clinical visits. Cost-effective and feasible strategies are urgently needed to improve timely patient follow-up. (author's) Language: English Keywords: ZAMBIA | RESEARCH REPORT | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | AIDS PREVENTION | ANTIRETROVIRAL THERAPY | COMMUNITY HEALTH SERVICES | USER COMPLIANCE | TIME FACTORS | CLINIC VISITS | HOME VISITS | DISTANCE | MOTIVATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | HIV Infections | Viral Diseases | Diseases | AIDS | HIV | Primary Health Care | Health Services | Delivery of Health Care | Health | Behavior | Population Dynamics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Communication | Geographic Factors | Psychological Factors Document Number: 325503 |
| 18. Title: The Oportunidades Program increases the linear growth of children enrolled at young ages in urban Mexico. Author: Leroy JL; Garcia-Guerra A; Garcia R; Dominguez C; Rivera J Source: Journal of Nutrition. 2008 Apr;138(4):793-798. Abstract: The goal of this study was to evaluate the impact of Mexico's conditional cash transfer program, Oportunidades, on the growth of children less than 24 mo of age living in urban areas. Beneficiary families received cash transfers, a fortified food (targeted to pregnant and lactating women, children 6-23 mo, and children with low weight 2-4 y), and curative health services, among other benefits. Program benefits were conditional on preventative health care utilization and attendance of health and nutrition education sessions. We estimated the impact of the program after 2 y of operation in a panel of 432 children less than 24 mo of age at baseline (2002). We used difference-in-difference propensity score matching, which takes into account nonrandom program participation and the effects of unobserved fixed characteristics on outcomes. All models controlled for child age, sex, baseline anthropometry, and maternal height. Anthropometric Z-scores were calculated using the new WHO growth reference standards. There was no overall association between program participation and growth in children 6 to 24 mo of age. Children in intervention families younger than 6 mo of age at baseline grew 1.5 cm (P less than 0.05) more than children in comparison families, corresponding to 0.41 height-for-age Z-scores (HAZ) (P less than 0.05). They also gained an additional 0.76 kg (P less than 0.01) or 0.47 weight-for-height Z-scores (P less than 0.05). Children living in the poorest intervention households tended (0.05 less than P less than 0.10) to be taller than comparison children (0.9 cm, 0.27 HAZ). Oportunidades, with its strong nutrition component, is an effective tool to improve the growth of infants in poor urban households. (author's) Language: English Keywords: MEXICO | RESEARCH REPORT | EVALUATION | LONGITUDINAL STUDIES | HOUSEHOLDS | CHILD | YOUTH | PREGNANT WOMEN | PRIMARY HEALTH CARE | HEALTH SERVICES | UTILIZATION OF HEALTH CARE | CLINIC VISITS | CHILD DEVELOPMENT | SOCIAL WELFARE | MICROECONOMIC FACTORS | NUTRITION PROGRAMS | North America | Americas | Developing Countries | Studies | Research Methodology | Family and Household | Sociocultural Factors | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Service Statistics | Program Activities | Programs | Organization and Administration | Biology | Economic Factors Document Number: 325553 |
| 19. Title: Strategies for communicating contraceptive effectiveness. (Review) Author: Lopez LM; Steiner MJ; Grimes DA; Schulz KF Source: Cochrane Database of Systematic Reviews. 2008 Apr 23;(2):1-41. ID:CD006964 Abstract: Knowledge of contraceptive effectiveness is crucial to making an informed choice. The consumer has to comprehend the pros and cons of the contraceptive methods being considered. Choice may be influenced by understanding the likelihood of pregnancy with each method and factors that influence effectiveness. The objective of this study was to review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy. The authors searched the computerized databases MEDLINE, POPLINE, CENTRAL, PsycINFO, and EMBASE for studies of communicating contraceptive effectiveness. We also examined references lists of relevant articles, and wrote to known investigators for information about other published or unpublished trials. We included randomized controlled trials that compared methods for communicating contraceptive effectiveness to consumers. The comparison could be usual practice or an alternative to the experimental intervention. Data were abstracted by two authors and entered into RevMan. For dichotomous variables, the Peto odds ratio (OR) with 95% confidence intervals (CI) was calculated. For continuous variables, the weighted mean difference (WMD) was computed. Five trials met the inclusion criteria. In one study, knowledge gain favored a slide-and-sound presentation versus a physician's oral presentation (WMD -19.00; 95% CI -27.52 to -10.48). Another trial showed a table with effectiveness categories led to more correct answers than one based on numbers [ORs were 2.42 (95% CI 1.43 to 4.12) and 2.19 (95% CI 1.21 to 3.97)] or a table with categories and numbers [ORs were 2.58 (95% CI 1.5 to 4.42) and 2.03 (95% CI 1.13 to 3.64)]. One trial examined contraceptive choice: women in the expanded program were more likely to choose sterilization (OR 4.26; 95% CI 2.46 to 7.37) or use a modern contraceptive method (OR 2.35; 95% CI 1.82 to 3.03). No trial had an explicit theoretical base, but each used concepts from common theories or models.We have limited evidence about what works to help consumers choose an appropriate contraceptive method. For presenting pregnancy risk data, one trial showed that categories were better than numbers. In another trial, audiovisual aids worked better than the usual oral presentation. Strategies for communicating information should be examined in clinical settings and assessed for effect on contraceptive choice and retention of knowledge. To expand the knowledge base of what works in contraceptive counseling, randomized trials could intentionally use and test theories or models. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL TRIALS | THEORETICAL MODELS | COUPLES | COMMUNICATION STRATEGY | CONTRACEPTIVE EFFECTIVENESS | DECISION MAKING | CONTRACEPTIVE METHODS | CONTRACEPTIVE METHODS CHOSEN | PREGNANCY RATE | AUDIOVISUAL AIDS | CLINIC VISITS | KNOWLEDGE | FAMILY PLANNING EDUCATION | Clinical Research | Research Methodology | Family Characteristics | Family and Household | Sociocultural Factors | Communication | Contraception | Family Planning | Behavior | Contraceptive Usage | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Educational Methods | Educational Activities | Education | Service Statistics | Program Activities | Programs | Organization and Administration Document Number: 323111 |
| 20. Title: Changes in STI services following a community based STI-intervention project in Cambodia. Author: O'Farrell N; Sano P; Sopheap S; Heng LS; Sun LP; Vun MC; Fylkesnes K; Godwin P Source: Southeast Asian Journal of Tropical Medicine and Public Health. 2008 Sep;39(5):867-75. Abstract: The aim of this study was to assess changes in sexually transmitted infections (STI) related care following a STI project with a particular focus on registered brothel-based (direct) female sex workers (DFSWs) in four border provinces of Cambodia. A survey of health care facilities providing STI care was undertaken and the results compared with a baseline survey done two years previously. The main components of the project were: renovation of the STI clinics, STI training, formation of mobile teams, provision of STI drugs, and the introduction of basic laboratory tests at STI clinics. Interviews were held with health care providers and STI patients and a manual check was made of the STI register and special forms for DFSWs. Clinical management of STI cases was assessed for DFSWs, women with vaginal discharge and men with urethral discharge. Advice given to clients about condom use, partner notification and STI education was assessed and availability of STI drugs was reviewed. STI clinic attendance by DFSWs each month increased from 72% (296/412) to 93% (459/496). The proportion of DFSWs diagnosed with presumed STIs decreased from 86.5% (256/296) to 25.5% (117/459) and cervicitis from 32.8% (135/412) to 12.6% (58/459). The percentage of men attending STI clinics decreased from 26.9% (251/933) to 9.4% (102/1,080). The proportion of presumed STI cases/all cases attending health centers decreased from 7.0% (934/13,177) to 4.3% (739/17,224). The introduction of laboratory tests coincided with a marked reduction in DFSWs diagnosed with cervicitis. Further validation studies are required to determine whether this reduction was accompanied by a real decrease in gonorrhea and chlamydia. Language: English Keywords: CAMBODIA | RESEARCH REPORT | KAP SURVEYS | BASELINE SURVEYS | COMMUNITY | SEX WORKERS | WOMEN IN DEVELOPMENT | SEXUALLY TRANSMITTED DISEASE PREVENTION | BORDER CROSSING | SEX EDUCATION | COMMUNITY HEALTH SERVICES | SEX FACTORS | PREVALENCE | SAFER SEX | CLINIC VISITS | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | Sex Behavior | Behavior | Economic Development | Economic Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | International Migration | Migration | Population Dynamics | Demographic Factors | Education | Primary Health Care | Health Services | Delivery of Health Care | Health | Population Characteristics | Measurement | Service Statistics | Program Activities | Programs | Organization and Administration Document Number: 330337 |
| 21. Peer Reviewed Title: Self-reported reasons among HIV-infected patients for missing clinic appointments. Author: Park WB; Kim JY; Kim SH; Kim HB; Kim NJ Source: International Journal of STD and AIDS. 2008 Feb;19(2):125-126. Abstract: Although adherence to clinic visits is important for successful clinical outcome in HIV treatment, little is known about the reasons patients with HIV miss appointments. We prospectively monitored the self-reported reasons for missed clinic appointments among HIV patients at a university hospital in South Korea from June through December 2006. Of the 1562 scheduled clinic visits, 131 (8%) of appointments were missed. Work schedule, forgetfulness and lack of motivation were the primary reasons given for missed appointments. Considering these factors when scheduling appointments may improve adherence to clinic attendance among HIV-infected patients. (author's) Language: English Keywords: REPUBLIC OF KOREA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | BEHAVIOR | CLINIC VISITS | HIV | Asia, Eastern | Asia | Developed Countries | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Service Statistics Document Number: 325329 |
| 22. Peer Reviewed Title: Process indicators in the Program for Humanization of Prenatal Care and Childbirth in Ceara State, Brazil: analysis of a historical series (2001-2006). Author: Passos AA; Moura ER Source: Cadernos De Saude Publica. 2008 Jul;24(7):1572-80. Abstract: This was a descriptive, exploratory, documental study of trends that aimed to analyze process indicators in the Program for Humanization of Prenatal Care and Childbirth in Ceara State, Brazil, from 2001 to 2006. The authors analyzed data from 312,507 pregnant women. In 2001, the year the program was implemented in the State, the system tabulated data for three of the seven process indicators; beginning in 2002, all indicators were tabulated. Total enrollment of pregnant women was the only indicator that increased every year until 2006, while the other indicators increased from 2002 until 2005, but declined from 2005 to 2006. When combining the completion of six prenatal visits with a postpartum visit, routine laboratory tests, or both, the percentages declined. Tetanus immunization reached the highest percentage in 2002 (68.34%), decreasing to 60.86% in 2006. The combination of six prenatal visits, a postpartum visit, laboratory tests, tetanus immunization, and HIV test was the indicator with the lowest percentage for the State (15.67%), although it was higher than the national average. Even considering flaws in the use of the Prenatal Care Information System, it is unacceptable that prenatal care still lacks complete coverage for such basic elements as routine laboratory tests and tetanus immunization. Language: English Keywords: BRAZIL | RESEARCH REPORT | DATA ANALYSIS | PREGNANT WOMEN | MATERNAL-CHILD HEALTH SERVICES | STANDARDS | ANTENATAL CARE | CHILDBIRTH | CLINIC VISITS | TETANUS | IMMUNIZATION | HIV TESTING | INFORMATION RETRIEVAL SYSTEMS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Maternal Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Service Statistics | Program Activities | Programs | Organization and Administration | Infections | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Data Storage and Retrieval | Information Processing | Information Document Number: 342210 |
| 23. Peer Reviewed Title: Decreased waiting periods in a public pregnancy termination clinic. Author: Patel A; Panchal H; Patel R; Keith L Source: Contraception. 2008 Feb;77(2):105-107. Abstract: In our public hospital, first-trimester pregnancy termination historically had been performed in an operating room by suction curettage on a separate day following the initial clinic visit. To increase efficiency, we instituted three changes over a 2-year period: (a) pregnancy termination procedures were relocated to the outpatient area; (b) same-day service was initiated; and (c) manual vacuum aspiration was introduced. Our primary objective was to assess the effects of these changes on the waiting period in days from the intake visit to the day of termination procedure. Our secondary objectives included assessing any decrease in gestational age at the time of procedure, increases in the numbers of procedures at less than 9 weeks, the numbers of procedures per session and the proportion done on the day of intake. This is a retrospective cross-sectional review of the clinical records of patients who requested pregnancy termination. Data were obtained on 625 patients who underwent a surgical termination of pregnancy from February 1, 2004, to January 31, 2006. The waiting period decreased from 20.3 to 3.6 days (p less than .01), and mean gestational age at termination decreased from 11 to 9 weeks (p less than .01). The proportion at less than 9 weeks' gestation increased from 1.7% to 40% (p less than .01). The number of procedures per session increased by 52.7% (p less than .01). The percentage of same-day procedures increased from 7% to 62%. We improved efficiency of care by reducing the waiting period and terminating pregnancies earlier in gestation with manual equipment. (author's) Language: English Keywords: UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | HOSPITALS | PROGRAM EFFICIENCY | GESTATIONAL AGE | CLINIC VISITS | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Health Facilities | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Fetus | Pregnancy | Reproduction | Service Statistics | Program Activities Document Number: 324408 Notification |
| 24. Peer Reviewed Title: Effective contraceptive use: an exploration of theory-based influences. Author: Peyman N; Oakley D Source: Health Education Research. 2008 Dec 1; Abstract: The purpose of this study was to explore factors that influence oral contraceptive (OC) use among women in Iran using the Theory of Planned Behavior (TPB) and concept of self-efficacy (SE). The study sample consisted of 360 married OC users, aged 18-49 years recruited at public health centers of Mashhad, 900 km east of Tehran. SE had the strongest association with the intent to use after the clinic visit (r = 0.784) and with actual use (r = 0.452). Family planning self-efficacy combined with TPB variables accounted for 65% of the variance for intent and 27% of the variance in behavior. The results provide support for a theory-based approach to improved family planning care that specifically addresses more effective use. Development and evaluation of culturally appropriate public education and changes in clinical efforts designed to enhance the sense of SE are discussed. Language: English Keywords: IRAN | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | THEORETICAL MODELS | WOMEN IN DEVELOPMENT | CONTRACEPTIVE USAGE | USER COMPLIANCE | ORAL CONTRACEPTIVES | CLINIC VISITS | CONTRACEPTIVE PREVALENCE | CULTURE | Middle East | Developing Countries | Family Planning Surveys | Family Planning | Research Methodology | Economic Development | Economic Factors | Contraception | Behavior | Contraceptive Methods | Service Statistics | Program Activities | Programs | Organization and Administration | Sociocultural Factors Document Number: 341488 |
| 25. Title: Adverse effects of antiretroviral treatment. Author: Sharma A; Vora R; Modi M; Sharma A; Marfatia Y Source: Indian Journal of Dermatology, Venereology and Leprology. 2008 May-Jun;74(3):235-238. Abstract: The introduction of highly active antiretroviral therapy (HAART) has led to significant reduction in acquired immune deficiency syndrome (AIDS)-related morbidity and mortality. Adverse drug reactions (ADRs) to antiretroviral treatment (ART) are however, major obstacles in its success. AIMS: We sought to study the adverse effects of ART in a resource-restricted setting in India. Hundred patients on ART were studied prospectively over a period of two years. All patients were asked to visit the clinic if they developed any symptoms or on a monthly basis. They were screened clinically and investigated suitably for any ADRs. Out of the 100 patients, ten patients did not come for follow-up; only 90 cases were available for evaluation. ADRs were observed in 64 cases (71.1%) - the maximal frequency of ADRs was seen with zidovudine (AZT) (50%) followed by stavudine (d4T) (47.9%), efavirenz (EFV) (45.4%) and finally, Nevirapine (NVP) (18.4%). Most common ADRs were cutaneous (44.4%) followed by hematological(32.2%), neurological (31.1%), metabolic (22.2%) and gastrointestinal (20%). Most common cutaneous ADRs observed were nail hyperpigmentation (14.4%) and rash (13.3%). Immune reconstitution inflammatory syndrome (IRIS) was observed as a paradoxical reaction to ART in 20 (22.2%) cases. To optimize adherence and thus, efficacy of ART, clinicians must focus on preventing adverse effects whenever possible, and distinguish those that are self-limited from those that are potentially serious. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINIC VISITS | TREATMENT | ANTIRETROVIRAL THERAPY | SIDE EFFECTS | AIDS | TUBERCULOSIS | TOXICITY | Developing Countries | Asia, Southern | Asia | Service Statistics | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | HIV Infections | Viral Diseases | Diseases | Infections | Physiology | Biology Document Number: 327367 |
| 26. Title: Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. Author: Talam NC; Gatongi P; Rotich J; Kimaiyo S Source: East African Journal of Public Health. 2008 Aug;5(2):74-78. Abstract: Objective: To determine important factors that affect antiretroviral drug adherence among HIV/AIDS male and female adult patients (18 years and above) attending Moi Teaching and Referral Hospital, Eldoret, Kenya. Methods: A cross sectional study involving 384 HIV/AIDS adult patients attending Moi Teaching and Referral Hospital, Eldoret was conducted. These patients were on ARV drugs. They were investigated for factors that affected their drug adherence based on observing the timing of doses and keeping of clinic appointments for drug refills during the months of May, June and July 2005. Data were collected from the respondents using interviewer-administered questionnaires to patients and self-administered questionnaires by ten key informants (nurses and clinicians in charge of HIV/AIDS clinic) selected by purposive sampling. The key variables examined were demographic, other characteristics of the patients and adherence factors. Data were analysed using Statistical Package for Social Sciences (SPSS) version 10.0 for frequencies, cross-tabulations and Chi-Squared test and statistical significance set at p<0.05. Results: Sixty-eight percent of the respondents on ARVs were females. 52.1% had secondary and post secondary education. They were aged between 18-63 years (mean age 36.1 +or-8.5 years). Results showed that only 43.2% adhered to the prescribed time of taking drugs. The most commonly cited reasons for missing the prescribed dosing time by the patients were: Being away from home 68.8%, being too busy 58.9%, forgetting 49.0%, having too many medicines to take 32.6% and stigma attached to ARVs 28.9%. There was no significant difference between males and females based on timing of taking medications ( 2= 2.9412, p = 0.0861). On the basis of keeping clinic appointments, all the respondents claimed to adhere to scheduled clinics. However, from hospital records, it was established that only 93.5% of the respondents kept clinic appointments. The most common reasons for poor adherence to clinic appointments were; Being away from home (50%), forgetting (50%), being too busy (50%), stigma (70%), feeling sick (80%) and changes in work routine (60%). Conclusion: The key factors affecting adherence were; being away from home, being busy and forgetting. It was recommended that patients should be educated on the importance of strict adherence to the prescribed doses of ARVs as a suitable measure of intervention. Future research should explore multiple-target interventions to resolve the barriers to adherence. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ADULTS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | TIME FACTORS | DISTANCE | STIGMA | EMPLOYMENT | CLINIC VISITS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | HIV | Population Dynamics | Geographic Factors | Social Problems | Sociocultural Factors | Macroeconomic Factors | Economic Factors | Service Statistics | Program Activities | Programs | Organization and Administration Document Number: 323082 |
| 27. Peer Reviewed Title: Heterosexual anal sex activity in the year after an STD clinic visit. Author: Tian LH; Peterman TA; Tao G; Brooks LC; Metcalf C; Malotte CK; Paul SM; Douglas JM Jr Source: Sexually Transmitted Diseases. 2008 Nov;35(11):905-9. Abstract: OBJECTIVES: To describe heterosexual anal sex activity during a year and to identify factors associated with heterosexual anal sex and condom use during anal sex. METHODS: Secondary analysis of data from a trial conducted in 3 public sexually transmitted disease (STD) clinics. Patients described sexual behaviors every 3-months for the year. Logistic regression models with generalized estimating equations were used to include multiple observations for each subject. RESULTS: Two thousand three hundred fifty-seven heterosexual subjects reported on 6611 3-month intervals that included 9235 partnerships. About 18.3% of subjects had anal sex in a particular 3-month interval and 39.3% in the year. About 23.5% of subjects had anal sex in at least two 3-month intervals in the year. Anal sex was associated with having more sex acts, 2 or more sex partners, unprotected vaginal sex, and a main partner. For anal sex in the past 3 months, 27.3% of subjects consistently used condoms, and 63% of subjects never used condoms. Consistent condom use for anal sex was associated with having consistent condom use for vaginal sex, 2 or more partners, and anal sex with casual or new partner. CONCLUSION: STD clinic patients were commonly engaged in heterosexual anal sex, and most of them never used condoms during anal sex. Patients who had anal sex tended to also engage in other risk behaviors that put them at risk of STD/human immunodeficiency virus. Clinicians should ask about anal sex, appropriately examine and test patients who have had anal sex, and recommend condom use for both anal and vaginal sex. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | MULTIPLE PARTNERS | HETEROSEXUALS | ANAL SEX | SEXUALLY TRANSMITTED DISEASES | CLINIC VISITS | SEX BEHAVIOR | CONTRACEPTIVE PREVALENCE | CONDOM USE | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Sexual Partners | Behavior | Reproductive Tract Infections | Infections | Diseases | Service Statistics | Program Activities | Programs | Organization and Administration | |