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Title: Sexual and reproductive health and HIV linkages: evidence review and recommendations.
Author: World Health Organization [WHO]; United Nations Population Fund [UNFPA]; International Planned Parenthood Federation [IPPF]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; University of California, San Francisco. Global Health Sciences
Source: Geneva, Switzerland, WHO, 2009 Apr. [8] p.
Abstract: The importance of linking sexual and reproductive health (SRH) and HIV is widely recognized. The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to SRH and HIV prevention, treatment, care and support. In order to gain a clearer understanding of the effectiveness, optimal circumstances, and best practices for strengthening SRH and HIV linkages, a systematic review of the literature was conducted. The findings corroborate the many benefits gained from linking SRH and HIV policies, systems and services. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CLIENTS | HIV TESTING | COUNSELING | HIV PREVENTION | FAMILY PLANNING | MATERNAL HEALTH | SEXUALLY TRANSMITTED DISEASE PREVENTION | CHILD HEALTH | MANAGEMENT | KNOWLEDGE | ATTITUDES | STIGMA | BEHAVIOR | FEES | HIV/FP INTEGRATION | INTERVENTIONS | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Sociocultural Factors | Psychological Factors | Social Problems | Financial Activities | Economic Factors
Document Number: 331466

2.
Title: Counsellors are human [letter]
Author: Anand V
Source: Indian Journal of Medical Ethics. 2009 Jul-Sep;6(3):169-70.
Abstract: This letter touches on the subject of the medical knowledge of physicians in India. It first discusses male circumcision and then moves on to India not having an established system for sharing medical information and updates. It asks that better systems of regularly updating the medical knowledge of Indian physicians be developed.
Language: English
Keywords:
INDIA | CRITIQUE | PROVIDERS WITH CLIENTS | MALE CIRCUMCISION | KNOWLEDGE | INFORMED CONSENT | FEES | INFORMATION DISTRIBUTION | Asia, Southern | Asia | Developing Countries | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Sociocultural Factors | Financial Activities | Economic Factors | Communication
Document Number: 342876

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Peer Reviewed

Title: Incidence and correlates of 'catastrophic' maternal health care expenditure in India.
Author: Bonu S; Bhushan I; Rani M; Anderson I
Source: Health Policy and Planning. 2009 Aug 17;
Abstract: Using data from the 60(th) round of the National Sample Survey of India (2004), the study investigates the incidence and correlates of 'catastrophic' maternal expenditure (ME) in India. Data on ME come from 6879 births that took place during 365 days prior to the survey. The study adapts earlier definitions and methods for catastrophic total health care expenditure to measure 'catastrophic' ME as: (i) maternal health care expenditure more than 10% of the annual normative household consumption expenditure (ME-1), and (ii) maternal health care expenditure more than 40% of the annual 'capacity to pay' (ME-2). The 'capacity to pay' was derived by subtracting state-wise poverty-line household expenditure from household consumption expenditure. The average maternal expenditure varied by place of delivery: US$9.5, US$24.7 and US$104.3 for birth at home, in a public facility and in a private facility, respectively. Sixteen per cent of households incurred ME of more than 10% of total household consumption expenditure (ME-1), while 51% households incurred ME of more than 40% of household 'capacity to pay' (ME-2). While incidence of ME-1 increased with income decile, the reverse was observed for ME-2, reflecting higher non-utilization of institutional maternal care and its non-affordability among poorer households. All the households from the poorest decile and 99% from the second poorest decile paid more than 40% of their capacity to pay. Multivariate regression results indicate that antenatal care and delivery care in private facilities increased the chances of ME-1 and ME-2 (P < 0.001). Measuring maternal expenditure against 'capacity to pay' (ME-2) may be better than measuring it as a proportion of overall household expenditure when assessing financial constraints in the use of maternal services. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase utilization of maternal services and reduce the financial distress associated with ME.
Language: English
Keywords:
INDIA | RESEARCH REPORT | EXPENDITURES | INCIDENCE | MATERNAL HEALTH | UTILIZATION OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | FEES | Asia, Southern | Asia | Developing Countries | Financial Activities | Economic Factors | Measurement | Research Methodology | Health | Health Services | Delivery of Health Care | Primary Health Care
Document Number: 342553

5.
Peer Reviewed

Title: Financial barriers to HIV treatment in Yaounde, Cameroon: first results of a national cross-sectional survey.
Author: Boyer S; Marcellin F; Ongolo-Zogo P; Abega SC; Nantchouang R; Spire B; Moatti JP
Source: Bulletin of the World Health Organization. 2009 Apr;87(4):279-87.
Abstract: OBJECTIVE: To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaounde, Cameroon. METHODS: Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaounde) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months. FINDINGS: Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/microl; P = 0.04). CONCLUSION: Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection.
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | FEES | ANTIRETROVIRAL THERAPY | OBSTACLES | TREATMENT | ANTIRETROVIRAL DRUGS | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Financial Activities | Economic Factors | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation
Document Number: 342978

6.
Title: [A fixed dose anti-HIV combination for the poor? Triomune] Triom une: la tritherapie du pauvre ?
Author: Garcia MV; Mukeba-Tshialala D; Vaira D; Moutschen M
Source: Revue Medicale De Liege. 2009 Jan;64(1):32-6.
Abstract: Despite a relative global stabilization of its incidence, HIV infection remains a major threat for public health, principally in Africa where it concerns more than 22 million people and constitutes the first cause of death on the continent. To face the emergency of the HIV/AIDS epidemics on the African continent, the primary goal is to make available to all patients free and efficient antiretroviral medications. Such a goal cannot be dissociated from large scale prevention campaigns. In 2000, Triomune, one of the first fixed dose combinations of three antiretrovirals (stavudine, lamivudine & nevirapine) was launched by the Indian drug company Cipla, specialized in the production of low cost medications. Its convenient pill burden (one pill twice a day) and its very low cost (around 30 US $ per month) make Triomune an appealing solution for the treatment of HIV/AIDS in Africa. Unfortunately, Triomune presents several drawbacks (low genetic barrier, frequent side effects) and one of its constituents is not used in Europe anymore. Other first line treatments are urgently needed.
Language: French
Keywords:
AFRICA | RESEARCH REPORT | INCIDENCE | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | HIV INFECTIONS | FEES | NEEDS ASSESSMENT | PREVENTION AND CONTROL | TREATMENT | PROGRAM ACCESSIBILITY | Developing Countries | Measurement | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341155

Peer Reviewed

Title: Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study.
Author: Huy R; Wichmann O; Beatty M; Ngan C; Duong S; Margolis HS; Vong S
Source: BMC Public Health. 2009;9:155.
Abstract: BACKGROUND: The average annual reported dengue incidence in Cambodia is 3.3/1,000 among children < 15 years of age (2002-2007). To estimate the economic burden of dengue, accurate cost-of-illness data are essential. We conducted a prospective, community-based, matched case-control study to assess the cost and impact of an episode of dengue fever and other febrile illness on households in rural Cambodia. METHODS: In 2006, active fever surveillance was conducted among a cohort of 6,694 children aged < or = 15 years in 16 villages in Kampong Cham province, Cambodia. Subsequently, a case-control study was performed by individually assigning one non-dengue febrile control from the cohort to each laboratory-confirmed dengue case. Parents of cases and controls were interviewed using a standardized questionnaire to determine household-level, illness-related expenditures for medical and non-medical costs, and estimated income loss (see Additional file 1). The household socio-economic status was determined and its possible association with health seeking behaviour and the ability to pay for the costs of a febrile illness. RESULTS: Between September and November 2006, a total of 60 household heads were interviewed: 30 with dengue-positive and 30 with dengue-negative febrile children. Mean total dengue-related costs did not differ from those of other febrile illnesses (31.5 vs. 27.2 US dollars, p = 0.44). Hospitalization almost tripled the costs of dengue (from 14.3 to 40.1 US dollars) and doubled the costs of other febrile illnesses (from 17.0 to 36.2 US dollars). To finance the cost of a febrile illness, 67% of households incurred an average debt of 23.5 US dollars and higher debt was associated with hospitalization compared to outpatient treatment (23.1 US dollars vs. 4.5 US dollars, p < 0.001). These costs compared to an average one-week expenditure on food of 9.5 US dollars per household (range 2.5-21.3). In multivariate analysis, higher socio-economic status (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4-13.2), duration of fever (OR 2.1; 95%CI 1.3-3.5), and age (OR 0.8; 95%CI 0.7-0.9) were independently associated with hospitalization. CONCLUSION: In Cambodia, dengue and other febrile illnesses pose a financial burden to households. A possible reason for a lower rate of hospitalization among children from poor households could be the burden of higher illness-related costs and debts.
Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | PROSPECTIVE STUDIES | RURAL POPULATION | DENGUE | FEVER | FEES | HOUSEHOLDS | MICROECONOMIC FACTORS | MORBIDITY | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Body Temperature | Physiology | Biology | Financial Activities | Economic Factors | Family and Household | Sociocultural Factors
Document Number: 342904

8.
Peer Reviewed

Title: Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India.
Author: Iyengar SD; Iyengar K; Suhalka V; Agarwal K
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):303-12.
Abstract: A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.
Language: English
Keywords:
INDIA | RURAL AREAS | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | WOMEN | CHILDBIRTH | FEES | TRADITIONAL HEALTH PRACTICES | OBSTETRICS | OXYTOCIN | INTERVIEWS | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Demographic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Financial Activities | Economic Factors | Culture | Sociocultural Factors | Medicine | Health Services | Delivery of Health Care | Health | Pituitary Hormones | Hormones | Endocrine System | Physiology | Biology | Data Collection
Document Number: 341927

9.
Title: Baseline survey on functioning of abortion services in government approved CAC centers in three pilot districts of Nepal.
Author: Karki C; Ojha M; Rayamajhi RT
Source: Kathmandu University Medical Journal. 2009 Jan- Mar;7(25):31-9.
Abstract: BACKGROUND: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. OBJECTIVE: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. MATERIALS AND METHODS: Direct observation of the functioning of these centers, assessment of physical facilities and service provider's skill was done. At the same time service provider's attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. RESULT: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. CONCLUSION: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | ABORTION | PILOT PROJECTS | HEALTH PERSONNEL | HEALTH SERVICES EVALUATION | FEES | ATTITUDES | KNOWLEDGE | EQUIPMENT AND SUPPLIES | Developing Countries | Asia, Southern | Asia | Fertility Control, Postconception | Family Planning | Studies | Research Methodology | Delivery of Health Care | Health | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Psychological Factors | Behavior | Sociocultural Factors | Medical Procedures | Medicine | Health Services
Document Number: 342477 Notification

10.

Peer Reviewed

Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation.
Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG
Source: Reproductive Health Matters. 2009 May;17(33):120-132.
Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation.
Spanish Abstract: En 2005, antes de la legalizaci�n del aborto en el Distrito Federal de M�xico, se realiz� una evaluaci�n del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos p�blicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los c�lculos de costos directos inclu�an personal, medicamentos, suministros desechables, y equipo m�dico para inducir el aborto o tratar abortos incompletos y otras complicaciones. Tambi�n se calcularon los costos indirectos de las pacientes en viajes, cuido de ni�os y sueldos perdidos. El costo promedio por cada aborto con dilataci�n y curetaje fue de US $143. Para la aspiraci�n manual endouterina (AMEU), fue de US $111 en tres hospitales p�blicos y US $53 en una cl�nica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales p�blicos vari� de US $601 a m�s de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podr�an disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al a�o. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en �mbitos ambulatorios, disminuir�an tambi�n los costos de la atenci�n del aborto, lo cual ser�a un gran beneficio tanto para el sistema de salud de M�xico como para las mujeres que buscan servicios de aborto. A�n se necesitan m�s investigaciones para explorar si se han logrado ahorros en costos post-legalizaci�n.
French Abstract: En 2005, avant la l�galisation de l'avortement, on a �valu� les r�sultats et le co�t de l'avortement sur le syst�me sanitaire � Mexico, dans des �tablissements publics et priv�s. Les donn�es ont �t� obtenues aupr�s du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des co�ts incluaient le personnel, les m�dicaments, les consommables et l'�quipement m�dical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de d�placement, de garde d'enfants et de perte de gain des patientes ont aussi �t� calcul�s. Le co�t moyen par avortement avec dilatation et curetage �tait de $US143. Par aspiration manuelle, il �tait de $US 111 dans trois h�pitaux publics et $US 53 dans une clinique priv�e. Le co�t moyen de l'avortement m�dicamenteux avec du misoprostol seul �tait de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les h�pitaux publics allait de $US 601 � plus de $US 2100. Un acc�s �largi � l'aspiration manuelle et � l'avortement pr�coce au misoprostol permettrait de r�duire de 62% les co�ts gouvernementaux, avec des �conomies potentielles se chiffrant � $US 1,6 million par an. En r�duisant les complications par l'am�lioration de l'acc�s � des services ambulatoires s�rs, on diminuerait encore le co�t des soins de l'avortement, avec de nets avantages pour le syst�me de sant� mexicain et les femmes souhaitant avorter. Il faut mener des recherches suppl�mentaires pour d�terminer si des �conomies ont �t� r�alis�es apr�s l'adoption de la l�galisation.
Language: English
Keywords:
MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation
Document Number: 342021 Notification

11.

12.

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

13.

Peer Reviewed

Title: Health economics of contraception.
Author: Mavranezouli I
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):187-198.
Abstract: Unintended pregnancies constitute a global problem associated with substantial costs to health and social services, and emotional distress to women, their families and society as a whole. Provision of contraception has been demonstrated to be a particularly cost-effective healthcare intervention as, besides preventing a significant number of unintended pregnancies, it also results in great cost-savings to society. Male and female sterilization and long-acting reversible methods (such as the copper-T intra-uterine device and the subdermal implant) constitute the most cost-effective contraceptive options, followed by other hormonal methods (such as oral contraceptives); barrier and behavioural methods (such as the male condom and withdrawal, respectively) are least cost-effective compared with other contraceptive options. Nevertheless, when compared with no method, they still prevent a large number of unintended pregnancies, thus leading to important cost-savings. Improvements in compliance and continuation rates are expected to further enhance the contraceptive benefits and cost-savings associated with contraceptive use.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | COST BENEFIT ANALYSIS | ECONOMICS | FEES | CONTRACEPTION | PUBLIC HEALTH | Developed Countries | Europe, Western | Europe | Quantitative Evaluation | Evaluation | Social Sciences | Science | Sociocultural Factors | Financial Activities | Economic Factors | Family Planning | Health
Document Number: 329667

14.

Peer Reviewed

Title: Health insurance coverage and prescription contraceptive use among young women at risk for unintended pregnancy.
Author: Nearns J
Source: Contraception. 2009 Feb;79(2):105-10.
Abstract: BACKGROUND: This study investigates the relationships between health insurance coverage and prescription contraceptive use among women 18-24 years of age at risk for unintended pregnancy. STUDY DESIGN: Data from the 2002 National Survey of Family Growth were analyzed. The sample comprised 1049 women 18-24 years of age at risk for unintended pregnancy. Multivariate logistic regression analysis was employed to examine the likelihood of prescription contraceptive use (1) between uninsured women versus ones with private insurance, Medicaid or another form of government insurance and (2) between those who had consistent versus inconsistent insurance coverage, after adjusting for a range of sociodemographic and sexual health factors. RESULTS: Twenty percent of the participants were uninsured and over 30% had inconsistent coverage. Only 55% were currently using prescription contraceptives. In multivariate analyses, young women with private insurance or Medicaid were more likely than the uninsured to use prescription contraceptives. No significant differences in prescription contraceptive use were found between other forms of government insurance and uninsurance or between consistent and inconsistent coverage. CONCLUSIONS: Access to comprehensive health insurance should be considered one strategy to address the high rates of unintended pregnancy among this vulnerable population.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | MULTIVARIATE ANALYSIS | YOUTH | PREGNANCY, UNPLANNED | CONTRACEPTION | HEALTH INSURANCE | PRESCRIPTIONS | FEES | RISK FACTORS | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Family Planning | Financial Activities | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Biology
Document Number: 329612

15.

Peer Reviewed

Title: Feasibility, acceptability and cost of home-based HIV testing in rural Kenya.
Author: Negin J; Wariero J; Mutuo P; Jan S; Pronyk P
Source: Tropical Medicine and International Health. 2009 Aug;14(8):849-55.
Abstract: OBJECTIVE: To demonstrate the feasibility, acceptability and cost of home-based HIV testing and to examine the applicability of the model to high HIV prevalence settings. METHODS: Quantitative, qualitative and cost data were collected during a home-based HIV testing program in a high-prevalence rural area of Kenya; data on age, gender and marital status along with HIV test results were collected. This was complemented with qualitative research including key informant interviews with counselors and program managers to highlight experiences and challenges. Direct costs of the interventions were estimated through the review of budgets and monthly expenditure sheets. RESULTS: Of 3180 15-49-year olds exposed to a community awareness campaign, 2033 (63.9%) agreed to be visited by counselors, of whom 1984 (97.6%) agreed to be tested and receive the results. Adult HIV prevalence was 8.2% and married women were 4.8 times more likely to be HIV-positive than those never married. Counselors reported feeling welcomed and noted the enthusiasm of the community towards testing. The total cost of the exercise was $17,569. The program cost was $2.60 for each of the 6750 community members, $5.88 for each person tested, and $84 per positive case detected. CONCLUSION: This study suggests that home-based HIV testing is feasible with high uptake, and has the potential to substantially expand access to HIV testing services. There is a strong economic case for the extension of such a screening program to other communities.
Language: English
Keywords:
KENYA | RESEARCH REPORT | DATA ANALYSIS | HIV TESTING | HOME CARE | FEES | COMMUNITY-BASED DISTRIBUTION | PROGRAM ACCEPTABILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Care and Support | Financial Activities | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Program Evaluation
Document Number: 342977

16.

Peer Reviewed

Title: MALE PARTICIPATION IN PREGNANCY AND DELIVERY IN NIGERIA: A SURVEY OF ANTENATAL ATTENDEES.
Author: Olayemi O; Bello FA; Aimakhu CO; Obajimi GO; Adekunle AO
Source: Journal of Biosocial Science. 2009 Mar 23;41:493-503.
Abstract: Summary.This was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic - paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompanytheir wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | MEN | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MEN'S INVOLVEMENT | ANTENATAL CARE | CHILDBIRTH | ATTITUDES | TRANSPORTATION | FEES | EDUCATIONAL STATUS | CULTURE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Economic Development | Economic Factors | Population Characteristics | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Psychological Factors | Behavior | Financial Activities | Socioeconomic Status | Socioeconomic Factors | Sociocultural Factors
Document Number: 341481

17.

Peer Reviewed

Title: Out-of-pocket costs for facility-based maternity care in three African countries.
Author: Perkins M; Brazier E; Themmen E; Bassane B; Diallo D; Mutunga A; Mwakajonga T; Ngobola O
Source: Health Policy and Planning. 2009 Jul;24(4):289-300.
Abstract: OBJECTIVE To estimate out-of-pocket medical expenses to women and families for maternity care at all levels of the health system in Burkina Faso, Kenya and Tanzania. METHODS In a population-based survey in 2003, 6345 women who had given birth in the previous 24 months were interviewed about the costs incurred during childbirth. Three years later, in 2006, an additional 8302 women with recent deliveries were interviewed in the same districts to explore their maternity care-seeking experiences and associated costs. FINDINGS: The majority of women interviewed reported paying out-of-pocket costs for facility-based deliveries. Out-of-pocket costs were highest in Kenya (a mean of US$18.4 for normal and complicated deliveries), where 98% of women who delivered in a health facility had to pay some fees. In Burkina Faso, 92% of women reported paying some fees (mean of US$7.9). Costs were lowest in Tanzania, where 91% of women reported paying some fees (mean of US$5.1). In all three countries, women in the poorest wealth quintile did not pay significantly less for maternity costs than the wealthiest women. Costs for complicated delivery were double those for normal delivery in Burkina Faso and Kenya, and represented more than 16% of mean monthly household income in Burkina Faso, and 35% in Kenya. In Tanzania and Burkina Faso most institutional births were at mid-level government health facilities (health centres or dispensaries). In contrast, in Kenya, 42% of births were at government hospitals, and 28% were at private or mission facilities, contributing to the overall higher costs in this country compared with Burkina Faso and Tanzania. However, among women delivering in government health facilities in Kenya, reported out-of-pocket costs were significantly lower in 2006 than in 2003, indicating that a 2004 national policy eliminating user fees at mid- and lower-level government health facilities was having some impact.
Language: English
Keywords:
TANZANIA | KENYA | BURKINA FASO | RESEARCH REPORT | INTERVIEWS | MOTHERS | PREGNANCY | CHILDBIRTH | FEES | PREGNANCY OUTCOMES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Africa, Western | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Reproduction | Financial Activities | Economic Factors
Document Number: 342991

18.

Peer Reviewed

Title: A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa).
Author: Ridde V; Diarra A
Source: BMC Health Services Research. 2009;9:89.
Abstract: BACKGROUND: African policy-makers are increasingly considering abolishing user fees as a solution to improve access to health care systems. There is little evidence on this subject in West Africa, and particularly in countries that have organized their healthcare system on the basis of the Bamako Initiative. This article presents a process evaluation of an NGO intervention to abolish user fees in Niger for children under five years and pregnant women. METHODS: The intervention was launched in 2006 in two health districts and 43 health centres. The intervention consisted of abolishing user fees and improving the quality of services (drugs, ambulance, etc.). We carried out a process evaluation in April 2007 using qualitative and quantitative data. Three data collection methods were used: i) individual in-depth interviews (n = 85) and focus groups (n = 8); ii) participant observation in 12 health centres; and iii) self-administered structured questionnaires (n = 51 health staff). RESULTS: The population favoured abolition; health officials and local decision-makers were in favour, but they worried about its sustainability. Among health workers, opposition to providing free services was more widespread. The strengths of the process were: a top-down phase of information and raising community awareness; appropriate incentive measures; a good drug supply system; and the organization of a medical evacuation system. The major weaknesses of the process were: the perverse effects of incentive bonuses; the lack of community-based management committees' involvement in the management; the creation of a system running in parallel with the BI system; the lack of action to support the service offer; and the poor coordination of the availability of free services at different levels of the health pyramid. Some unintended outcomes are also documented. CONCLUSION: The linkages between systems in which some patients pay (Bamako Initiative) and some do not should be carefully considered and organized in accordance with the local reality. For the poorest patients to really benefit, it is essential that, at the same time, the quality of services be improved and mechanisms be put in place to prevent abuses. Much remains to be done to generate knowledge on the processes for abolishing fees in West Africa.
Language: English
Keywords:
NIGER | RESEARCH REPORT | EVALUATION | DATA COLLECTION | PREGNANT WOMEN | CHILDREN | FEES | HEALTH SERVICES | QUALITY OF HEALTH CARE | HEALTH POLICY | INTERVENTIONS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Financial Activities | Economic Factors | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors
Document Number: 342503

19.

Peer Reviewed

Title: Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study.
Author: Srivastava NM; Awasthi S; Agarwal GG
Source: BMC Health Services Research. 2009;9:61.
Abstract: BACKGROUND: The state of Uttar Pradesh, India accounts for one-quarter of India's neonatal deaths and 8 percent of those worldwide. More than half (52%) of these deaths occur due to infections. In order to achieve Millennium Development Goal-4 of reducing child mortality by two-thirds by the year 2015, it is important to study factors which affect neonatal health. In Uttar Pradesh there is meager data for spending on health care in general and neonates in particular. METHODS: The study was conducted at an urban Reproductive and Child Health (RCH) center and a District hospital. Neonates were enrolled within 48 hours of birth and were followed-up once at 6 weeks +/- 15 days at the OPD of the respective hospitals or at home. This study assessed (1) distribution of neonatal illnesses and different health providers sought (2) distribution of out-of-pocket expenditures by type of illness and type of health provider sought (3) socio-economic distribution of neonatal illnesses, care-seeking behavior and out-of-pocket expenditures. Per-protocol analysis was performed. RESULTS: Five hundred and ten neonates were enrolled and 481(94.4%) were followed-up. Parents of 50.3% (242/481) neonates reported at least one symptom of illness. Of these 22.3% (107/481) neonates had illnesses with at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign. Among IMNCI illnesses, point prevalence of septicemia was 6.2% and pneumonia was 5.2% while among non-IMNCI illnesses point prevalence of upper respiratory infection was 9.5%, and diarrhea was 7%. Community based non-government dispensers (NGDs) were leading health providers (37.6%). Mean monthly income of families was 2804 Indian Rupees (INR) (range: 800 to 14000; n = 510), where US$ 1 = 42 INR. Mean out-of-pocket expenditure on neonatal illness was 547.5 INR (range: 1 to 15000; n = 202) and mean out-of-pocket expenditure for hospitalization was 4993 INR (range: 41 to 15000; n = 17). All hospitalizations were for IMNCI illnesses. Neonates from lower income strata were less likely to receive any medical care (p < 0.0001) and were also less likely to be seen by a Government provider (p = 0.03). CONCLUSION: Since more than half of the neonates have morbidity and out-of-pocket expenditure on neonatal illnesses often exceeds the family income of the lower strata of the low income group in the community, there is a need to either introduce health insurance scheme or subsidize health care for them. Also, since NGDs, half of which could be unqualified are leading health providers, qualified medical care-seeking for sick newborns should be promoted in urban Lucknow.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | INFANT | CLIENTS | EXPENDITURES | PRIMARY HEALTH CARE | BEHAVIOR | HEALTH SERVICES | UTILIZATION OF HEALTH CARE | CHILD HEALTH | FEES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Program Activities | Programs | Organization and Administration | Financial Activities | Economic Factors | Delivery of Health Care | Health
Document Number: 342508

20.

Peer Reviewed

Title: Cost effectiveness of contraceptives in the United States.
Author: Trussell J; Lalla AM; Doan QV; Reyes E; Pinto L; Gricar J
Source: Contraception. 2009 Jan;79(1):5-14.
Abstract: BACKGROUND: The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer's perspective. METHODS: A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. RESULTS: Any contraceptive method is superior to "no method". The three least expensive methods were the copper-T intrauterine device (IUD) (US$647), vasectomy (US$713) and levonorgestrel (LNG)-20 intrauterine system (IUS) (US$930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy and plan disenrollment rates. CONCLUSION: The copper-T IUD, vasectomy and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy and time horizon are influential factors that determine the overall value of a contraceptive method.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CLIENTS | COST EFFECTIVENESS | MARKOV CHAIN | CONTRACEPTION | VAGINAL BARRIER METHODS | IUD, COPPER RELEASING | FEES | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Evaluation Indexes | Quantitative Evaluation | Evaluation | Probability | Statistical Studies | Studies | Research Methodology | Family Planning | Barrier Methods | Contraceptive Methods | IUD | Financial Activities | Economic Factors
Document Number: 330541

21.

Title: Expanding access to contraception: IUD fees and subsidies in Egypt.
Author: Abt Associates. Private Sector Partnerships One [PSP-One]
Source: Bethesda, Maryland, Abt Associates, PSP-One, [2008]. 2 p. (Global Research Brief. LAPM Brief 3USAID Contract No. GPO-I-00-04-00007-00)
Abstract: One way for developing countries to afford the costs of family planning is to reduce the number of women with high ability to pay from obtaining subsidized (public) services. Various papers have pointed out that wealthy women receive a subsidy when they use the public sector. This brief describes the first attempt, as far as we know, to calculate this subsidy. The brief focuses specifically on Egypt and on IUDs. We estimated that direct costs of IUD provision in the public and NGO sectors in Egypt totaled $3.08 ($1.25 for insertion by the doctor, $0.95 for counseling by the nurse, $0.58 for the IUD, and $0.30 for other supplies required for insertion). Prices women pay vary substantially by sector, and are highest in the commercial sector and lowest in the public sector. The price varies with wealth within the commercial and NGO sectors but not within the public sector. The average price paid by IUD users in the commercial sector increases substantially with wealth. In fact, women in the highest quintile pay a price about twice that brief of women in the lowest quintile. The wealthiest IUD users also pay the highest prices in the NGO sector, while those in the third and fourth quintile pay somewhat less, and users in the lowest two quintiles pay the lowest prices. Users who access the public and NGO sectors, regardless of ability to pay, always paid an average price lower than did women accessing the commercial sector. (Excerpts)
Language: English
Keywords:
EGYPT | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CURRENTLY MARRIED | WOMEN | CONTRACEPTIVE AVAILABILITY | IUD | FEES | SOCIOECONOMIC STATUS | COMMERCIAL SECTOR | PUBLIC SECTOR | RESOURCE ALLOCATION | Developing Countries | Africa, North | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Marital Status | Nuptiality | Contraception | Family Planning | Contraceptive Methods | Financial Activities | Economic Factors | Socioeconomic Factors | Commerce | Macroeconomic Factors
Document Number: 331619

22.

Peer Reviewed

Title: Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil.
Author: Barros AJ; Santos IS; Bertoldi AD
Source: BMC Health Services Research. 2008 Mar 18;8:57.
Abstract: In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | MOTHERS | PREGNANT WOMEN | CHILDBIRTH | NATIONAL HEALTH SERVICES | FEES | MATERNAL-CHILD HEALTH SERVICES | HEALTH SERVICES EVALUATION | QUALITY OF HEALTH CARE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors | Primary Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 326351

23.
Title: Costing of scaling up HIV/AIDS treatment in Mexico.
Author: Bautista-Arredondo S; Dmytraczenko T; Kombe G; Bertozzi SM
Source: Salud Publica de Mexico. 2008;50 Suppl 4:S437-44.
Abstract: OBJECTIVE: To determine the net effect of introducing highly active antiretroviral treatment (HAART) in Mexico on total annual per-patient costs for HIV/AIDS care, taking into account potential savings from treatment of opportunistic infections and hospitalizations. MATERIAL AND METHODS: A multi-center, retrospective patient chart review and collection of unit cost data were performed to describe the utilization of services and estimate costs of care for 1003 adult HIV+ patients in the public sector. RESULTS: HAART is not cost-saving and the average annual cost per patient increases after initiation of HAART due to antiretrovirals, accounting for 90% of total costs. Hospitalizations do decrease post-HAART, but not enough to offset the increased cost. CONCLUSIONS: Scaling up access to HAART is feasible in middle income settings. Since antiretrovirals are so costly, optimizing efficiency in procurement and prescribing is paramount. The observed adherence was low, suggesting that a proportion of these high drug costs translated into limited health benefits.
Language: English
Keywords:
MEXICO | RESEARCH REPORT | QUANTITATIVE RESEARCH | CLIENTS | PERSONS LIVING WITH HIV/AIDS | FEES | HIV INFECTIONS | UTILIZATION OF HEALTH CARE | TREATMENT | North America | Americas | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Financial Activities | Economic Factors | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine
Document Number: 330580

24.

Title: Adherence to highly active antiretroviral therapy and its correlates among HIV infected pediatric patients in Ethiopia.
Author: Biadgilign S; Deribew A; Amberbir A; Deribe K
Source: BMC Pediatrics. 2008;8:53.
Abstract: BACKGROUND: The introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. This study determines the rates and factors associated with adherence to Antiretroviral (ARV) Drug therapy in HIV-infected children who were receiving Highly Active Antiretroviral Therapy (HAART) in Addis Ababa, Ethiopia in 2008. METHODS: A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18 - April 28, 2008. The study population entailed parents/caretaker and index children who were following ART in the health facilities. A structured questionnaire was used for data collection. RESULTS: A total of 390 children respondents were included in the study with a response rate of 91%. The majority, equaling 205 (52.6%) of the children, were greater than 9 years of age. Fifty five percent of the children were girls. A total of 339 children (86.9%) as reported by caregivers were adherent to antiretroviral drugs for the past 7 days before the interview. Numerous variables were found to be significantly associated with adherence: children whose parents did not pay a fee for treatment [OR = 0.39 (95%CI: 0.16, 0.92)], children who had ever received any nutritional support from the clinic [OR = 0.34 (95%CI: 0.14, 0.79)] were less likely to adhere. Whereas children who took co-trimoxazole medication/syrup besides ARVs [OR = 3.65 (95%CI: 1.24, 10.74)], children who did not know their sero-status [OR = 2.53 (95%CI: 1.24, 5.19)] and children who were not aware of their caregiver's health problem [OR = 2.45 (95%CI: 1.25, 4.81)] were more likely to adhere than their counterparts. CONCLUSION: Adherence to HAART in children in Addis Ababa was higher than other similar set-ups. However, there are still significant numbers of children who are non-adherent to HAART.
Language: English
Keywords:
ETHIOPIA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | PARENTS | URBAN POPULATION | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | FEES | CHILD NUTRITION | NUTRITION PROGRAMS | KNOWLEDGE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Behavior | HIV | Financial Activities | Economic Factors | Nutrition | Health | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 330255

25.

Peer Reviewed

Title: Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries.
Author: Brinkhof MW; Dabis F; Myer L; Bangsberg DR; Boulle A
Source: Bulletin of the World Health Organization. 2008 Jul;86(7):559-567.
Abstract: The objective of the study was to analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings. Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with � 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months. Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count > or = 50 cells/�l, a count < 25 cells/�l was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41). Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries. (author's)
Language: English
Keywords:
AFRICA | BRAZIL | INDIA | THAILAND | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | MORTALITY | RISK FACTORS | FEES | ECONOMIC FACTORS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Asia, Southern | Asia | Asia, Southeastern | HIV Infections | Viral Diseases | Diseases | HIV | Behavior | Population Dynamics | Demographic Factors | Population | Biology | Financial Activities
Document Number: 327546

26.

Title: USAID / Haiti: Social marketing assessment, 2008.
Author: Clary TA
Source: Washington, D.C., Global Health Technical Assistance Project, 2008 Sep. [54] p. (Report No. 01-008-153USAID Contract No. GHS-I-00-05-00005-00)
Abstract: Despite nearly 20 years of social marketing programs in Haiti, the country is still facing many challenges. Suboptimal coordination and poor infrastructure have resulted in some geographic areas having a plethora of overlapping socially marketed products, while others face fairly frequent stockouts within the social marketing system. Further, the concept of social marketing is still, in some cases, not well understood or fully supported by partner organizations, including the host country government, local organizations, and the private commercial sector. USAID / Haiti, the main funder of social marketing programs during the last several years, is now redefining what it hopes to accomplish through its support. During the course of this assignment numerous meetings and interviews were held, a dozen site visits conducted, and nearly 50 documents reviewed. The main conclusion from this intelligence gathering is this: social marketing programs in Haiti have benefited the health of Haitians, need to becontinued, but also need strengthening in a number of areas. (Excerpts)
Language: English
Keywords:
HAITI | SUMMARY REPORT | USAID | SOCIAL MARKETING | FUNDS | COORDINATION | LOGISTICS | DATA QUALITY | PRIVATE SECTOR | TRAINING ACTIVITIES | PROMOTION | CONTRACEPTIVE DISTRIBUTION | PROGRAM EVALUATION | FEES | Developing Countries | Caribbean | Americas | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Marketing | Economic Factors | Financial Activities | Organization and Administration | Management | Data Analysis | Research Methodology | Macroeconomic Factors | Training Programs | Education | Distributional Activities | Program Activities | Programs
Document Number: 331439

27.

Peer Reviewed

Title: Costing universal access of highly active antiretroviral therapy in Benin.
Author: Hounton SH; Akonde A; Zannou DM; Bashi J; Meda N
Source: AIDS Care. 2008 May;20(5):582-587.
Abstract: The study aimed to estimate costs of provision and access to highly active antiretroviral therapy (HAART) in order to assist in planning and resource allocation regarding scaling up and sustainable access to HAART in Benin. A prospective study was carried out to collect data on costs of provision of care at the Outpatient Treatment Centre (OTC) of the National University hospital in Cotonou, Benin and on costs borne by people living with HIV/AIDS (PLWHA) and their families in accessing care. We used an Excel model, a macro costing approach and WHO guidelines for costing health services. Annual costs were subsequently extrapolated from a societal perspective over a 10-year time horizon. Sensitivity analysis was conducted on major cost categories. The study population was mostly of middle age (median age of 38, IQR 34-42), married (65%), working class (60%) with low literacy (70% primary education level or less). The main drivers of costs of HAART service provision were drugs (73%), biological monitoring (15%) and personnel (8%). Annual costs of provision of HAART and household costs borne by PLWHA and families in seeking care amounted to 1160 USD and 111 USD per PLWHA respectively. These household costs are respectively 40% and 14% of household health and education related costs and may represent catastrophic health expenditures for patients and families. The provision of drugs and biological monitoring, and household costs in accessing care, remain by far the main barriers to ensuring universal access to HAART. (author's)
Language: English
Keywords:
BENIN | RESEARCH REPORT | PROSPECTIVE STUDIES | DATA COLLECTION | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | FEES | TREATMENT | PROGRAM SUSTAINABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Financial Activities | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration
Document Number: 326945

28.
Peer Reviewed

Title: Male midwives: preferred managers of sexually transmitted infections in men in developing countries?
Author: Hsieh EJ; Garcia PJ; Roca SL
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2008 Oct;24(4):271-5.
Abstract: OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.
Language: English
Keywords:
PERU | RESEARCH REPORT | KAP SURVEYS | MIDWIVES AND MIDWIFERY | MEN | URBAN POPULATION | SEXUALLY TRANSMITTED DISEASES | SEX FACTORS | MANAGEMENT | DEMOGRAPHIC FACTORS | PRIVATE SECTOR | FEES | HUMAN GEOGRAPHY | South America, Western | South America | Latin America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Population | Population Characteristics | Reproductive Tract Infections | Infections | Diseases | Organization and Administration | Macroeconomic Factors | Economic Factors | Financial Activities | Geography | Social Sciences | Science | Sociocultural Factors
Document Number: 330332

29.

Peer Reviewed

Title: The intersections of gender and class in health status and health care.
Author: Iyer A; Sen G; Ostlin P
Source: Global Public Health. 2008;3 Suppl 1:13-24.
Abstract: It is increasingly recognized that different axes of social power relations, such as gender and class, are interrelated, not as additive but as intersecting processes. This paper has reviewed existing research on the intersections between gender and class, and their impacts on health status and access to health care. The review suggests that intersecting stratification processes can significantly alter the impacts of any one dimension of inequality taken by itself. Studies confirm that socio-economic status measures cannot fully account for gender inequalities in health. A number of studies show that both gender and class affect the way in which risk factors are translated into health outcomes, but their intersections can be complex. Other studies indicate that responses to unaffordable health care often vary by the gender and class location of sick individuals and their households. They strongly suggest that economic class should not be analysed by itself, and that apparent class differences can be misinterpreted without gender analysis. Insufficient attention to intersectionality in much of the health literature has significant human costs, because those affected most negatively tend to be those who are poorest and most oppressed by gender and other forms of social inequality. The programme and policy costs are also likely to be high in terms of poorly functioning programmes, and ineffective poverty alleviation and social and health policies. (author's)
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | CLIENTS | HEALTH STATUS INDEXES | GENDER ISSUES | SOCIAL CLASS | INEQUALITIES | FEES | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | RISK FACTORS | SOCIOECONOMIC FACTORS | Program Activities | Programs | Organization and Administration | Health | Sociocultural Factors | Socioeconomic Status | Economic Factors | Financial Activities | Health Services | Delivery of Health Care | Program Evaluation | Biology
Document Number: 326804

30.

Peer Reviewed

Title: Abortion in the United States: Incidence and access to services, 2005.
Author: Jones RK; Zolna MR; Henshaw SK; Finer LB
Source: Perspectives on Sexual and Reproductive Health. 2008 Mar;40(1):6-16.
Abstract: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | WOMEN | ABORTION RATE | ABORTION | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | INCIDENCE | CENSUS | FAMILY PLANNING SURVEYS | GESTATIONAL AGE | FEES | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Program Evaluation | Programs | Organization and Administration | Health | Measurement | Population Statistics | Health Facilities | Fetus | Pregnancy | Reproduction | Financial Activities | Economic Factors
Document Number: 325186 Notification


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