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Peer Reviewed

Title: Determinants of perceived morbidity and use of health services by children less than 15 years old in rural Bangladesh.
Author: Alam N; van Ginneken JK; Timaeus I
Source: Maternal and Child Health Journal. 2009 Jan;13(1):119-29.
Abstract: This study examined the association of a number of social and economic and other factors with perceived morbidity and use of health services by children in rural Bangladesh, using the data of a health and socioeconomic survey conducted in Matlab, Bangladesh in 1996. One of the factors of interest was women's social position measured with indicators such as their education, domestic autonomy, social networks and social prestige. Other factors of interest were economic in nature and included the availability of high-quality primary health care (PHC) facilities in one part of the study area. A total of 52% of the 3,793 children below 15 had an episode of an acute illness in the month preceding the interview. The medical care sought for acute illnesses was grouped into four categories: medical doctors, paramedics, traditional and untrained village doctors (including drug sellers) and homeopaths. A total of 55% of the children who were sick in the past month consulted any type of health provider. Logistic regression was used to estimate the effects of the various independent variables on the two dependent variables: perceived morbidity of under-15 children and health service use for under-15 sick children. The results revealed that age of the child was the most important factor influencing perceived morbidity while social and economic variables were in general not related to perceived morbidity. Prolonged and severe illnesses and illnesses of young and male children were more likely to be treated by health providers, particularly by physicians. While women's education and social network influenced visits to any health providers socioeconomic indicators influenced visits to physicians. Availability of PHC facilities in one part of the study area also led to more use of modern medical care. The findings highlight that improvement of women's education and of social and economic status in general, in combination with more availability of high-quality PHC will in Bangladesh lead to better health care of children.
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | CHILDREN | MORBIDITY | INFECTIONS | UTILIZATION OF HEALTH CARE | BEHAVIOR | MATERNAL HEALTH | EDUCATION | SOCIAL NETWORKS | Developing Countries | Asia, Southern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Health | Friends and Relatives | Family and Household | Sociocultural Factors
Document Number: 330857

Peer Reviewed

Title: Neonatal near miss: a measure of the quality of obstetric care.
Author: Avenant T
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):369-374.
Abstract: Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as “near miss”, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | PREGNANCY | MATERNAL MORTALITY | PERINATAL MORTALITY | MORBIDITY | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | MEASUREMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology
Document Number: 341303

Title: Placental malaria, maternal HIV infection and infant morbidity.
Author: Briand V; Badaut C; Cot M
Source: Annals of Tropical Paediatrics. 2009 Jun;29(2):71-83.
Abstract: Co-infection with malaria and HIV in pregnant women is particularly common in sub-Saharan Africa and has serious consequences for both mother and newborn child. Numerous studies have been published on the effects in pregnancy of HIV on malaria infection and on the effects of malaria on HIV infection. The increased prevalence and intensity of parasitaemia (placental and peripheral infection and parasite density) in HIV-infected women is well established. Similarly, malaria infection seems to be associated with higher viral loads. However, there is still uncertainty as to the influence of malaria on the clinical course of HIV infection, mother-to-child transmission of HIV, and the consequences of co-infection on post-neonatal infant morbidity and mortality. These questions require further investigation. In terms of prevention, intermittent preventive treatment with two doses of sulfadoxine-pyrimethamine (SP) has been found less effective in preventing malaria in HIV-infected than uninfected women, and a higher dosage (such as monthly SP) has been recommended. Regarding malaria, there is also a lack of clear recommendations for women taking daily cotrimoxazole prophylaxis, and anti-malarial-anti-retroviral interactions are not well understood. Multi-centre clinical trials should be undertaken to investigate effective, coherent and well-tolerated strategies to prevent malaria in HIV-infected women. Safe alternatives to SP should be identified and evaluated rapidly. Finally, a central pharmaco-vigilance network should be instituted to report adverse effects.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | MALARIA | HIV INFECTIONS | MALARIA PREVENTION | RESEARCH AND DEVELOPMENT | NEEDS | MATERNAL HEALTH | MORBIDITY | Africa | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Technology | Economic Factors | Health
Document Number: 342065

Peer Reviewed

Title: The national response to the HIV/AIDS epidemic in Peru: accomplishments and gaps--a review.
Author: Caceres CF; Mendoza W
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S60-6.
Abstract: In Peru, after the first case of AIDS was reported in 1983, nearly 20,000 AIDS cases have been notified to date and between 20,000 and 79,000 persons are estimated to be living with HIV. Despite a relatively low HIV prevalence in the general population, the epidemic has importantly mobilized social actors and economic resources and has helped articulate a very active field within the Peruvian health sector. In recent years, the country has become the largest recipient of HIV funding from the Global Fund for AIDS, Tuberculosis, and Malaria in Latin America, for which a substantial national counterpart has been committed. Peru's predictable selection as one of the 12 focal countries for the 5-year impact evaluation of the Global Fund suggested that an analysis of the response to the HIV epidemic in Peru may provide significant lessons on the possibilities of international aid in the AIDS field, particularly in the Latin American context. This article presents an analysis of the impact of the HIV/AIDS epidemic and the nature of the response articulated by the State and civil society in Peru, based on the Universal Access Principles proposed by World Health Organization, UNAIDS, and others. Relying on a number of recent secondary sources, we focus not only on the impact of the epidemic on morbidity and death but also on the changes in society as a whole, particularly in social movements and their dynamic relationship with the State. We start with an epidemiological overview and move to describe the role of social actors in response to the epidemic and then propose a framework for the analysis of the scope and limitations of the national response and elaborate on potential courses of action that may lead to strengthen accomplishments and resolve remaining gaps.
Language: English
Keywords:
PERU | RESEARCH REPORT | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | MORBIDITY | DEATH RATE | HEALTH POLICY | PUBLIC HEALTH | EPIDEMIOLOGY | EVALUATION | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Policy | Political Factors | Sociocultural Factors | Health
Document Number: 341319

Title: Massive Pulmonary Embolism Associated With Factor V Leiden, Prothrombin, and Methylenetetrahydrofolate Reductase Gene Mutations in a Young Patient on Oral Contraceptive Pills: A Case Report.
Author: Charafeddine KM; Mahfouz R; Ibrahim G; Taher A; Hoballah J; Taha A
Source: Clinical and Applied Thrombosis / Hemostasis. 2009 Jun 10;
Abstract: Factor V Leiden (Factor V G1691A), prothrombin gene mutation G20210A, and homozygous C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene are known to predispose venous thromboembolism (VTE). We present herein a rare case of a young woman heterozygous for these mutations and taking oral contraceptive pills for less than 2 months, diagnosed to have massive deep venous thrombosis and bilateral pulmonary embolism. The patient was managed for 10 days in the hospital and discharged home on oral anticoagulants. This case suggests that screening for these factors in people with family history of thrombosis and in relatives of patients with these mutations is highly recommended to prevent fatal consequences. In addition, a new guideline for treatment and prophylaxis with anticoagulant for these patients and others who are at risk of developing VTE (American College of Chest Physicians [ACCP] guidelines-Chest 2008) has been published recently. Our recommendation is to promote for the internationally published algorithms through their application, where necessary, to prevent any future thrombotic morbidity or mortality incidents.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PREVALENCE | PULMONARY EMBOLISM | THROMBOEMBOLISM | MORBIDITY | Developed Countries | North America | Americas | Measurement | Research Methodology | Embolism | Vascular Diseases | Diseases
Document Number: 341600

Peer Reviewed

Title: Complications of surgical abortion.
Author: Diedrich J; Steinauer J
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):205-12.
Abstract: Surgical abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries. Though the risk of complications is low, it increases exponentially with gestational age. Factors increasing risk of morbidity may be demographic, such as increasing patient age; medical, such as prior cesarean delivery; and procedural, such as inadequate dilation. This chapter will provide information on how to recognize factors that increase risk, steps to minimize risk, and to identify and manage complications promptly.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | ABORTION | PREGNANCY, SECOND TRIMESTER | MORBIDITY | BLEEDING | POSTABORTION CARE | CERVICAL LACERATION | Developed Countries | North America | Americas | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Diseases | Signs and Symptoms | Health Services | Delivery of Health Care | Health
Document Number: 342243 Notification

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

10.

Peer Reviewed

Title: Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.
Author: Kafulafula G; Mwatha A; Chen YQ; Aboud S; Martinson F; Hoffman I; Fawzi W; Read JS; Valentine M; Mwinga K; Goldenberg R; Taha TE
Source: Pediatrics. 2009 Jul;124(1):e137-44.
Abstract: BACKGROUND: Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants. OBJECTIVE: Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality. METHODS: We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications. RESULTS: Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics. CONCLUSIONS: There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | DATA ANALYSIS | CLINICAL TRIALS | PREGNANT WOMEN | PREMATURE BIRTH | NEONATAL DISEASES AND ABNORMALITIES | ANTIBIOTICS | MORBIDITY | NEONATAL MORTALITY | Africa | Developing Countries | Research Methodology | Clinical Research | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics
Document Number: 342887

11.

Title: Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities.
Author: Knight M; Kurinczuk JJ; Spark P; Brocklehurst P
Source: BMJ. 2009;338:b542.
Abstract: OBJECTIVE: To describe on a national basis ethnic differences in severe maternal morbidity in the United Kingdom. DESIGN: National cohort study using the UK Obstetric Surveillance System (UKOSS). SETTING: All hospitals with consultant led maternity units in the UK. PARTICIPANTS: 686 women with severe maternal morbidity between February 2005 and February 2006. MAIN OUTCOME MEASURES: Rates, risk ratios, and odds ratios of severe maternal morbidity in different ethnic groups. RESULTS: 686 cases of severe maternal morbidity were reported in an estimated 775 186 maternities, representing an estimated incidence of 89 (95% confidence interval 82 to 95) cases per 100 000 maternities. 74% of women were white, and 26% were non-white. The estimated risk of severe maternal morbidity in white women was 80 cases per 100 000 maternities, and that in non-white women was 126 cases per 100,000 (risk difference 46 (27 to 66) cases per 100 000; risk ratio 1.58, 95% confidence interval 1.33 to 1.87). Black African women (risk difference 108 (18 to 197) cases per 100,000 maternities; risk ratio 2.35, 1.45 to 3.81) and black Caribbean women (risk difference 116 (59 to 172) cases per 100 000 maternities; risk ratio 2.45, 1.81 to 3.31) had the highest risk compared with white women. The risk in non-white women remained high after adjustment for differences in age, socioeconomic and smoking status, body mass index, and parity (odds ratio 1.50, 1.15 to 1.96). CONCLUSIONS: Severe maternal morbidity is significantly more common among non-white women than among white women in the UK, particularly in black African and Caribbean ethnic groups. This pattern is very similar to reported ethnic differences in maternal death rates. These differences may be due to the presence of pre-existing maternal medical factors or to factors related to care during pregnancy, labour, and birth; they are unlikely to be due to differences in age, socioeconomic or smoking status, body mass index, or parity. This highlights to clinicians and policy makers the importance of tailored maternity services and improved access to care for women from ethnic minorities. National information on the ethnicity of women giving birth in the UK is needed to enable ongoing accurate study of these inequalities.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | COHORT ANALYSIS | INCIDENCE | ETHNIC GROUPS | WOMEN | MORBIDITY | MATERNAL MORTALITY | INEQUALITIES | Developed Countries | Europe, Western | Europe | Research Methodology | Measurement | Cultural Background | Population Characteristics | Demographic Factors | Population | Diseases | Mortality | Population Dynamics | Socioeconomic Factors | Economic Factors
Document Number: 330604

12.

Peer Reviewed

Title: Severe chronic morbidity following childbirth.
Author: Leung TY; Chung H
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):401-423.
Abstract: Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CHILDBIRTH | FISTULA | OBSTETRICAL SURGERY | MORBIDITY | PREVENTION AND CONTROL | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341305

13.

Peer Reviewed

Title: A country-wide malaria survey in Mozambique. II. Malaria attributable proportion of fever and establishment of malaria case definition in children across different epidemiological settings.
Author: Mabunda S; Aponte JJ; Tiago A; Alonso P
Source: Malaria Journal. 2009;8:74.
Abstract: BACKGROUND: Protection against clinical malaria episodes is acquired slowly after frequent exposure to malaria parasites. This is reflected by a decrease with increasing age in both parasite density and incidence of clinical episodes. In many settings of stable malaria transmission, the presence of asymptomatic malaria parasite carriers is common and the definition of clinical malaria remains uncertain. METHODS: Between February 2002 and April 2003, a country-wide malaria survey was conducted in 24 districts of Mozambique, aiming to characterize the malaria transmission intensities and to estimate the proportion of fever cases attributable to malaria infections in order to establish the malaria case definition. A total of 8,816 children less than ten years of age were selected for the study. Axillary temperature was measured in all participating subjects and finger prick blood collections were taken to prepare thick and thin films for identification of parasite species and determination of parasite density. The proportion of fever cases attributable to malaria infection was estimated using a logistic regression of the fever on a monotonic function of the parasite density and, using bootstrap facilities, bootstrapped estimated confidence intervals, as well as the sensitivity and specificity for different parasite density cut-offs were produced. RESULTS: Overall, the prevalence of Plasmodium falciparum was 52.4% (4,616/8,816). The prevalence of fever (axillary temperature >or= 37.5 degrees C) was 9.4% (766/8,816). Fever episodes peaked among children below 12 months of life [15.1% (206/1,517)]. The lowest fever prevalence of 5.9% (67/1,224) was recorded amongst children between five and seven years of age. Among 4,098 parasitized children, 498/4,098 (13.02%) had fever. The prevalence of malaria infections associated with fever peaked among children in the less than twelve months age group and thereafter decreased rapidly with increasing age (p < 0.001). High parasite densities were significantly associated with fever (p < 0.04). The proportion of fever attributed to malaria was 37.8% (95% CI 32.9% - 42.7%). An age-specific pattern was observed with significant variations across different regions in the country. In general, among children less than 12 months of life, the proportion of fever attributed to malaria infection was 43.5% (95% CI 25.8% - 61.2%), in children aged between 12 and 59 months of age was 39.6% (95% CI 30.3% - 48.9%), and among children aged between 5 and 10 years old was 21.5% (95% CI 11.6% - 31.4%). CONCLUSION: This study confirms that malaria remains a major cause of febrile illness during childhood. It also defines the relation between parasite density and fever and how this varies with age and region. This may help guide case definition for clinical trials of preventive tools, as well as provide definitions that may improve the precision of measurement of the burden of disease.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | EPIDEMIOLOGY | CHILDREN | MALARIA | DISEASES | RISK FACTORS | MORBIDITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Public Health | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases
Document Number: 342254

14.

Peer Reviewed

Title: RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study.
Author: Mathisen M; Strand TA; Sharma BN; Chandyo RK; Valentiner-Branth P; Basnet S; Adhikari RK; Hvidsten D; Shrestha PS; Sommerfelt H
Source: BMC Medicine. 2009;7:35.
Abstract: BACKGROUND: Pneumonia is among the main causes of illness and death in children <5 years of age. There is a need to better describe the epidemiology of viral community-acquired pneumonia (CAP) in developing countries. METHODS: From July 2004 to June 2007, we examined nasopharyngeal aspirates (NPA) from 2,230 cases of pneumonia (World Health Organization criteria) in children 2 to 35 months old recruited in a randomized trial of zinc supplementation at a field clinic in Bhaktapur, Nepal. The specimens were examined for respiratory syncytial virus (RSV), influenza virus type A (InfA) and B (InfB), parainfluenza virus types 1, 2 and 3 (PIV1, PIV2, and PIV3), and human metapneumovirus (hMPV) using a multiplex reverse transcriptase polymerase chain reaction (PCR) assay. RESULTS: We identified 919 virus isolates in 887 (40.0%) of the 2,219 NPA specimens with a valid PCR result, of which 334 (15.1%) yielded RSV, 164 (7.4%) InfA, 129 (5.8%) PIV3, 98 (4.4%) PIV1, 93 (4.2%) hMPV, 84 (3.8%) InfB, and 17 (0.8%) PIV2. CAP occurred in an epidemic pattern with substantial temporal variation during the three years of study. The largest peaks of pneumonia occurrence coincided with peaks of RSV infection, which occurred in epidemics during the rainy season and in winter. The monthly number of RSV infections was positively correlated with relative humidity (rs = 0.40, P = 0.01), but not with temperature or rainfall. An hMPV epidemic occurred during one of the three winter seasons and the monthly number of hMPV cases was also associated with relative humidity (rs = 0.55, P = 0.0005). CONCLUSION: Respiratory RNA viruses were detected from NPA in 40% of CAP cases in our study. The most commonly isolated viruses were RSV, InfA, and PIV3. RSV infections contributed substantially to the observed CAP epidemics. The occurrence of viral CAP in this community seemed to reflect more or less overlapping micro-epidemics with several respiratory viruses, highlighting the challenges of developing and implementing effective public health control measures.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | RANDOMIZED RESPONSE TECHNIC | CHILDREN | MORBIDITY | DEATH RATE | PNEUMONIA | VITAMINS AND MINERALS | ZINC | RESPIRATORY INFECTIONS | TREATMENT | Developing Countries | Asia, Southern | Asia | Questionnaire Design | Survey Methodology | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Mortality | Population Dynamics | Pulmonary Effects | Physiology | Biology | Metals | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342879

15.

Peer Reviewed

Title: Reduced morbidity and mortality in the first year after initiating highly active anti-retroviral therapy (HAART) among Ugandan adults.
Author: Miiro G; Todd J; Mpendo J; Watera C; Munderi P; Nakubulwa S; Kaddu I; Rutebarika D; Grosskurth H
Source: Tropical Medicine and International Health. 2009 May;14(5):556-63.
Abstract: OBJECTIVE: To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility. METHODS: Between 1999 and 2006, we collected morbidity data from a community-based cohort of HAART-eligible patients, comparing patients initiating HAART and those non-HAART. Patients aged 15 years or older visited the clinic every 6 months and when ill. Baseline data on patients' characteristics, WHO stage, haemoglobin and CD4+ T-cell counts, along with follow-up data on morbidity (new, recurrent and drug-related), were collected for the first year after initiating HAART or becoming HAART-eligible. We estimated the overall effect of HAART on morbidity; adjusted for the effect of cotrimoxazole prophylaxis by Mantel-Haenszel methods. A negative binomial regression model was used to assess rate ratios (RR) after adjustment for other confounders, including cotrimoxazole. RESULTS: A total of 219 HAART patients (median age 37 years; 73% women; 82% using cotrimoxazole prophylaxis, median haemoglobin 11.7 g/dl and median CD4+ 131 cells/microl) experienced 94 events in 127 person-years. 616 non-HAART patients (median age 33 years; 70% women; 26% using cotrimoxazole prophylaxis, median haemoglobin 11.2 g/dl and median CD4+ 130 cells/microl) experienced 862 events in 474 person-years. The overall morbidity during the first year of HAART was 80% lower than among non-HAART patients (adjusted RR = 0.20, 95% CI: 0.12-0.34). Cotrimoxazole prophylaxis also reduced morbidity (adjusted RR = 0.65, 95% CI: 0.45-0.94). CONCLUSION: These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ADULTS | MORTALITY | MORBIDITY | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | CONTRACEPTIVE USE-EFFECTIVENESS | LABORATORY PROCEDURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 342743

16.

Title: Ventilator-associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence.
Author: Morrow BM; Argent AC
Source: Journal of Paediatrics and Child Health. 2009 Mar;45(3):104-11.
Abstract: AIM: To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP). METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5. RESULTS: A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively. CONCLUSIONS: VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | INFANT | PNEUMONIA | SIGNS AND SYMPTOMS | HOSPITALS | ANTIBIOTICS | MORBIDITY | INFANT MORTALITY | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pulmonary Effects | Physiology | Biology | Diseases | Health Facilities | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Mortality | Population Dynamics | Viral Diseases
Document Number: 341838

17.

Peer Reviewed

Title: Obstetric fistulae in West Africa: patient perspectives.
Author: Nathan LM; Rochat CH; Grigorescu B; Banks E
Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e40-2.
Abstract: OBJECTIVE: The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. STUDY DESIGN: At l'Hopital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. RESULTS: The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. CONCLUSION: Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients.
Language: English
Keywords:
AFRICA, WESTERN | RESEARCH REPORT | WOMEN | CLIENTS | FISTULA | MORBIDITY | PUBLIC HEALTH | PREGNANCY COMPLICATIONS | Developing Countries | Africa, Sub Saharan | Africa | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Diseases | Health
Document Number: 341240

18.

Title: Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity.
Author: Oliveira Neto AF; Parpinelli MA; Cecatti JG; Souza JP; Sousa MH
Source: International Journal of Gynaecology and Obstetrics. 2009 Jun;105(3):252-6.
Abstract: OBJECTIVE: To identify factors associated with maternal death among women with severe maternal morbidity. METHODS: A retrospective study of 673 women admitted to an obstetric intensive care unit was undertaken. The odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for selected characteristics. The maternal mortality and severe maternal morbidity ratios were determined for groups of complications according to outcome (death or survival). RESULTS: The risk of maternal death was higher among adolescents (OR 3.3; 95% CI, 1-9.7) and patients referred from other hospitals (OR 9.8; 95% CI, 2.7-53.3). The severe maternal morbidity ratio was 46.6 per 1000 deliveries and the mortality:morbidity ratio 1:37.4. Obstetric complications led to 65.8% of admissions and 50% of maternal deaths. The number of interventions/procedures and total maximum sequential organ failure assessment score were higher in cases of death. CONCLUSION: The strong association between interhospital transfer and maternal death suggests delays in diagnosis, management, and referral. Adopting organ dysfunction-based criteria may contribute toward identifying the most severe cases.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | RETROSPECTIVE STUDIES | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | MATERNAL MORTALITY | PREGNANCY | MORBIDITY | EMERGENCY SERVICES | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Mortality | Reproduction | Diseases | Health Services | Delivery of Health Care | Health
Document Number: 341371

19.

21.

Peer Reviewed

Title: Severe acute maternal morbidity in low-income countries.
Author: Ronsmans C
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):305-316.
Abstract: Although obstetric complications are sometimes presented as a relatively easy alternative to maternal deaths, difficulties remain in their definition and identification, and there is limited experience with the use of severe obstetric complications as a starting point for audits or case reviews or as an indicator for monitoring the success of safe motherhood programmes in low-income countries. In this paper we review published studies reporting on the measurement of severe acute maternal morbidity in low-income countries. We found 37 studies from 24 countries. We describe the definition and ascertainment of cases of severe acute maternal morbidity and we give examples of how information on severe acute maternal morbidity has been used to inform safe motherhood programmes in low-income countries.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | LOW INCOME POPULATION | MORBIDITY | SAFE MOTHERHOOD | MATERNAL HEALTH | MEASUREMENT | MATERNAL MORTALITY | OBSTETRICS | SURGERY | REPRODUCTIVE HEALTH | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Diseases | Health | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Treatment | Medical Procedures
Document Number: 330188

22.

Title: Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz.
Author: Roost M; Altamirano VC; Liljestrand J; Essen B
Source: BJOG. 2009 Aug;116(9):1210-7.
Abstract: OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.
Language: English
Keywords:
BOLIVIA | URBAN AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | HOSPITALS | MATERNAL MORTALITY | MORBIDITY | PREGNANCY COMPLICATIONS | INFECTIONS | MATERNAL HEALTH SERVICES | REFERRAL AND CONSULTATION | Developing Countries | South America, Central | South America | Latin America | Americas | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Mortality | Population Dynamics | Demographic Factors | Diseases | Maternal-Child Health Services | Primary Health Care | Program Activities | Programs | Organization and Administration
Document Number: 342832

23.

Peer Reviewed

Title: Maternal near miss - towards a standard tool for monitoring quality of maternal health care.
Author: Say L; Souza JP; Pattinson RC
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):287-296.
Abstract: Maternal mortality is still among the worst performing health indicators in resource-poor settings. For deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system and take corrective action. However, although a significant public health problem, maternal deaths are rare in absolute numbers especially within an individual facility. Studying cases of women who nearly died but survived a complication during pregnancy, childbirth or postpartum (maternal near miss or severe acute maternal morbidity) are increasingly recognized as useful means to examine quality of obstetric care. Nevertheless, routine implementation and wider application of this concept in reviewing clinical care has been limited due to the lack of a standard definition and uniform case-identification criteria. WHO has initiated a process in agreeing on a definition and developing a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases for monitoring and improving quality of obstetric care. A list of identification criteria was proposed together with one single definition. This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | MONITORING | CLIENTS | MOTHERS | PREGNANCY | SAFETY | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | MORBIDITY | RISK FACTORS | MATERNAL HEALTH | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Program Activities | Programs | Organization and Administration | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Reproduction | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases
Document Number: 341302

24.

Title: Maternal mortality in patients admitted to an intensive care unit in Jamaica.
Author: Scarlett M; Isaacs MA; Fredrick-Johnston S; Kulkarni S; McCaw-Binns A
Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):169-70.
Abstract: A retrospective review was conducted of severe acute maternal morbidity (SAMM) admissions to the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI), Jamaica, between January 2001 and December 2006. UHWI has 550 beds and is one of three tertiary care referral centers on the island; it has two 8-bed ICUs. A total of 57 women with SAMM were admitted to the ICU over the study period, representing 2.8% of ICU admissions and 0.4% of total maternal admissions to the hospital. The mean age of the women was 30 years (range, 26-36 years) and the mean duration of stay in the ICU was 6 days (range, 1-35 days). The most common diagnoses were hypertensive disorders of pregnancy, sickle cell disease, and hemorrhagic disorders (Table 1). The cause of the admission in 32 (56.1%) patients was a direct obstetric cause, while for 25 (43.8%) patients the cause was non-obstetric. Only 2 patients with viable pregnancies had inadequate prenatal care. Twenty-five women were admitted after cesarean delivery, 11 after vaginal delivery, 6 following laparotomy, and 6 after induced abortion.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY COMPLICATIONS | MATERNAL MORTALITY | MORBIDITY | HOSPITALS | CAUSES OF DEATH | OBSTETRICS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Medicine | Health Services
Document Number: 341380

25.

26.

Title: Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India.
Author: Shroff M; Griffiths P; Adair L; Suchindran C; Bentley M
Source: Maternal and Child Nutrition. 2009 Jan;5(1):64-74.
Abstract: Child stunting, an outcome of chronic undernutrition, contributes to poor quality of life, morbidity and mortality. In South Asia, the low status of women is thought to be one of the primary determinants of undernutrition across the lifespan. Low female status can result in compromised health outcomes for women, which in turn are related to lower infant birthweight and may affect the quality of infant care and nutrition. Maternal autonomy (defined as a woman's personal power in the household and her ability to influence and change her environment) is likely an important factor influencing child care and ultimately infant and child health outcomes. To examine the relationship between maternal autonomy and child stunting in Andhra Pradesh, India, we analysed data from National Family Health Survey (NFHS)-2. We used cross-sectional demographic, health and anthropometric information for mothers and their oldest child <36 months (n = 821) from NFHS-2. The main explanatory variables of autonomy are presented by four dimensions - decision making, permission to travel, attitude towards domestic violence and financial autonomy - constructed using seven binary variables. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child. Women with higher autonomy {indicated by access to money [odds ratio (OR) = 0.731; 95% confidence interval (CI) 0.546, 0.981] and freedom to choose to go to the market [OR = 0.593; 95% CI 0.376, 0.933]} were significantly less likely to have a stunted child, after controlling for household socio-economic status and mother's education. In this south Indian state, two dimensions of female autonomy have an independent effect on child growth, suggesting the need for interventions that increase women's financial and physical autonomy.
Language: English
Keywords:
INDIA | RESEARCH REPORT | ANTHROPOMETRY | PREGNANT WOMEN | CHILDREN | MATERNAL NUTRITION | MALNUTRITION | BODY HEIGHT | BODY WEIGHT | QUALITY OF LIFE | MORBIDITY | EVALUATION | Asia, Southern | Asia | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Nutrition | Health | Nutrition Disorders | Diseases | Physiology | Biology | Social Welfare | Economic Factors
Document Number: 330818

27.

Peer Reviewed

Title: The impact of social capital on HIV-related actions as mediated by personal and proxy efficacies in Namibia.
Author: Smith RA; Rimal R
Source: AIDS and Behavior. 2009 Feb;13(1):133-144.
Abstract: Social capital is associated with the enactment of positive health behaviors and health outcomes because it provides people a means to cope with life's stresses. This study asked whether, and to what extent, efficacy beliefs serve as mediating mechanism in the relationship between social capital and HIV-prevention behaviors, and if it is differentially associated with HIV-prevention behaviors that are aligned on a continuum ranging from individual action (practicing monogamy) to collective action (use of HIV services). In an investigation with a sample from Gobabis, Namibia (N = 300), regression models revealed that bonding, bridging, and linking social capital differentially predicted personal and proxy efficacy. In addition, both social capital variables and types of efficacy differentially predicted HIV-related behaviors and intentions that varied in their social demand. Our findings did not support a mediation model for efficacy in between social capital and HIV-related behaviors and intentions.
Language: English
Keywords:
NAMIBIA | RESEARCH REPORT | HIV | MORBIDITY | HUMAN CAPITAL | KNOWLEDGE | PARTICIPATION | STRESS | SOCIOECONOMIC FACTORS | INFORMATION SOURCES | CONDOM USE | PRIMARY HEALTH CARE | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Human Resources | Economic Factors | Sociocultural Factors | Social Behavior | Behavior | Psychological Factors | Information | Risk Reduction Behavior | Health Services | Delivery of Health Care | Health
Document Number: 330153

28.

29.

Title: Estimates of health care system costs of unsafe abortion in Africa and Latin America.
Author: Vlassoff M; Walker D; Shearer J; Newlands D; Singh S
Source: International Perspectives on Sexual and Reproductive Health. 2009 Sep;35(3):114-121.
Abstract: Each year, 19 million unsafe abortions occur in developing countries, and an estimated five million women are treated for the resulting serious medical complications. Meanwhile, the economic impact of postabortion care on health care systems in Africa and Latin America is poorly understood (data for Asia are lacking). METHODS: Two main approaches were used to estimate the cost of postabortion care: calculating the average cost of care per patient, as represented in 20 empirical studies, and analyzing treatment costs using the WHO Mother-Baby Package model, which enumerates the costs of specific components of treatment related to postabortion complications. The average cost estimates from each approach were multiplied by the annual number of cases of hospitalization for postabortion care to generate regional cost estimates. Three methods (low severity, weighted severity, and inclusion of overhead and capital costs) were used to generate a range of per-patient and regional cost estimates. RESULTS: The average per-patient cost of postabortion care ranged from $83 in Africa to $94 in Latin America (2006 US$); estimates based on the WHO Mother-Baby Package model were between $57 and $109 per case. The health system costs of postabortion care in the two regions combined ranged from $159 million to $333 million per year. The average estimates from the two approaches were similar: $280 million and $274 million, respectively. CONCLUSIONS: The costs of treating medical complications from unsafe abortion constitute a significant financial burden on public health care systems in the developing world, and postabortion complications are a significant cause of maternal morbidity.
Spanish Abstract: Contexto: Cada año ocurren 19 millones de abortos inseguros en los países en desarrollo y se estima que cincomillones de mujeres reciben tratamiento por complicaciones médicas graves resultantes. Entretanto, es poco lo que se conoce sobre el impacto económico de la atención postaborto en los sistemas de salud en África y América Latina (en Asia no hay estudios).Métodos: Dos enfoques principales fueron utilizados para estimar el costo de la atención postaborto: calcular el costo promedio de atención por paciente, como se describe en 20 estudios empíricos; y analizar los costos de tratamiento con el modelo de PaqueteMadre-Bebé de la OMS, el cual enumera los costos de componentes específicos de tratamiento relacionados con las complicaciones postaborto. Las estimaciones de costo promedio de cada enfoque se multiplicaron por el número anual de casos de hospitalización por atención postaborto para generar estimaciones regionales de costo. Tresmétodos (severidad baja, severidad ponderada e inclusión de costos administrativos y de capital) fueron usados para generar una gama de estimaciones de costo por paciente y por región. Resultados: El costo promedio de la atención postaborto por paciente. en US dólares de 2006, varió de $83 en África a $94 en América Latina; las estimaciones basadas en el modelo de Paquete Madre-Bebé de la OMS fueron entre $57 y $109 por caso. Los costos de la atención postaborto para el sistema de salud en las dos regiones combinadas variaron entre $159 millones y $333 millones por año. Las estimaciones centrales de los dos enfoques fueron similares: $280 millones y $274 millones, respectivamente. Conclusiones: Los costos del tratamiento de las complicacionesmédicas derivadas del aborto inseguro constituyen una significativa carga financiera para los sistemas de salud pública en elmundo en desarrollo; y las complicaciones postaborto son una causa significativa de morbilidad materna.
French Abstract: Contexte: Chaque année, 19 millions d’avortements non médicalisés sont pratiqués dans lemonde en développement et on estime à cinq millions le nombre de femmes traitées pour les complications médicales graves qui en résultent. L’impact économique des soins après avortement sur les systèmes de soins de santé d’Afrique et d’Amérique latine est cependantmal compris (aucune étude n’est disponible pour l’Asie). Méthodes: Deux grandes approches ont été adoptées pour estimer le coût des soins après avortement: le calcul du coût moyen des soins par patiente, tel que représenté dans 20 études empiriques, et l’analyse des coûts de traitement selon le modèle du Dossier mère-enfant de l’OMS, qui énumère les coûts des composants spécifiques du traitement des complications de l’avortement. Les estimations de coûts moyens obtenues de chaque approche ont été multipliées par le nombre annuel de cas d’hospitalisation pour soins après avortement dans le but de produire des estimations de coûts régionales. Troisméthodes (faible gravité, gravité pondérée et inclusion des frais généraux et coûts en capital) ont été utilisées pour générer une plage d’estimations des coûts par patiente et régionaux. Résultats: Le coût moyen par patiente des soins après avortement varie entre 83 dollars en Afrique et 94 dollars en Amérique latine (en dollars américains de 2006). Les estimations basées sur le modèle du Dossier mère-enfant de l’OMS varient entre 57 et 109 dollars par cas. La charge sanitaire des soins après avortement dans les deux régions combinées varie entre 159 et 333millions de dollars par an. Les deux approches produisent des estimations centrales similaires: 280 millions et 274 millions de dollars, respectivement. Conclusions: Les coûts du traitement des complications médicales de l’avortement non médicalisé représentent une charge financière considérable pour les systèmes de soins de santé publique du monde en développement. Les complications de l’avortement représentent en outre une cause significative de morbidité maternelle.
Language: English
Keywords:
AFRICA | LATIN AMERICA | RESEARCH REPORT | WOMEN | CLIENTS | IMPACT | POSTABORTION CARE | TREATMENT | MORBIDITY | Developing Countries | Americas | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Communication | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Diseases
Document Number: 343001

30.

Peer Reviewed

Title: Morbidity in HIV-1-Infected children treated or not treated with highly active antiretroviral therapy (HAART), Abidjan, Cote d'Ivoire, 2000-04.
Author: Walenda C; Kouakoussui A; Rouet F; Wemin L; Anaky MF; Msellati P
Source: Journal of Tropical Pediatrics. 2009 Jun;55(3):170-6.
Abstract: BACKGROUND: In the 2008 UNAIDS epidemic update, 33 million people worldwide were estimated infected with HIV, including 2.2 million children. In Cote d'Ivoire, 480,000 adults and 60,000 children were HIV-infected. Studies in developed countries have shown an improvement of children's morbidity under HAART treatment. OBJECTIVE: The objective of this study is to describe and compare morbidity in relation to evolution of the disease in HIV-1-infected children in Cote d'Ivoire, according to symptoms and the presence or absence of HAART treatment. METHODOLOGY: A total of 273 HIV-1-infected children from age 18 months to 18 years were included from October 2000 until December 2003. Follow-up was continued until 30 September 2004. The study population was divided in three groups. Group 1 included symptomatic children treated under HAART. Group 2 included asymptomatic children who did not need HAART treatment. Group 3 included children who met criteria to be treated at inclusion but were not treated. PRINCIPAL FINDINGS: The three most common diseases in Group 1 before treatment were bronchitis, diarrhoea and ear nose and throat (ENT) diseases. Under treatment, the three most common diseases in Group 1 were bronchitis, ENT diseases and diarrhoea. The three most occurring diseases in Group 2 were bronchitis, ENT diseases and skin infectious diseases. The three most occurring diseases in Group 3 were bronchitis, diarrhoea and ENT diseases. CONCLUSIONS: The incidence of diseases was significantly lower among asymptomatic children than among symptomatic untreated children (p < 0.0001). The morbidity found in symptomatic children who received treatment was similar to that encountered in asymptomatic children. The main reason for death in all of the groups was tuberculosis.
Language: English
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | COHORT ANALYSIS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | MORBIDITY | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | SIGNS AND SYMPTOMS | DISEASES | INCIDENCE | MORTALITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | HIV | Measurement | Population Dynamics
Document Number: 341970


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