1.  Peer Reviewed Title: Community-based skilled birth attendants in Bangladesh: attending deliveries at home. Author: Ahmed T; Jakaria SM Source: Reproductive Health Matters. 2009 May;17(33):45-50. Abstract: Only 15% of births in Bangladesh in 2007 were delivered at health facilities, but the increase over previous years has been significant, and treatment-seeking from a medically trained provider for obstetric complications has also increased. A programme to create a cadre of skilled birth attendants for home births was launched by the Government of Bangladesh in 2004. The training, for community-based health and family planning fieldworkers, covers 74 essential midwifery skills and danger signs for referral. Training of trainers and supervisors for the fieldworkers was also initiated. By the end of 2008 an estimated 4,000 out of a proposed 13,500 skilled birth attendants and 50 of 4,000 proposed supervisors had been trained and were working in 56 districts. There needs to be a full evaluation of the programme and whether it has reduced maternal deaths. Bangladesh now needs to decide how long to invest in this programme and/or whether to train a new cadre of fully qualified midwives, as proposed by the Nursing Council. We believe this programme can only be an interim measure, not a long-term solution, as more women decide to seek institutional delivery and professional midwifery care. For the moment, though, task-shifting seems to have yielded beneficial results and important insights into human resources planning for safe motherhood in Bangladesh. Spanish Abstract: En 2007, sólo el 15% de los partos en Bangladesh ocurrieron en establecimientos de salud. En comparación con años anteriores, este porcentaje ha aumentado considerablemente, al igual que la búsqueda de tratamiento de complicaciones obstétricas brindado por un profesional médico capacitado. En 2004, el Gobierno de Bangladesh lanzó un programa para crear una categoría de asistentes de partos calificados que ayudaran con los partos domiciliares. La capacitación de trabajadores comunitarios de la salud y de planificación familiar, abarca 74 habilidades esenciales de partería y los signos de alarma para dar referencias. También se inició la capacitación de capacitadores y supervisores de los trabajadores de campo. A finales de 2008, aproximadamente 4,000 de los 13,500 asistentes de partos calificados y 50 de los 4,000 supervisores propuestos habían recibido capacitación y estaban trabajando en 56 distritos. Es necesario realizar una evaluación completa del programa y determinar si éste ha logrado disminuir la tasa de muertes maternas. Bangladesh debe decidir por cuánto tiempo continuar invirtiendo en este programa y/o si capacitar a un nuevo grupo de parteras profesionales plenamente cualificadas, como propone el Consejo de Enfermería. Estimamos que este programa es sólo una medida provisional, no una solución de largo plazo, ya que cada vez más aumenta el número de mujeres que deciden buscar atención institucional y cuidados de partería profesionales. No obstante, por ahora la reasignación de tareas parece haber dado buenos resultados e importantes datos sobre los recursos humanos en la planificación de la maternidad sin riesgos en Bangladesh. French Abstract: Au Bangladesh, en 2007, 15% seulement des naissances avaient eu lieu dans un établissement de santé, mais la hausse par rapport aux précédentes années était sensible et le recours aux services d'un prestataire formé médicalement pour les complications obstétricales avait aussi augmenté. En 2004, le Gouvernement a lancé un programme de création d'un groupe d'accoucheuses qualifiés pour les naissances à domicile. La formation des agents de santé et de planification familiale communautaires couvre 74 compétences obstétricales essentielles et les signes de danger exigeant le transfert de la patiente. La formation des formateurs et des superviseurs des agents de terrain a aussi été lancée. Fin 2008, environ 4000 des 13 500 accoucheuses qualifiés envisagés et 50 des 4000 superviseurs prévus avaient été formés et travaillaient dans 56 districts. Il faut mener une évaluation complète du programme et déterminer s'il a diminué les décès maternels. Le Bangladesh doit maintenant décider pendant combien de temps investir dans ce programme et/ou s'il souhaite former un nouveau groupe de sages-femmes pleinement qualifiées, ainsi que l'a proposé le Conseil des infirmières. Nous pensons que ce programme ne peut être qu'une mesure provisoire et non une solution à long terme, à mesure que davantage de femmes opteront pour un accouchement institutionnel et des soins de sages-femmes professionnelles. Pour le moment, néanmoins, la délégation des tâches semble avoir produit des résultats positifs et des connaissances précieuses sur la planification des ressources humaines pour une maternité à moindre risque au Bangladesh. Language: English Keywords: BANGLADESH | PROGRESS REPORT | PILOT PROJECTS | COMMUNITY WORKERS | MIDWIVES AND MIDWIFERY | CHILDBIRTH | REFERRAL AND CONSULTATION | GOVERNMENT PROGRAMS | TRAINING OF TRAINERS | MEDICAL SUPERVISION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Program Activities | Programs | Organization and Administration | Training Programs | Education | Supervision | Management Document Number: 342014 |
| 2. Title: Adherence and treatment response among HIV-1 infected adults receiving antiretroviral therapy in a rural government hospital in southwestern Uganda. Author: Bajunirwe F; Arts EJ; Tisch DJ; King CH; Debanne SM Source: Journal of the International Association of Physicians in AIDS Care. 2009 Mar-Apr;8(2):139-147. Abstract: Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving (n = 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n = 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] = 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | RURAL POPULATION | HIV INFECTIONS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | SEX FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | HIV | Programs | Organization and Administration Document Number: 331336 |
| 3. Peer Reviewed Title: Women's use of private and government health facilities for childbirth in Nairobi's informal settlements. Author: Bazant ES; Koening MA; Fotso JC; Mills S Source: Studies in Family Planning. 2009 Mar;40(1):39-50. Abstract: The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | REFUGEES | TRADITIONAL BIRTH ATTENDANTS | HOUSEHOLDS | CHILDBIRTH | REFUGEE CAMPS | UTILIZATION OF HEALTH CARE | PRIVATE SECTOR | GOVERNMENT PROGRAMS | HEALTH FACILITIES | DEMOGRAPHIC FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Population | Migrants | Migration | Population Dynamics | Health Personnel | Delivery of Health Care | Health | Family and Household | Sociocultural Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Residence Characteristics | Population Distribution | Geographic Factors | Health Services | Macroeconomic Factors | Programs | Organization and Administration Document Number: 341077 |
| 4. Peer Reviewed Title: Achieving the health Millennium Development Goals for South Africa: challenges and priorities. Author: Chopra M; Lawn JE; Sanders D; Barron P; Abdool Karim SS; Bradshaw D; Jewkes R; Abdool Karim Q; Flisher AJ; Mayosi BM; Tollman SM; Churchyard GJ; Coovadia H Author: Lancet South Africa team Source: Lancet. 2009 Sep 19;374(9694):1023-31. Abstract: 15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country--will they do so or will another opportunity and many more lives be lost? Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | POLITICAL FACTORS | LEADERSHIP | GOALS | SOCIAL DEVELOPMENT | HIV PREVENTION | AIDS PREVENTION | HEALTH SERVICES | GOVERNMENT PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Sociocultural Factors | Organization and Administration | Planning | Economic Factors | HIV Infections | Viral Diseases | Diseases | AIDS | Delivery of Health Care | Health | Programs Document Number: 342958 |
| 5. Peer Reviewed Title: Factors associated with low early uptake of a national program to prevent mother to child transmission of HIV (PMTCT): results of a survey of mothers and providers, Botswana, 2003. Author: Creek T; Ntumy R; Mazhani L; Moore J; Smith M; Han G; Shaffer N; Kilmarx PH Source: AIDS and Behavior. 2009 Apr;13(2):356-364. Abstract: In Francistown, Botswana, approximately 40% of pregnant women are HIV positive. PMTCT has been available since 1999, antiretroviral (ARV) therapy since 2001, and 95% of women have antenatal care (ANC) and deliver in hospital. However, in 2002, only 33% of ANC clients were tested for HIV, and not all women with HIV received services. In 2003, we conducted a survey of 504 pregnant and postpartum women to explore reasons for poor program uptake, and interviewed 82 health providers about PMTCT. Most women (95%) believed that all pregnant women should be tested for HIV. In multivariate analysis, factors associated with having an HIV test included being interviewed at an urban site, having a high PMTCT knowledge score, knowing someone receiving PMTCT or ARV therapy, and having a partner who had been tested for HIV. Neither fear of stigma nor resistance from partners were frequent reasons for refusing an HIV test. Providers of HIV services reported discomfort with their knowledge and skills, and 84% believed HIV testing should be routine. Ensuring adequate knowledge about HIV and PMTCT, creating systems whereby HIV-positive women receiving care can educate and support other women, and making HIV testing routine for pregnant women may improve the uptake of HIV testing. Language: English Keywords: BOTSWANA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | SEXUAL PARTNERS | POSTPARTUM WOMEN | URBAN POPULATION | HEALTH PERSONNEL | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | GOVERNMENT PROGRAMS | ANTENATAL CARE | KNOWLEDGE | HIV TESTING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Puerperium | Reproduction | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 340126 |
| 6. Peer Reviewed Title: Adolescent access to emergency contraception: a comment on the UK context. Author: Fallon D Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):120-6. Abstract: The provision of emergency contraception (EC) in the United Kingdom (UK) has been transformed over the past decade through advances in pharmacology and the implementation of governmental measures to reduce teenage pregnancy rates. This paper considers how these issues have developed in the current social and political context with specific reference to adolescent access to EC in the UK. It highlights the concerns caused by increased availability of EC and the tension between adolescent rights to confidential treatment and advice, and professional anxiety about encouraging secrecy or parental deception. It concludes that adolescents, whilst benefiting from increased access to EC may also face a series of challenges as a result. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | GOVERNMENT PROGRAMS | ADOLESCENT PREGNANCY | PREVENTION AND CONTROL | POLITICAL FACTORS | CONFIDENTIAL INFORMATION | FAMILY PLANNING EDUCATION | PARENTAL CONSENT | Developed Countries | Europe, Western | Europe | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Programs | Organization and Administration | Reproductive Behavior | Fertility | Population Dynamics | Diseases | Sociocultural Factors | Ethics | Education Document Number: 330933 |
| 7. Title: Universal access to antiretroviral therapy and HIV stigma in Botswana [letter] Author: Gamper A; Nathaniel S; Robbe IJ Source: American Journal of Public Health. 2009 Jun;99(6):968-9; author reply 969. Abstract: We welcome the insights provided by Wolfe et al into the impact of access to antiretroviral therapy on HIV stigma in Botswana. It is an important subject for investigation as HIV stigma affects compliance with HIV treatment and community attitudes worldwide. We particularly commend the authors for using anticipated stigma as a second measure of attitudes toward HIV, because social desirability will affect those attitudes reported by respondents. We question how the respondents to the study were selected, particularly because the authors mention that they were not able to access "more remote" areas. There might be greater stigma associated with HIV infection among populations who live further away from health services and therefore who have less access to antiretroviral therapy. We recognize that the decision not to question respondents about their personal HIV status may have had valid methodological reasoning, for example, to maximize participation or rapport during the interviews. However, it would have been helpful if the authors had discussed in more detail the cultural context for admitting stigma. For example, the study participants might have been reluctant to admit negative attitudes toward people with HIV infection unless generally these attitudes were acceptable. To further the study findings and our understanding of HIV stigma and treatment in Botswana, we believe it would be beneficial to know how many people are aware of the national treatment program; it would also be helpful to use qualitative methods of inquiry to investigate attitudes toward the program. Furthermore, barriers to treatment access could be identified, particularly among vulnerable groups such as widowed women, because these could be related to stigma issues. (full-text) Language: English Keywords: BOTSWANA | CRITIQUE | ANTIRETROVIRAL THERAPY | PROGRAM ACCESSIBILITY | HIV INFECTIONS | STIGMA | ATTITUDES | GOVERNMENT PROGRAMS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV | Viral Diseases | Diseases | Program Evaluation | Programs | Organization and Administration | Social Problems | Sociocultural Factors | Psychological Factors | Behavior Document Number: 341685 |
| 8. Title: Evaluating the President's Emergency Plan for AIDS Relief: time to scale it up [editorial] Author: Gross R; Bisson G Source: Annals of Internal Medicine. 2009 May 19;150(10):727-8. Abstract: This editorial examines the President's Emergency Plan for AIDS Relief (PEPFAR) and measures the effects of the program by comparing trends in AIDS-related death rates and HIV prevalence rates. It also discusses PEPFAR's achievement of some of its goals but will have to meet a higher standard and document impact by gathering credible evidence in the future and note which aspects of the program are working and which are not. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | SUMMARY REPORT | EVALUATION | AIDS PREVENTION | HIV PREVENTION | LIFE EXPECTANCY | GOVERNMENT PROGRAMS | PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | Developed Countries | North America | Americas | AIDS | HIV Infections | Viral Diseases | Diseases | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 341603 |
| 9. Title: The Thai Government's Repatriation and Reintegration Programmes: responding to trafficked female commercial sex workers from the Greater Mekong Subregion. Author: Jayagupta R Source: International Migration. 2009 Jun;47(2):227-253. Abstract: Since the 1990s, trafficked women and girls from neighbouring countries in the Greater Mekong Subregion (GMS), including Myanmar, Lao People's Democratic Republic (Laos), Cambodia, Viet Nam, and Yunnan province in southern China, have increasingly migrated to Thailand and worked in the country's thriving commercial sex industry. In response, the Thai government has launched a range of programmes to supplement its earlier programmes designed primarily to combat internal trafficking. This paper concentrates on one component of the Thai government's response: repatriation and reintegration. The paper is organized as follows: First, a definition of human trafficking, particularly as it relates to women and children, is provided. Second, a succinct discussion of the history of the domestic trafficking of women and girls into commercial sex work in Thailand, focusing especially on the Thai government's broad response to this dilemma, is given. Third, the dynamics of the relatively recent surge of trafficked women and girls from neighbouring GMS countries working in Thailand's commercial sex industry and the Thai government's efforts to combat this are discussed. Finally, the paper focuses on repatriation and reintegration in Thailand; by briefly discussing the situation that trafficked women and girls confront in this process, and by defining repatriation, reintegration, and reintegration assistance. The Thai government's repatriation and reintegration programmes are then described and critically reviewed, focusing particularly on the Kredtrakarn Protection and Occupational Development Centre. Recommendations on how to improve existing repatriation and reintegration programmes are provided. Above all, greater collaboration must take place in order to effectively and efficiently implement policies, plans, and projects to more successfully reintegrate trafficked women and girls back into neighbouring GMS countries, in particular at the local level. Language: English Keywords: THAILAND | CRITIQUE | SEX WORKERS | HUMAN TRAFFICKING | SEXUAL EXPLOITATION | GOVERNMENT PROGRAMS | LEGISLATION | SOCIAL PROTECTION | POLICY | Developing Countries | Asia, Southeastern | Asia | Sex Behavior | Behavior | Crime | Social Problems | Sociocultural Factors | Programs | Organization and Administration | Political Factors Document Number: 341297 |
| 10. Peer Reviewed Title: Early assessment of the implementation of a national programme for the prevention of mother-to-child transmission of HIV in Cameroon and the effects of staff training: a survey in 70 rural health care facilities. Author: Labhardt ND; Manga E; Ndam M; Balo JR; Bischoff A; Stoll B Source: Tropical Medicine and International Health. 2009 Mar;14(3):288-93. Abstract: OBJECTIVES: To assess the availability of equipment and the staff's knowledge to prevent Mother-To-Child Transmission (PMTCT) in rural healthcare facilities recently covered by the national PMTCT programme in Cameroon. METHODS: In eight districts inventories of antiviral drugs and HIV test kits were made on site, using a standardised check-list. Knowledge of HIV and PMTCT was evaluated with a multiple-choice (MC) questionnaire based on typical clinical PMTCT cases. Staff participated subsequently in a 2-day training on HIV/AIDS and the Cameroon PMTCT guidelines. Immediately after training and after 7 months, retention of knowledge was tested with the same questions but in different order and layout. RESULTS: Sixty two peripheral nurse-led clinics and the eight district hospitals were assessed. Whereas all district hospitals presented complete equipment, only six of the peripheral clinics (10%) were equipped with both complete testing materials and a full set of drugs to provide PMTCT. Thirty six peripheral facilities (58%) possessed full equipment for HIV-testing and 8 (13%) stocked all PMTCT drugs. Of 137 nurses, 102 (74%) agreed to the two knowledge tests. Fewer than 66% knew that HIV-diagnosis requires positive results in two different types of rapid tests and only 19% chose the right recommendation on infant-feeding for HIV-positive mothers. Correct answers on drug regimens in different PMTCT settings varied from 25% to 56%. All percentages of correct answers improved greatly with training (P < 0.001) and retention remained high 7 months after training (P < 0.001). CONCLUSIONS: Prevent Mother-To-Child Transmission programmes in settings such as rural Cameroon need to be adapted to the special needs of peripheral nurse-led clinics. Appropriate short training may considerably improve nurses' competence in PMTCT. Other important components are regular supervision and measures to guarantee supply of equipment in rural areas. Language: English Keywords: CAMEROON | EVALUATION REPORT | KAP SURVEYS | HEALTH PERSONNEL | INFANT | GOVERNMENT PROGRAMS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | TRAINING PROGRAMS | RURAL HEALTH SERVICES | KNOWLEDGE | HIV TESTING | ANTIRETROVIRAL DRUGS | EQUIPMENT AND SUPPLIES | PROGRAM EVALUATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Programs | Organization and Administration | Disease Transmission Control | Prevention and Control | Diseases | HIV Infections | Viral Diseases | Education | Health Services | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Treatment Document Number: 330960 |
| 11. Peer Reviewed Title: A public policy approach to local models of HIV/AIDS control in Brazil. Author: Le Loup G; de Assis A; Costa-Couto MH; Thoenig JC; Fleury S; de Camargo K Jr; Larouze B Source: American Journal of Public Health. 2009 Jun;99(6):1108-15. Abstract: OBJECTIVES: We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability. METHODS: We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, Sao Paulo and Para. RESULTS: Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability. CONCLUSIONS: Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs. Language: English Keywords: BRAZIL | RESEARCH REPORT | NONGOVERNMENTAL ORGANIZATIONS | AIDS PREVENTION | HIV PREVENTION | HEALTH POLICY | DECENTRALIZATION | GOVERNMENT PROGRAMS | COORDINATION | IMPLEMENTATION | PROGRAM SUSTAINABILITY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | AIDS | HIV Infections | Viral Diseases | Diseases | Policy | Programs | Organization and Administration Document Number: 341684 |
| 12. Peer Reviewed Title: Adult clinical and immunologic outcomes of the national antiretroviral treatment program in Rwanda during 2004-2005. Author: Lowrance DW; Ndamage F; Kayirangwa E; Ndagije F; Lo W; Hoover DR; Hanson J; Elul B; Ayaba A; Ellerbrock T; Rukundo A; Shumbusho F; Nash D; Mugabo J; Assimwe A Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):49-55. Abstract: BACKGROUND: By December 2007, over 48,000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact. METHODS: We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative, stratified, random sample of 3194 adults (> or =15 years) who initiated ART from January 1, 2004, through December 31, 2005. FINDINGS: At ART initiation, the median patient age was 37 years and 65% were female. Overall, the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation, 92% and 86% of patients, respectively, remained on ART at their original site. By 6 months, 3.6% were dead and 3.4% were lost to follow-up; by 12 months, 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data, median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation, respectively. CONCLUSIONS: Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality. Language: English Keywords: RWANDA | RESEARCH REPORT | DATA QUALITY | IMMUNOLOGIC FACTORS | IMMUNOLOGICAL EFFECTS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HIV INFECTIONS | TREATMENT | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Data Analysis | Research Methodology | Immunity | Immune System | Physiology | Biology | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Document Number: 342884 |
| 13. Peer Reviewed Title: Household survey of hepatitis B vaccine coverage among Brazilian children. Author: Luna EJ; Veras MA; Flannery B; de Moraes JC Author: the Vaccine Coverage Survey 2007 Group Source: Vaccine. 2009 Jul 16; Abstract: We conducted a multi-stage household cluster survey to calculate hepatitis B vaccine coverage among children 18-30 months of age in 27 Brazilian cities. Hepatitis B vaccine is administered at birth, 1 month and 6 months of age by Brazil's national immunization program. Among 17,749 children surveyed, 40.2% received a birth dose until the first day of life, 94.8% received at least one dose of hepatitis B vaccine, and 86.7% completed the three-dose series by 12 months of age. Increased coverage with the birth dose and administration of hepatitis B in combination with diphtheria-tetanus-pertussis-Haemophilus influenzae type b antigens could improve protection against hepatitis B. Language: English Keywords: BRAZIL | URBAN AREAS | RESEARCH REPORT | SURVEYS | COHORT ANALYSIS | HOUSEHOLDS | CHILDREN | HEPATITIS | IMMUNIZATION SCHEDULE | GOVERNMENT PROGRAMS | VACCINATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Geographic Factors | Population | Sampling Studies | Studies | Research Methodology | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Viral Diseases | Diseases | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration Document Number: 342281 |
| 14. Peer Reviewed Title: Evaluation of simple rapid HIV assays and development of national rapid HIV test algorithms in Dar es Salaam, Tanzania. Author: Lyamuya EF; Aboud S; Urassa WK; Sufi J; Mbwana J; Ndugulile F; Massambu C Source: BMC Infectious Diseases. 2009;9:19. Abstract: BACKGROUND: Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. METHODS: Five rapid HIV assays: Determine HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold HIV-1/2 (Trinity Biotech) were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). RESULTS: Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9), respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold, Determine and SD Bioline assays. CONCLUSION: An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive samples on the Determine or SD Bioline gave 100% sensitivity (95% CI; 99.1-100) and 100% specificity (95% CI; 96-99.1) with Uni-Gold as tiebreaker for discordant results. Language: English Keywords: TANZANIA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | URBAN POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | BLOOD DONORS | HIV TESTING | TIME FACTORS | GOVERNMENT PROGRAMS | HEALTH SERVICES EVALUATION | VOLUNTARY COUNSELING AND TESTING | RELIABILITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Population Dynamics | Programs | Organization and Administration | Program Evaluation | Measurement Document Number: 330705 |
15.  Title: Blind optimism: Challenging the myths about private health care in poor countries. Author: Marriott A Source: Oxford, United Kingdom, Oxfam International, 2009 Feb. 55 p. (Oxfam Briefing Paper No. 125) Abstract: 'The realization of the right to health for millions of people in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. The private sector can play a role in health care. But this paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritizing this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | EVALUATION | POPULATION | PRIVATE SECTOR | HEALTH SERVICES EVALUATION | PROGRAM ACCESSIBILITY | INEQUALITIES | CAPACITY BUILDING | WORLD BANK | GOVERNMENT PROGRAMS | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors | Program Sustainability | International Agencies | Organizations | Political Factors | Sociocultural Factors | Health Document Number: 331349 |
| 16. Peer Reviewed Title: Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa. Author: Mate KS; Bennett B; Mphatswe W; Barker P; Rollins N Source: PloS One. 2009;4(5):e5483. Abstract: BACKGROUND: Recent changes to South Africa's prevention of mother-to-child transmission of HIV (PMTCT) guidelines have raised hope that the national goal of reducing perinatal HIV transmission rates to less than 5% can be attained. While programmatic efforts to reach this target are underway, obtaining complete and accurate data from clinical sites to track progress presents a major challenge. We assessed the completeness and accuracy of routine PMTCT data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa. METHODOLOGY/PRINCIPAL FINDINGS: We surveyed the completeness and accuracy of data reported for six key PMTCT data elements between January and December 2007 from all 316 clinics and hospitals in three districts. Through visits to randomly selected sites, we reconstructed reports for the same six PMTCT data elements from clinic registers and assessed accuracy of the monthly reports previously submitted to the DHIS. Data elements were reported only 50.3% of the time and were "accurate" (i.e. within 10% of reconstructed values) 12.8% of the time. The data element "Antenatal Clients Tested for HIV" was the most accurate data element (i.e. consistent with the reconstructed value) 19.8% of the time, while "HIV PCR testing of baby born to HIV positive mother" was the least accurate with only 5.3% of clinics meeting the definition of accuracy. CONCLUSIONS/SIGNIFICANCE: Data collected and reported in the public health system across three large, high HIV-prevalence Districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality. Language: English Keywords: SOUTH AFRICA | EVALUATION REPORT | DATA ANALYSIS | SAMPLING STUDIES | GOVERNMENT PROGRAMS | HIV INFECTIONS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | ANTIRETROVIRAL THERAPY | HEALTH FACILITIES | INFORMATION RETRIEVAL SYSTEMS | RELIABILITY | DATA REPORTING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Research Methodology | Studies | Programs | Organization and Administration | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Data Storage and Retrieval | Information Processing | Information | Measurement | Data Collection Document Number: 342171 |
| 17. Peer Reviewed Title: Provision of anaesthesia services for emergency obstetric care through task shifting in South Asia. Author: Mavalankar D; Sriram V Source: Reproductive Health Matters. 2009 May;17(33):21-31. Abstract: Anaesthesia is required for certain procedures in emergency obstetric care, such as caesarean section and the repair of ruptured uterus. Task shifting for provision of anaesthesia has been implemented in public sector rural hospitals of South Asia in recent years because of significant shortages of anaesthetists, but there has been limited research on this issue. This paper reviews the literature on this topic and documents existing programmes for task shifting anaesthesia services to mid-level providers in South Asia to increase access to emergency obstetric care and reduce maternal mortality. We found that task shifting of anaesthesia services has been effective in expanding coverage and access to care in South Asia, but most programmes have not been implemented systematically as part of an overall human resources strategy. A comprehensive approach, to maximise the benefits of these programmes, calls for countries to appoint a director at national or state level who is responsible for the availability of anaesthesia services in rural areas; legal protections, licensing by a competent authority and registration to perform anaesthesia services, including prescription of anaesthesia drugs; supportive managerial arrangements, competency-based training, monitoring and evaluation; performance rewards, career structure and job clarity; adequate equipment and supplies; support from specialist anaesthetists and quality assurance for safety. Spanish Abstract: La anestesia es necesaria para ciertos procedimientos en los cuidados obstétricos de emergencia, como la cesárea y la histerorrafia. En los últimos años se han cambiado las tareas para el suministro de anestesia en hospitales públicos rurales de Asia meridional debido a la considerable escasez de anestesistas, pero ha habido pocas investigaciones al respecto. En este artículo se revisa el material publicado sobre este tema y se documentan los programas para reasignar las tareas en los servicios de anestesia a los prestadores de servicios de nivel intermedio en Asia meridional, con el fin de ampliar el acceso a los cuidados obstétricos de emergencia y disminuir las tasas de mortalidad materna. Encontramos que al cambiar las tareas de los servicios de anestesia se ha logrado ampliar la cobertura y el acceso a los servicios, pero la mayoría de los programas no han sido implementados sistemáticamente como parte de una estrategia general de recursos humanos. El enfoque integral para maximizar los beneficios de estos programas requiere nombrar a un director, a nivel nacional o estatal, que sea responsable de la disponibilidad de servicios de anestesia en zonas rurales; protecciones jurídicas, permiso de una autoridad competente y registro para proporcionar servicios de anestesia, incluido recetar anestésicos; acuerdos administrativos de apoyo, capacitación basada en la competencia, monitoreo y evaluación; recompensas por el desempeño en el trabajo, estructura profesional y claridad laboral; equipo y suministros adecuados; apoyo de anestesistas especializados y garantía de la calidad para la seguridad. French Abstract: Certains soins obstétricaux d'urgence, comme une césarienne ou la réparation d'une perforation utérine, nécessitent une anesthésie. En raison de la pénurie aiguë d'anesthésistes, des hôpitaux ruraux du secteur public d'Asie du Sud pratiquent la délégation des tâches, mais cela a suscité peu de recherches. Cet article examine les publications sur la question et documente les programmes de délégation des services anesthésiques aux prestataires de niveau intermédiaire en Asie du Sud pour élargir l'accès aux soins obstétricaux d'urgence et réduire la mortalité maternelle. Nous avons constaté que la délégation des services d'anesthésie a permis d'élargir la couverture et l'accès aux soins, mais la plupart des programmes n'ont pas été appliqués systématiquement dans le cadre d'une stratégie globale des ressources humaines. Pour optimiser les avantages de ces programmes, une approche d'ensemble recommande les mesures suivantes aux pays: nomination d'un directeur national ou au niveau de l'État qui sera responsable de la disponibilité des services anesthésiques dans les zones rurales; mesures de protection juridique, enregistrement et autorisation par une autorité compétente de la réalisation des actes d'anesthésie, notamment la prescription d'anesthésiques; dispositions administratives positives, formation, suivi et évaluation fondés sur les compétences; primes à la performance, plans d'avancement et description claire des postes; fournitures et équipements adaptés; soutien des anesthésistes spécialisés et assurance qualité pour la sécurité. Language: English Keywords: ASIA, SOUTHERN | RURAL AREAS | RESEARCH REPORT | LITERATURE REVIEW | PARAMEDICAL PERSONNEL | NURSES AND NURSING | ANESTHESIA | EMERGENCY SERVICES | OBSTETRICS | GOVERNMENT PROGRAMS | PROGRAM ACCESSIBILITY | TRAINING PROGRAMS | HEALTH POLICY | Asia | Developing Countries | Geographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Programs | Organization and Administration | Program Evaluation | Education | Policy | Political Factors | Sociocultural Factors Document Number: 342012 |
| 18. Peer Reviewed Title: The burden of non-communicable diseases in South Africa. Author: Mayosi BM; Flisher AJ; Lalloo UG; Sitas F; Tollman SM; Bradshaw D Source: Lancet. 2009 Sep 12;374(9693):934-47. Abstract: 15 years after its first democratic election, South Africa is in the midst of a profound health transition that is characterised by a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders. Non-communicable diseases are emerging in both rural and urban areas, most prominently in poor people living in urban settings, and are resulting in increasing pressure on acute and chronic health-care services. Major factors include demographic change leading to a rise in the proportion of people older than 60 years, despite the negative effect of HIV/AIDS on life expectancy. The burden of these diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from HIV/AIDS. The scale of the challenge posed by the combined and growing burden of HIV/AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services. We urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess, and implement integrated care interventions for chronic infectious and non-communicable diseases. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RURAL AREAS | RURAL POPULATION | LOW INCOME POPULATION | PRIMARY HEALTH CARE | DISEASES | HEALTH SERVICES | QUALITY OF HEALTH CARE | DEMOGRAPHIC TRANSITION | DEMOGRAPHIC AGING | HIV PREVENTION | AIDS PREVENTION | INTEGRATED PROGRAMS | GOVERNMENT PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Population Characteristics | Demographic Factors | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Population Dynamics | HIV Infections | Viral Diseases | AIDS Document Number: 342869 |
| 19. Title: Management capacity assessment for national health programs: a study of RCH program in India. Author: Ramani KV; Mavalankar D Source: Journal of Health Organization and Management. 2009;23(1):133-42. Abstract: PURPOSE: This paper aims to focus on the management capacity assessment of the Reproductive and Child Health (RCH) program at the state level. DESIGN/METHODOLOGY/APPROACH: Based on an extensive literature survey, and discussions with senior officers in charge of RCH program at the central and state level, the authors have developed a conceptual framework for management capacity assessment. Central to their framework are a few determinants of management capacity, a set of indicators to estimate these determinants, and a management capacity assessment tool to be administered by each state. A pilot survey of the management tool in a few states helped the authors to refine each instrument and finalize the same. A suitable management structure is suggested for effective management of the RCH program based on the population in each state. FINDINGS: The assessment brought out the need to strengthen the planning and monitoring of RCH activities, HR management practices, and inter-departmental coordination. PRACTICAL IMPLICATIONS: The Ministry of Health and Family Welfare, Government of India has accepted the management tool and asked each state to administer it. The recommended management structure is used as a guideline by each state to identify the capacity gaps and take necessary steps to augment its management capacity. ORIGINALITY/VALUE: The authors' framework to assess the management capacity of RCH program is very comprehensive, the management tool is easy to administer, and assessment of capacity gaps can be made quickly. Language: English Keywords: INDIA | EVALUATION REPORT | MATERNAL-CHILD HEALTH SERVICES | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | HEALTH SERVICES ADMINISTRATION | CAPACITY BUILDING | MONITORING | PLANNING | IMPLEMENTATION | Asia, Southern | Asia | Developing Countries | Evaluation | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning | Programs | Organization and Administration | Management | Program Sustainability Document Number: 341808 |
| 20. Title: Developments in national policies for food and nutrition security in Brazil. Author: Rocha C Source: Development Policy Review. 2009 Mar;27(1):51-66. Abstract: Brazil is on track to achieve many of the Millennium Development Goals, and this is widely credited to bold and innovative government policies backed by new forms of popular participation in social policy. This article examines evaluation evidence on two of the most important recent initiatives in Brazil's policies for food and nutrition security (conditional cash transfers through Bolsa Família and support for family agriculture through the Programa de Aquisição de Alimentos). It also considers advances in older policies (such as the School Meals programme) and the work of the National Council for Food and Nutrition Security, which has culminated in national legislation establishing food and nutrition security as a right. Language: English Keywords: BRAZIL | PROGRESS REPORT | EVALUATION | POLICYMAKERS | NUTRITION PROGRAMS | HEALTH POLICY | SOCIAL POLICY | PARTICIPATION | GOVERNMENT PROGRAMS | INCENTIVES | HOME ECONOMICS | AGRICULTURAL DEVELOPMENT | SCHOOL-BASED SERVICES | LEGISLATION | HUMAN RIGHTS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Administrative Personnel | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Policy | Political Factors | Sociocultural Factors | Social Behavior | Behavior | Programs | Microeconomic Factors | Economic Factors | Rural Development Document Number: 341094 |
| 21. Title: Making the case for U.S. international family planning assistance. Author: Speidel JJ; Sinding S; Gillespie D; Maguire E; Neuse M Source: [Chapel Hill, North Carolina, Ipas], 2009 Jan. 15 p. (Report) Abstract: This report documents the urgent need for greater U.S. assistance to family planning programs in the developing world and recommends targeted investment in such programs, primarily through the U.S. Agency for International Development. Five former directors of the Population and Reproductive Health Program of the United States Agency for International Development (USAID) issue a call for renewed U.S. political and financial commitment to international family planning programs. USAID has been the largest donor to international population and family planning efforts and a transformative source of leadership and innovation in the field. Its professional staff and technical resources are unparalleled among donor agencies. However, its funding peaked in 1995 and has declined in real terms ever since, even as the worldwide demand for family planning and other reproductive health services has grown. As a result, many successful programs in developing countries have stagnated and global fertility decline has slowed. At the beginning of a new administration and a new Congress, it is time to reverse the decline in U.S. political and financial commitment to this field of signature U.S. leadership and accomplishment, to satisfy the unmet need for services, and to improve women's reproductive health worldwide. We estimate that USAID's population budget should be increased to $1.2 billion. (Excerpts) Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION REPORT | EVALUATION | POLICYMAKERS | FAMILY PLANNING | FOREIGN AID | USAID | REPRODUCTIVE HEALTH | FAMILY PLANNING POLICY | POPULATION POLICY | GOVERNMENT PROGRAMS | GOVERNMENT FINANCING | Developed Countries | North America | Americas | Administrative Personnel | Organization and Administration | Financial Activities | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Health | Social Policy | Policy | Programs Document Number: 331360 |
| 22. Peer Reviewed Title: Education gender gaps in Pakistan: Is the labor market to blame? Author: Urquieta J; Angeles G; Mroz R; Lamadrid-Figueroa H; Hernandes B Source: Economic Development and Cultural Change. 2009 Apr;57(3):539-558. Abstract: Oportunidades (formerly PROGRESA) is a conditional cash transfer program ran by the Mexican federal government designed to break the intergenerational cycle of poverty. Among other activities, it provides free delivery attendance for women enrolled in the program. Skilled attendance at delivery has been identified as an effective strategy to reduce maternal mortality, an important health problem in Mexico. In this paper we assess the impact of Oportunidades on skilled attendance at delivery taking advantage of the experimental design implemented for the evaluation of this program in rural areas and using a variety of analytical techniques. The main results of the study indicate that Oportunidades had, at best, only a small effect on skilled attendance at delivery in treatment communities. The program had larger effects on those women who had one birth just prior to the experimental treatment and another birth subsequent to the experimental treatment. These results should lead to a review about the strategies used by Oportunidades to increase skilled attendance at delivery. Language: English Keywords: MEXICO | RESEARCH REPORT | CASE CONTROL STUDIES | KAP SURVEYS | STATISTICAL REGRESSION | MATHEMATICAL MODEL | MIDWIVES AND MIDWIFERY | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RURAL POPULATION | LOW INCOME POPULATION | CHILDBIRTH | GOVERNMENT PROGRAMS | POVERTY | INTERVENTIONS | North America | Americas | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Data Analysis | Theoretical Models | Health Personnel | Delivery of Health Care | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Programs | Organization and Administration Document Number: 341096 |
| 23. Title: Access to surgical sterilization through the National Health System, Ribeirao Preto, Southeastern Brazil. Author: Vieira EM; Souza L Source: Revista de Saude Publica. 2009 Jun;43(3):398-404. Abstract: OBJECTIVE: To characterize the profile of individuals who were unable to obtain the surgical contraception procedure, and associated factors. METHODS: This was a cross-sectional study conducted in Ribeirao Preto (Southeastern Brazil) in 2004, on 230 individuals who were unable to obtain sterilization surgery through the National Health System between 1999 and 2004. A questionnaire on sociodemographic information, use of contraceptive methods, aspects of sterilization and desire to undergo sterilization in the future was applied. The variables of sex, age, religion, per capita income, marital status and schooling level were compared between the total number of individuals who were unable to obtain this procedure and 297 individuals who were sterilized. RESULTS: Among the 230 interviewees, 21.3% were men and 78.7% were women. Most of them were married, white and Catholic and had had at least four years of schooling. The median monthly per capita income was R$ 140.00. Twenty-three of them (10%) had hopes of undergoing the operation. The remaining 207 were classified in two groups: 71% had decided to postpone the operation and 29% had faced obstacles in relation to gaining access to sterilization. The latter group was associated with being female, young and black. After logistic regression, being black was the only factor that remained associated with inability to obtain sterilization. Comparison with individuals who were able to obtain the procedure showed that being female, older, evangelical and single were associated with inability to obtain sterilization, while higher income and schooling levels favored access. CONCLUSIONS: Few of the individuals studied had not had access to sterilization. Most had postponed the procedure and a smaller proportion had encountered institutional obstacles. Blacks encountered more barriers than whites did. Language: EnglishPortuguese Keywords: BRAZIL | RESEARCH REPORT | STERILIZATION, SEXUAL | REPRODUCTIVE HEALTH | SOCIOECONOMIC FACTORS | NATIONAL HEALTH SERVICES | GOVERNMENT PROGRAMS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Family Planning | Health | Economic Factors | Health Services | Delivery of Health Care | Programs | Organization and Administration Document Number: 342579 |
| 24. Title: Five-year outcomes of the China National Free Antiretroviral Treatment Program. Author: Zhang F; Dou Z; Ma Y; Zhao Y; Liu Z; Bulterys M; Chen RY Source: Annals of Internal Medicine. 2009 Aug 18;151(4):241-51, W-52. Abstract: BACKGROUND: China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included more than 52 000 patients. OBJECTIVE: To report 5-year outcomes on adult mortality and immunologic treatment failure rates and risk factors. DESIGN: Open cohort analysis of a prospectively collected, observational database. SETTING: China. PATIENTS: All patients in the national treatment database from June 2002 to August 2008. Patients were excluded if they had not started triple therapy or had missing treatment regimen information. INTERVENTION: Antiretroviral therapy according to Chinese national treatment guidelines. MEASUREMENTS: Mortality rate and immunologic treatment failure rate, according to World Health Organization criteria. RESULTS: Of 52 191 patients, 48 785 were included. Median age was 38 years, 58% were men, 53% were infected through plasma or blood, and the median baseline CD4 cell count was 0.118x10(9) cells/L. Mortality was greatest during the first 3 months of treatment (22.6 deaths per 100 person-years) but decreased to a steady rate of 4 to 5 deaths per 100 person-years after 6 months and maintained this rate over the subsequent 4.5 years. The strongest mortality risk factors were a baseline CD4 cell count less than 0.050x10(9) cells/L (adjusted hazard ratio [HR] compared with a count>or=0.200x10(9) cells/L, 3.3 [95% CI, 2.9 to 3.8]) and having 4 to 5 baseline symptom categories (adjusted HR compared with no baseline symptom categories, 3.4 [CI, 2.9 to 4.0]). Treatment failure was determined among 31 070 patients with 1 or more follow-up CD4 cell counts. Overall, treatment failed for 25% of patients (12.0 treatment failures per 100 person-years), with the cumulative treatment failure rate increasing to 50% at 5 years. Limitation: Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. CONCLUSION: The National Free Antiretroviral Treatment Program reduced mortality among adult patients in China with AIDS to rates similar to those of other low- or middle-income countries. A cumulative immunologic treatment failure rate of 50% after 5 years, due to the limited availability of second-line regimens, is of great concern. Language: English Keywords: CHINA | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | CLIENTS | AIDS | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | IMMUNOLOGICAL EFFECTS | MORTALITY | RISK FACTORS | TIME FACTORS | ANTIRETROVIRAL DRUGS | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Immunity | Immune System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Health | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342649 |
| 25. Title: AIDS orphanages in China: reality and challenges. Author: Zhao Q; Li X; Kaljee LM; Fang X; Stanton B; Zhang L Source: AIDS Patient Care and STDs. 2009 Apr;23(4):297-303. Abstract: With the increasing number of AIDS orphans in China, the government has been building AIDS orphanages since 2004 to accommodate some of those children who have lost both parents to AIDS. However, no data are available regarding the quality of this model of institutional care of AIDS orphans in China. This study, based on qualitative data from children and workers in AIDS orphanages, examines the daily lives, needs, and feelings of orphans and explores the advantages and disadvantages of institutionalized care of AIDS orphans in China. The current study was conducted in 2006-2007 in two rural counties of central China. Data in the current study included individual in-depth interviews with 23 children who lost both of their parents to HIV/AIDS (ages 8 to 17 years) living in AIDS orphanages and 5 AIDS orphanage workers. Findings in this study reveal that children living in orphanages mostly felt that the living conditions were better than the families they lived with after the death of their parents. However, according to the children and orphanage workers, the institutional care has some disadvantages, such as administrative restraints, limited psychological guidance, stigma, lack of education on AIDS, and financial burdens of the operation. Implications for intervention programs include continuing support from the government and nongovernmental organizations, improvements in administrative styles, and the need of incorporating psychological support within the institutions. Language: English Keywords: CHINA | RESEARCH REPORT | QUALITATIVE RESEARCH | ORPHANS AND VULNERABLE CHILDREN | PARENTS | AIDS | CAUSES OF DEATH | QUALITY OF LIFE | GOVERNMENT PROGRAMS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Family and Household | Sociocultural Factors | Family Relationships | Family Characteristics | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Social Welfare | Economic Factors | Programs | Organization and Administration Document Number: 341352 |
| 26. Title: AWARENESS Project. Democratic Republic of Congo country report, 2003-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [17] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: In 2003, the USAID Mission and the National Reproductive Health Program (PNSR) invited IRH to introduce the SDM in the Democratic Republic of Congo (DRC). The strategy focused on training providers and integrating the SDM into existing clinic, community, and pharmacy services in Kinshasa, Lubumbashi, and Bukavu, and the rural area of Katako Kombe. By 2004, 14 organizations were able to offer the SDM. CycleBeads are included in the national list of essential medicines and the five-year contraceptive security plan. The SDM is part of in-service family planning training curricula. The PNSR is developing national norms and protocols and intends to include the SDM. IRH also worked with the MOH to incorporate the SDM into national policies and logistics and reporting systems. However, the lack of overall government norms and functioning distribution and reporting systems is an obstacle requiring more comprehensive attention than the AWARENESS Project could offer. The program leveraged significant resources, as most partners paid for their own training programs and CycleBeads. The Congolese program participated in a study to determine the impact of the social marketing campaign, a general evaluation of SDM integration in the DRC. Major findings from the simulated client study showed that 89% of clinic providers gave spontaneous information on the SDM as opposed to only 38% of pharmacists; confidentiality was observed in over 70% of both clinics and pharmacies; 96% of providers in clinics told clients that CycleBeads represent a woman?s cycle while only 35% of pharmacists did so; and 7% of clinic providers attempted to convince clients to use other methods of family planning as opposed to 23% of pharmacists. The success of recent initiatives in DRC to introduce the TDM through services of an faith-based organization (FBO) suggest that this method may also be an appropriate addition to family planning services. (excerpt) Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327619 |
| 27. Title: AWARENESS Project. Ecuador country report, 2001-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [13] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: CEMOPLAF (the Centro Médico de Orientación y Planificación) wanted to include SDM in its services in an effort to address unmet need. A pilot study showed a strong potential for the SDM to address this need and demonstrated feasibility of service provision in clinics and in the community. It also showed that clients were able to use the SDM correctly with a single counseling session. The longterm follow-up of pilot study participants continuing with the SDM demonstrated that while the majority of discontinuation during the first quarter of year one was due to cycles out of range; discontinuation during the second and third year had more to do with birth spacing and other life circumstances. Based on these results, CEMOPLAF provided training and technical input to its close partner, the MOH, and executed a social marketing program that introduced the SDM into pharmacies with mass media support. A study of the social marketing approach, conducted with the Population Council, showed awareness of the SDM increased from 4% to 34%, intention to use increased from 27% to 32%, demand for the SDM increased five-fold in pharmacies and clinics in one month during the mass media campaign, and both clinic-based providers and pharmacists provided correct information. CEMOPLAF used research results to advocate successfully for integrating the SDM into MOH norms and training curricula. Currently, the SDM is available in all CEMOPLAF and 11 MOH clinics in 11 of 22 departments. A number of local NGOs have also adopted the SDM. By including the SDM in national norms and the maternity program, the MOH committed to expanding the SDM to all its clinics by purchasing materials in exchange for training and technical assistance from CEMOPLAF. (excerpt) Language: English Keywords: ECUADOR | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | South America, Western | South America | Latin America | Americas | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327620 |
| 28. Title: AWARENESS Project. Guatemala country report, 2002-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [21] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: With a population of 12 million, Guatemala is the largest country in Central America. Contraceptive prevalence in 2002 was relatively low, at 43% for women aged 15-49, and was even lower among rural (under 35%) and indigenous women (24%). In 2002, the Ministry of Health (MOH) and the Social Security Institute (IGGS) requested assistance from the AWARENESS Project to expand contraceptive choice through the integration of fertility awareness-based methods (FAM) into the method mix. The program functioned in USAID priority zones including the largely indigenous departments of the Altiplano (Quetzaltenango, Solola, and Huehuetenango), Santa Rosa, Chimaltenango, and Alta Verapaz. It focused primarily on building evidence for the future scale-up of the Standard Days Method® (SDM), while also assessing the effectiveness and feasibility of the TwoDay Method ® (TDM). IRH used a diversified strategy to build the evidence base for FAM and subsequently establish the necessary support and conditions for scale up. With approximately 200 trainers and 2000 trained SDM providers, Guatemala has substantial capacity for offering SDM services. In the last three years, more than 13,000 women began using the SDM, most of whom previously had not used family planning. The SDM also is supported in norms and gradually is being included in management information and logistics systems, pre- and in-service training, and communication strategies. (excerpt) Language: English Keywords: GUATEMALA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Central America | Latin America | Americas | Developing Countries | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327621 |
| 29. Title: Using national resources to finance contraceptive procurement. Policy brief. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, [2008]. [9] p. (Policy Brief) Abstract: Driven by the increasing demand for and popularity of family planning, increasing population size, and changing demographics with more couples entering their fertile years, the financing requirement for contraceptives has become increasingly onerous. Strategies to finance contraceptives include expansion of the donor base; increased use of cost recovery, including revolving drug funds; greater use of the private sector; and direct government financing of contraceptive procurement. None of these is mutually exclusive, and to ensure contraceptive security, most countries are likely to use some or all of these approaches, and many others. Evidence suggests that many governments are beginning to finance contraceptive procurement using national resources, but limited data are publicly available regarding the global extent of this financing. This brief details the findings of a survey of the extent to which national governments of developing countries are using national resources to finance contraceptive procurement. The brief examines the different types of financing used, some of the benefits of this type of financing, and some of the issues it raises. Hopefully, this study can be repeated to track spending and will spur more rigorous efforts to measure this practice. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | GOVERNMENT PUBLICATION | SURVEYS | GOVERNMENT | USAID | LOGISTICS | CONTRACEPTIVE DISTRIBUTION | GOVERNMENT FINANCING | GOVERNMENT PROGRAMS | WORLD BANK | FOREIGN AID | FUNDS | Sampling Studies | Studies | Research Methodology | Political Factors | Sociocultural Factors | Government Agencies | Organizations | Management | Organization and Administration | Distributional Activities | Program Activities | Programs | Financial Activities | Economic Factors | International Agencies Document Number: 326278 |
| 30. Title: Community-based HIV interventions for young people. Author: UNAIDS. Inter-Agency Task Team on HIV and Young People Source: New York, New York, United Nations Population Fund, HIV/AIDS Branch, [2008]. 8 p. (Guidance Brief) Abstract: This Brief has been developed by the Inter-Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, development partners, civil society and other implementing partners on community HIV interventions for young people. It is part of a series of seven global Guidance Briefs that focus on HIV prevention, treatment, care and support interventions for young people that can be delivered through different settings and for a range of target groups. Language: English Keywords: DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | YOUTH | POLICYMAKERS | COMMUNITY | COMMUNITY HEALTH SERVICES | HIV PREVENTION | COMMUNITY PARTICIPATION | GOVERNMENT PROGRAMS | UNAIDS | MONITORING | PROGRAM EVALUATION | INTERNET | INFORMATION SOURCES | Age Factors | Population Characteristics | Demographic Factors | Population | Administrative Personnel | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Programs | UN | International Agencies | Organizations | Political Factors | |