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Peer Reviewed

Title: A new agenda for children affected by HIV/AIDS [editorial]
Source: Lancet. 2009 Feb 14;373(9663):517.
Abstract: As is so often the case in the provision of health care and deciding research agendas, children have been sidelined in the fight against HIV/AIDS. According to the latest UNAIDS figures, nearly 2 million children live with HIV worldwide, two-thirds in sub-Saharan Africa. In addition, 12 million children in sub-Saharan Africa have lost one or two parents due to HIV/AIDS. Many more live with a parent or carer with HIV. A very small proportion of infected children receive antiretroviral treatment, and prevention of mother-to-child transmission is only given to a third of women. Diagnosis in infancy is difficult and therefore often delayed. Child-friendly medication is lacking. 60% of children in southern Africa live in poverty. Now that HIV/AIDS is evolving from an acute emergency into a chronic epidemic, the way to deliver treatment and achieve prevention needs to change radically from an individualistic approach to a broader strategic one. Children and families need to take centre stage. In an excellent report, based on 2 years of research and analyses, the Joint Learning Initiative on Children and HIV/AIDS-an independent alliance of researchers, implementers, activists, policy makers, and people living with HIV-has presented recommendations for such a change in direction. Home Truths: Facing the Facts on Children, AIDS, and Poverty, released on Feb 10, points out three broad policies that will make an immediate and long lasting difference to children: support children through immediate or extended families and deliver integrated family-centred services; strengthen community action to support families; and address family poverty through national social protection. Such policies are AIDS-sensitive but not AIDS-directed. The family is the most important support structure for children. The report argues that the way orphans have been defined (as having lost one or both parents) and have become the centre of attention for many HIV/AIDS policies has been unhelpful, if not damaging. 88% of children labelled as orphans have a surviving parent and overall 95% continue to live with extended families. Additionally, children who live with HIV-positive parents have needs long before their parents die. Children need to stay within a family or kinship structure. Infected children usually live with others who are infected with the virus. The whole family, not the individual, needs to become the unit for support and treatment. The report advocates home health visiting and early childhood development interventions together with strategies to encourage children's education. The use of schools as intervention platforms misses the opportunity to reach children early and to reach those who are not in education-the majority in some countries. Economic strengthening of families has to be the basis to allow many of these programmes to fully succeed. The best immediate support for families is given by com munity groups. International donors need to work with these groups in partnership to avoid duplication, confusion, and waste of time and money. The authors suggest that coordination could be strengthened with a district committee that maintains an active register of community activities and devises a system of accountability that is understood by all and serves the com munity. All activities should be delivered within a framework that is based on best practice. Communities also have a crucial role to act as a backstop when families break down or when children live in an abusive environment. Family poverty and undernutrition can be addressed through income-transfer programmes, such as Mexico's Oportunidades programme or South Africa's child support grants. These projects are efficient and simple, empower women, and can act as a springboard for other more complex schemes, such as microfinance loans. Such economic support increases school attendance, reduces illnesses, improves growth, and encourages uptake of health services. The largest portion of money is usually used to purchase food. Extreme poverty, rather than HIV infection, should be used as a criterion to avoid stigma and resentment. The report argues that "any developing country, no matter how poor, can afford social protection packages for children". The positive effect of this policy is now established beyond doubt and no further pilot studies are needed. To integrate all these strategies, governments need to take the lead with national plans and frameworks to scale-up programmes for children and families. With this approach, society as a whole will be strengthened with intergenerational effects that will go a long way towards, but also go well beyond, tackling the effects of HIV/AIDS. Putting children and families at the centre will show long-term vision with guaranteed future benefits. (fulll-text)
Language: English
Keywords:
AFRICA, SUB SAHARAN | SUMMARY REPORT | CHILDREN | HIV INFECTIONS | AIDS | POVERTY | MALNUTRITION | CHILD HEALTH | HEALTH SERVICES | DELIVERY OF HEALTH CARE | TREATMENT | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Socioeconomic Factors | Economic Factors | Nutrition Disorders | Health | Medical Procedures | Medicine
Document Number: 341049

Title: The long wait: reproductive health care in Haiti.
Author: John Snow [JSI]. Research and Training Institute, Inc.
Source: Arlington, Virginia, JSI, Research and Training Institute, Inc., 2009. 22 p.
Abstract: The reproductive health status of Haiti's communities contributes to a life expectancy of 62.8 years for women in comparison to 75.5 years in neighboring Dominican Republic or 80.8 years for women in the U.S. According to Haiti's 2005-2006 Demography Health Survey, 37.5% of women have unmet family planning needs. Additionally, youth and rural area residents report greater unmet needs for family planning than the national average. Unmet family planning contributes to a high total fertility rate of 4.79 (5 in rural versus 2.8 in urban areas), a high infant morality (57 deaths per 1000 live births) and the highest maternal mortality rate in the western world-630 deaths per 100,000 live births. These alarming RH indicators prompted a team from JSI Research & Training Institute, Inc. (JSI) to visit Haiti in January 2009. The objectives of the study were: 1) to identify gaps in the availability and accessibility of comprehensive RH services including: Safer motherhood and emergency obstetric care (EmOC), Family planning, HIV/AIDS and sexually transmitted infections (STI) prevention, care and support, Gender-based violence (GBV) prevention, care and support, and Adolescent-focused RH programming for each of the above RH components. 2) to identify community-level responses and opportunities for strengthening the quality and availability of comprehensive RH services. This report presents the findings of this assessment.
Language: English
Keywords:
HAITI | SUMMARY REPORT | MOTHERS | SAFE MOTHERHOOD | REPRODUCTIVE HEALTH | HIV PREVENTION | AIDS PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | VIOLENCE AGAINST WOMEN | PREVENTION AND CONTROL | FAMILY PLANNING | HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | Developing Countries | Caribbean | Americas | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health | Health | HIV Infections | Viral Diseases | Diseases | AIDS | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Domestic Violence | Crime | Social Problems | Program Evaluation | Programs | Organization and Administration
Document Number: 341307

Title: Promoting health and equity: Evidence, policy and action: Cases from the Western Pacific Region.
Author: World Health Organization [WHO]. Regional Office for the Western Pacific
Source: Manila, Philippines, WHO, Regional Office for the Western Pacific, 2009 Mar. [173] p.
Abstract: Recent years have seen a growth in the evidence base on policies and actions to promote health equity. Despite efforts, however, the evidence shows that inequalities are increasing rather than decreasing in many countries. This may partly be due to faulty policy decisions. There is clearly need for a better evidence-based approach on health policies to achieve equity. At the same time, understanding is inadequate on how policy-makers can best make use of the growing evidence base on promoting equity in health. There is a need for stronger links between evidence and health policy-making and implementation. To respond in part to this need, the WHO Western Pacific Regional Office convened the High Level Meeting on Promoting Health Equity: Evidence, Policy and Action from 16-18 October 2007 in Phnom Penh, hosted by the Royal Government of Cambodia, to provide an opportunity to exchange experiences and identify ways to promote the more systematic use of equity research in health policy and action. Health ministers and other stake holders engaged in the evidence-to-policy process were invited to submit case studies that illustrate the process. This book compiles the nine cases presented at the meeting. An introductory chapter comprises a synthesis of the cases and the lessons learned from them.
Language: English
Keywords:
CAMBODIA | CHINA | VIETNAM | NEW ZEALAND | MALAYSIA | MONGOLIA | SUMMARY REPORT | CASE STUDIES | DELIVERY OF HEALTH CARE | PRIMARY HEALTH CARE | TREATMENT | HEALTH POLICY | HEALTH SERVICES | TUBERCULOSIS | CAPACITY BUILDING | PREVENTION AND CONTROL | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southeastern | Asia | Asia, Eastern | Oceania | Developed Countries | Asia, Northern | Studies | Research Methodology | Health | Medical Procedures | Medicine | Policy | Political Factors | Sociocultural Factors | Infections | Diseases | Program Sustainability | Programs | Organization and Administration | Program Evaluation
Document Number: 331453

Peer Reviewed

Title: HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
Author: Abdool Karim SS; Churchyard GJ; Abdool Karim Q; Lawn SD
Source: Lancet. 2009 Sep 12;374(9693):921-33.
Abstract: One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | DRUG RESISTANCE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | MANAGEMENT | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Medical Procedures | Medicine | Health
Document Number: 342870

Title: Cesarean section deliveries in the occupied Palestinian territory (oPt): An analysis of the 2006 Palestinian Family Health Survey.
Author: Abdul-Rahim HF; Abu-Rmeileh NM; Wick L
Source: Health Policy. 2009 Aug 10;
Abstract: OBJECTIVE: Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory. METHODS: Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15-49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable. RESULTS: Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector. CONCLUSIONS: There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.
Language: English
Keywords:
MIDDLE EAST | DEVELOPING COUNTRIES | PREVALENCE | HEALTH SURVEYS | WOMEN | CESAREAN SECTION | HEALTH SERVICES | DELIVERY OF HEALTH CARE | Measurement | Research Methodology | Health | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine
Document Number: 342538

9.
Title: Women's perspective in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth.
Author: Almeida CA; Tanaka OY
Source: Revista De Saude Publica. 2009 Feb;43(1):98-104.
Abstract: OBJECTIVE: To analyze the importance of inclusion, from women's perspective, in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth, carried out by the Brazilian Ministry of Health. METHODOLOGICAL PROCEDURES: This qualitative study was based on primary data collected in 2003 in an evaluation of the Program conducted in seven towns spread out among Brazil's five geographic regions. These sites were selected from a Federal Government data base utilized for quantitative analysis. Women attended by the Program were considered key informants when primary data was collected. Sixteen focal groups were performed in the primary care units. The Collective Subject Speech (CSS) method was used for qualitative analysis. The theoretical concepts of accessibility and Paideia Health within the framework of public health were used to interpret the findings. ANALYSIS OF RESULTS: The Program standardizes procedures to be taken in antenatal care and childbirth for all health services in the country, including the flow among these services. However, analysis of women's discourse in the focal groups elucidated the existence of dissonances between their needs and desires and many of the program's recommendations. Pregnant women thus choose among available services and professionals and try to set up their own schedules which, in turn, do not correspond to those set up by the program. This discrepancy damages the bond women establish with the health services and creates obstacles for the control of the activities actually provided by the health services to the women. CONCLUSIONS: Analysis of the Program based on women's perspective identified aspects that might result in more humanized and effective antenatal care, if they are taken into account in the redefinition or correction of the Program schedule Miolo abstract Miolo abstract Miolo abstract.
Language: EnglishPortuguese
Keywords:
BRAZIL | RESEARCH REPORT | FOCUS GROUPS | PREGNANT WOMEN | ANTENATAL CARE | MATERNAL-CHILD HEALTH SERVICES | DELIVERY OF HEALTH CARE | NEEDS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Primary Health Care | Health Services | Health | Economic Factors | Programs | Organization and Administration
Document Number: 341988

11.

Peer Reviewed

Title: Evidence behind the WHO guidelines: hospital care for children: what is the evidence that BCG vaccination should not be used in HIV-infected children?
Author: Bannister C; Bennett L; Carville A; Azzopardi P
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):78-82.
Abstract: The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at: http://www.ichrc.org. This review addresses the question: What is the evidence that BCG vaccination should not be used in HIV-infected children? The limited evidence currently available has been the basis of the WHO recommendation that BCG vaccination should not be used in HIV-positive children, as severe complications appear more commonly in HIV-infected individuals [8]. This decision is supported by the findings from the Fallo [13] and Hesseling [18, 20] studies. Although the WHO have suggested that HIV-infected infants should not be vaccinated this is obviously difficult in countries where BCG vaccination is administered before HIV status can be detected. Many high HIV-burden countries do not have viral-specific testing (such as PCR) routinely available to adequately assess the infection status of every new born infant. More research needs to be undertaken in this area to clarify the situation, and treating clinicians need to be made aware of this issue with all its complexity. The WHO recommendation highlights the need for viral-specific testing to be widely available in developing countries. This will ensure HIV-infected infants are not exposed to BCG which may be potentially dangerous and HIV-exposed but uninfected infants are not denied this important vaccine.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | WHO | STANDARDS | CHILDREN | HOSPITALS | DELIVERY OF HEALTH CARE | VACCINES | HIV INFECTIONS | Oceania | Developed Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Health | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases
Document Number: 341013

12.

13.
Title: HIV: time for the medical community to move forward [editorial]
Author: Chua AC
Source: Annals of the Academy of Medicine, Singapore. 2009 Feb;38(2):97-8.
Abstract: As we encourage more people to undergo HIV testing, it is important to understand the implications of an HIV diagnosis and to respect confidentiality and the voluntary consent process. Regarding HIV testing, 50% believe that it should be voluntary and 62.5% believe that mandatory HIV tests should be conducted on men who have sex with men (unpublished data -data available upon request from author). How do we begin to address these issues in our medical profession? We need sound policies and to challenge traditional medical education. (excerpt)
Language: English
Keywords:
SINGAPORE | SUMMARY REPORT | SCREENING | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HIV TESTING | HIV PREVENTION | TREATMENT | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH POLICY | INFORMED CONSENT | Asia, Southeastern | Asia | Developed Countries | Examinations and Diagnoses | Medical Procedures | Medicine | Health | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Policy | Political Factors | Sociocultural Factors
Document Number: 341548

14.

Title: Guinea. Village health committees drive family planning uptake: communities play lead role in increased acceptability, availability.
Author: Diakite O; Keita DR; Mwebesa W
Source: Washington, D.C., Core Group, [2009]. 8 p.
Abstract: This document highlights the Village Health Committee (VHC), a vital player in the child survival project and the integration of family planning work within Save the Children's portfolio in Guinea. The document briefly describes the committee's purpose, membership, and tasks. It focuses on a handful of the people and activities that exemplified the VHCs' unique role in ensuring that family planning was not only accessible but acceptable to the villagers they served. The document concludes with some outcomes of Save the Children's family planning component in Mandiana and Kouroussa. In effect, the VHCs' stellar success in building demand for contraception (when coupled with modest investments in existing health workers' ability to supply modern methods) resulted in a sustained increase in the use of contraception in the project zone.
Language: English
Keywords:
GUINEA | PROGRESS REPORT | EVALUATION | COMMUNITY | RURAL POPULATION | USAID | COMMUNITY HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | PERFORMANCE IMPROVEMENT | RURAL HEALTH SERVICES | FAMILY PLANNING | HEALTH SERVICES EVALUATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Residence Characteristics | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Health | Program Evaluation | Programs | Organization and Administration | Management
Document Number: 325193

15.

Title: Making payment for performance work.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :51-78.
Abstract: Here we discuss key issues to consider when designing and the steps to implementing a performance incentives program. Among our examples are those that went wrong as well as those that went right, because valuable lessons can be learned from each. While some of the issues may seem complicated, it is not necessary to get all the details right at the outset: refinements can and should be introduced along the way. Fundamentally different from many traditional approaches to improving the delivery of health services, performance incentives are about establishing what the results should be and then letting the key actors -- the patients, the providers -- figure out how to achieve them. Along the way, learning and fine-tuning are part and parcel of the process. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | INCENTIVES | HEALTH SERVICES | QUALITY OF HEALTH CARE | WAGES | DELIVERY OF HEALTH CARE | MONITORING | EVALUATION | HEALTH SERVICES ADMINISTRATION | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Macroeconomic Factors | Economic Factors
Document Number: 331463

16.

Title: Money into health.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls, [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :3-9.
Abstract: This book addresses one set of approaches to using money and other material goods to affect the actions of those who are delivering and receiving health services. More specifically, it is about how to use particular types of incentives -- those that reward or penalize specific types of results -- to motivate health-related behaviors. Performance incentives are defined as the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. In the conceptualization we use, performance incentives include those that operate at the level of the health facilities (or networks of facilities), the individual provider, the household decisionmakers, and the patients. In other words, we look at incentives on both the demand and the supply sides, at both individual and collective levels. In our framework, we do not include the conditional payments that donor agencies offer to national governments, such as additional grant monies if and when particularpolicy decisions are made. We look solely at the interface between provider and patient. (Excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | LITERATURE REVIEW | MALARIA PREVENTION | AIDS PREVENTION | HIV PREVENTION | FINANCIAL ACTIVITIES | FUNDS | HEALTH SERVICES | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | PROGRAM ACTIVITIES | Developed Countries | North America | Americas | Malaria | Parasitic Diseases | Diseases | AIDS | HIV Infections | Viral Diseases | Economic Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 331460

17.

Title: Using performance incentives.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :23-50.
Abstract: When the goal is to reduce needless death and disease, and part of what is getting in the way is a misalignment between health goals and the real-world behaviors of individual patients, health workers, and those who influence them, it may be time to consider performance incentives. These can complement other interventions, such as providing training, revamping infrastructure, and improving the supply of drugs and other inputs. Here we look at how performance incentives can contribute to better health results, increased use of services, enhanced quality, and improved efficiency. To identify the experiences to highlight in this book, we searched the published literature, consulted experts, and included regional and national cases with substantial documented evidence. The evidence discussed here and in the case summaries in part 2 relies on both evaluations conducted with varying degrees of rigor and other sources of information. It comes from qualitative surveys, baseline and endline statistics, contrasts between intervention and comparison groups, and routine program monitoring. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | INCENTIVES | DELIVERY OF HEALTH CARE | DISEASE PREVENTION | PROGRAM ACTIVITIES | INTERVENTIONS | PREVENTION AND CONTROL | HEALTH SERVICES ADMINISTRATION | EQUIPMENT AND SUPPLIES | Management | Organization and Administration | Health | Policy | Political Factors | Sociocultural Factors | Diseases | Programs | Medical Procedures | Medicine
Document Number: 331462

18.

Peer Reviewed

Title: Toward replacement fertility in Egypt and Tunisia.
Author: Eltigani EE
Source: Studies in Family Planning. 2009 Sep;40(3):215-226.
Abstract: Egypt and Tunisia began their fertility transition at almost identical fertility levels and at roughly the same time period, yet the difference in the pace of decline has been such that the total fertility rate (TFR) in Tunisia reached replacement level by the year 2001, whereas the TFR in Egypt remains above three live births per woman. This article draws on the secondary literature and on several nationally representative surveys from the two countries between 1978 and 2005 to provide empirical evidence of the difference in the pace of fertility decline and to analyze the determinants of the differential. Findings include (a) variation across the two countries in the consistency of fertility decline among the segments of the population leading the transition; (b) that the success of each country�s family planning program was influenced by the role of political leaders and the extent of the program�s integration with socioeconomic development objectives; (c) that the impact of contraception on TFR decline became an important factor in the mid-1980s; and (d) that the greatest determinant of the discrepancy in the pace of fertility decline is the disparity in age at marriage, which rose more significantly in Tunisia than in Egypt. The latter finding indicates that reaching replacement fertility in Egypt hinges primarily on further declines in marital fertility, resulting from reduction of wanted fertility and from an expansion of family planning program coverage and improved efficiency of service delivery and use.
Language: English
Keywords:
EGYPT | TUNISIA | RESEARCH REPORT | LITERATURE REVIEW | BELOW REPLACEMENT FERTILITY | FERTILITY DECLINE | SOCIOECONOMIC FACTORS | MARITAL FERTILITY | FAMILY PLANNING PROGRAMS | HEALTH SERVICES | DELIVERY OF HEALTH CARE | Developing Countries | Africa, North | Africa | Population Decrease | Population Dynamics | Demographic Factors | Population | Fertility Changes | Fertility | Economic Factors | Family Planning | Health
Document Number: 339703

19.
Peer Reviewed

Title: Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal.
Author: Falle TY; Mullany LC; Thatte N; Khatry SK; LeClerq SC; Darmstadt GL; Katz J; Tielsch JM
Source: Journal of Health, Population, and Nutrition. 2009 Feb;27(1):53-61.
Abstract: The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | RURAL AREAS | TRADITIONAL BIRTH ATTENDANTS | COMMUNITY WORKERS | KNOWLEDGE | ATTITUDES | NEONATAL MORTALITY | PERCEPTION | CHILDBIRTH | INTERVENTIONS | DELIVERY OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Health Personnel | Health | Sociocultural Factors | Psychological Factors | Behavior | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Programs | Organization and Administration
Document Number: 331129

20.

Peer Reviewed

Title: Challenge and co-operation: civil society activism for access to HIV treatment in Thailand.
Author: Ford N; Wilson D; Cawthorne P; Kumphitak A; Kasi-Sedapan S; Kaetkaew S; Teemanka S; Donmon B; Preuanbuapan C
Source: Tropical Medicine and International Health. 2009 Mar;14(3):258-66.
Abstract: Civil society has been a driving force behind efforts to increase access to treatment in Thailand. A focus on HIV medicines brought civil society and non-governmental and government actors together to fight for a single cause, creating a platform for joint action on practical issues to improve care for people with HIV/AIDS (PHA) within the public health system. The Thai Network of People with HIV/AIDS, in partnership with other actors, has provided concrete support for patients and for the health system as a whole; its efforts have contributed significantly to the availability of affordable generic medicines, early treatment for opportunistic infections, and an informed and responsible approach towards antiretroviral treatment that is critical to good adherence and treatment success. This change in perception of PHA from 'passive receiver' to 'co-provider' of health care has led to improved acceptance and support within the healthcare system. Today, most PHA in Thailand can access treatment, and efforts have shifted to supporting care for excluded populations.
Language: English
Keywords:
THAILAND | PROGRESS REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | NONGOVERNMENTAL ORGANIZATIONS | ADVOCACY | PROGRAM ACCESSIBILITY | AIDS PREVENTION | TREATMENT | ANTIRETROVIRAL THERAPY | DELIVERY OF HEALTH CARE | USER COMPLIANCE | PERCEPTION | ACCEPTANCE PROCESS | Developing Countries | Asia, Southeastern | Asia | HIV Infections | Viral Diseases | Diseases | Organizations | Political Factors | Sociocultural Factors | Communication | Program Evaluation | Programs | Organization and Administration | AIDS | Medical Procedures | Medicine | Health Services | Health | HIV | Behavior | Psychological Factors | Decision Making
Document Number: 330957

21.

22.

Peer Reviewed

Title: Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa.
Author: Harries J; Stinson K; Orner P
Source: BMC Public Health. 2009 Aug 18;9(1):296.
Abstract: ABSTRACT: BACKGROUND: Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning. In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. METHODS: Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. RESULTS: Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. CONCLUSIONS: This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | QUALITATIVE RESEARCH | HEALTH PERSONNEL | HEALTH SERVICES | DELIVERY OF HEALTH CARE | ABORTION | ATTITUDES | SAFETY | POSTABORTION CARE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Health | Fertility Control, Postconception | Family Planning | Psychological Factors | Behavior | Public Health
Document Number: 342550 Notification

23.

Title: The impact of HIV education on the lives of Ugandan nurses and nurse-midwives.
Author: Harrowing JN
Source: Advances in Nursing Science. 2009 Apr-Jun;32(2):E94-E108.
Abstract: In this ethnography, I explored the impact of an HIV/AIDS education program on the lives of 24 Ugandan nurses and nurse-midwives. Nurses who previously had viewed themselves simply as providers of advice and sympathy now saw themselves as more holistic, collaborative caregivers. They voiced an increased awareness of their role as leaders and advocates in the community with respect to policy. The education program had positive and synergistic effects on the nurses' professional practice, communication and problem-solving skills, confidence, and engagement in political and social change activities.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | NURSE-MIDWIVES | HIV INFECTIONS | HEALTH EDUCATION | HIV TESTING | COUNSELING | DELIVERY OF HEALTH CARE | AWARENESS | IMPACT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health Personnel | Health | Viral Diseases | Diseases | Education | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Clinic Activities | Program Activities | Programs | Organization and Administration | Knowledge | Sociocultural Factors | Communication
Document Number: 342437

24.

Peer Reviewed

Title: Fertility decline in Paraguay.
Author: Ishida K; Stupp P; Melian M
Source: Studies in Family Planning. 2009 Sep;40(3):227-234.
Abstract: Recent reproductive health survey show that the fertility rate in Paraguay decreased precipitously from 4.3 lifetime births per woman in 1995-98 to 2.9 births in 2001-04. In this study, we establish data consistency between the 1998 and 2004 surveys by comparing a series of cohort-specific period rates and use the Bongaarts framework of proximate determinants of fertility to demonstrate that an increase in the contraceptive prevalence rate (CPR) between 1998 and 2004 fully accounts for the fertility decline. Decomposition of rates shows that changes in group-specific CPRs explain a greater proportion of the change in the overall CPR than do changes in population composition by educational attainment, urban residence, region, and language spoken at home. Finally, we show that younger cohorts of women in 2004 reported ideal completed fertility desires of less than 2.9 births, suggesting that the fertility rate is likely to continue to decrease.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASES | FAMILY PLANNING | TREATMENT | HEALTH SERVICES | DELIVERY OF HEALTH CARE | INTEGRATED PROGRAMS | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Medical Procedures | Medicine | Health | Programs | Organization and Administration
Document Number: 339704

25.

Title: On the spatial inequalities of institutional versus home births in Ghana: a multilevel analysis.
Author: Johnson FA; Padmadas SS; Brown JJ
Source: Journal of Community Health. 2009;34:64-72.
Abstract: Spatial inequalities related to the choice of delivery care have not been studied systematically in Sub-Saharan Africa where maternal and perinatal health outcomes continue to worsen despite a range of safe motherhood interventions. Using retrospective data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the extent of changes in spatial inequalities associated with type of delivery care in Ghana with a focus on rural-urban differentials within and across the three ecological zones (Savannah, Forest and Coastal). More than one-half of births in Ghana continue to occur outside health institutions without any skilled obstetric care. While this is already known, we present evidence from multilevel analyses that there exist considerable and growing inequalities, with regard to birth settings between communities, within rural and urban areas and across the ecological zones. The results show evidence of poor and disproportionate use of institutional care at birth; the inequalities remained high and unchanged in both urban and rural communities within the Savannah zone and widening in urban communities of the Forest and Coastal zones. The key policy challenges in Ghana, therefore, include both increasing the uptake of institutional delivery care and ensuring equity in access to both public and private health institutions.
Language: English
Keywords:
GHANA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CHILDBIRTH | HOME CARE | HOSPITALS | INEQUALITIES | DELIVERY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Care and Support | Health Services | Health | Health Facilities | Socioeconomic Factors | Economic Factors | Primary Health Care
Document Number: 340222

26.

Peer Reviewed

Title: The Pediatric AIDS Corps: responding to the African HIV/AIDS health professional resource crisis.
Author: Kline MW; Ferris MG; Jones DC; Calles NR; Mizwa MB; Schwarzwald HL
Source: Pediatrics. 2009 Jan;123(1):134-6.
Abstract: Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment.
Language: English
Keywords:
AFRICA, SUB SAHARAN | EVALUATION REPORT | RECOMMENDATIONS | PILOT PROJECTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PHYSICIANS | HUMAN RESOURCES | CAPACITY BUILDING | HIV INFECTIONS | TREATMENT | PROGRAM DESIGN | TRAINING PROGRAMS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | Africa | Developing Countries | Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Health Personnel | Health | Economic Factors | Program Sustainability | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Education | Program Evaluation
Document Number: 328038

27.
Title: Innovative pediatric palliative care programs in four countries.
Author: Knapp C; Madden V; Marston J; Midson R; Murphy A; Shenkman E
Source: Journal of Palliative Care. 2009 Summer;25(2):132-6.
Abstract: Over the past three decades, pediatric palliative care programs have been developed and refined throughout the world. The purpose of this study was to provide information on experiences from four of those programs, yet we acknowledge that there are many other innovative programs that deserve recognition for the services they provide to children and families. This study is limited in that it is unable to compare outcomes from the four programs, such as patient-reported quality of life, that might help to better understand the impact of pediatric palliative care. Nonetheless, information sharing can inspire and educate others with the overarching goal of globally advancing pediatric palliative care.
Language: English
Keywords:
AUSTRALIA | SOUTH AFRICA | UNITED KINGDOM | UNITED STATES OF AMERICA | SUMMARY REPORT | CHILD HEALTH SERVICES | CARE AND SUPPORT | DELIVERY OF HEALTH CARE | IMPLEMENTATION | PROGRAM DESIGN | OBSTACLES | COUNSELING | REFERRAL AND CONSULTATION | FUNDS | Oceania | Developed Countries | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Europe, Western | Europe | North America | Americas | Maternal-Child Health Services | Primary Health Care | Health Services | Health | Programs | Organization and Administration | Clinic Activities | Program Activities | Financial Activities | Economic Factors
Document Number: 342874

28.
Peer Reviewed

Title: Directing diarrhoeal disease research towards disease-burden reduction.
Author: Kosek M; Lanata CF; Black RE; Walker DG; Snyder JD; Salam MA; Mahalanabis D; Fontaine O; Bhutta ZA; Bhatnagar S; Rudan I
Source: Journal of Health, Population, and Nutrition. 2009 Jun;27(3):319-31.
Abstract: Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015.
Language: English
Keywords:
DEVELOPING COUNTRIES | EVALUATION REPORT | RESEARCH ACTIVITIES | DIARRHEA | PREVENTION AND CONTROL | INTERVENTIONS | PROGRAM EFFECTIVENESS | PROGRAM SUSTAINABILITY | CHILD HEALTH | GOALS | DELIVERY OF HEALTH CARE | COST EFFECTIVENESS | Evaluation | Research Methodology | Diseases | Programs | Organization and Administration | Program Evaluation | Health | Planning | Evaluation Indexes | Quantitative Evaluation
Document Number: 341924

29.

Peer Reviewed

Title: Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment.
Author: Kruk ME; Paczkowski M; Mbaruku G; de Pinho H; Galea S
Source: American Journal of Public Health. 2009 Jul 16;
Abstract: Objectives. We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.Methods. Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters.Results. A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%.Conclusions. In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | RURAL POPULATION | PREGNANT WOMEN | CHILDBIRTH | HEALTH SERVICES | MATERNAL HEALTH | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | SATISFACTION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior
Document Number: 342039


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