1.  Title: Breaking down barriers to high-quality health care for the world's most vulnerable populations. Author: JHPIEGO Source: [Baltimore, Maryland], JHPIEGO, [2009]. [2] p. Abstract: Language: English Keywords: GLOBAL | SUMMARY REPORT | VOLUNTARY HEALTH AGENCIES | QUALITY OF HEALTH CARE | OBSTACLES | PROGRAM DEVELOPMENT | ADVOCACY | EVALUATION | POLICY DEVELOPMENT | DELIVERY OF HEALTH CARE | FUNDS | Organizations | Political Factors | Sociocultural Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Communication | Planning | Health | Financial Activities | Economic Factors Document Number: 331765 |
| 2. Title: Overcoming barriers to treatment for children. Author: Population Council Source: Momentum. 2009 Jun;:[1] p. Abstract: Only 11 percent of HIV-positive children eligible for treatment in Kenya receive life-saving therapy. Through surveys, group discussions, and interviews with families and health workers, Council researchers identified barriers that prevent parents and caregivers from seeking treatment for HIV-infected children. Applying its research findings, the Council and the government of Kenya are supporting community-awareness activities to educate and assist caregivers, inform them of available services, and reduce stigma. The Council is also working with health facilities to improve counseling, support, and outreach services, and to provide Kenya's government with recommendations for improving pediatric HIV services so HIV-positive children across the country receive life-saving treatment. (Excerpts) Language: English Keywords: KENYA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | OBSTACLES | TREATMENT | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Organization and Administration | Medical Procedures | Medicine | Delivery of Health Care | Health Document Number: 331492 |
| 3. Peer Reviewed Title: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh. Author: Anwar I; Kalim N; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):139-55. Abstract: This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted. Language: English Keywords: BANGLADESH | RURAL AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | IMPLEMENTATION | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTACLES | HEALTH FACILITIES | PUBLIC SECTOR | HUMAN RESOURCES | BLOOD SUPPLY | SAFE MOTHERHOOD | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Evaluation | Program Evaluation | Macroeconomic Factors | Economic Factors | Equipment and Supplies | Medical Procedures | Maternal Health Document Number: 341937 |
| 4. Peer Reviewed Title: Financial barriers to HIV treatment in Yaounde, Cameroon: first results of a national cross-sectional survey. Author: Boyer S; Marcellin F; Ongolo-Zogo P; Abega SC; Nantchouang R; Spire B; Moatti JP Source: Bulletin of the World Health Organization. 2009 Apr;87(4):279-87. Abstract: OBJECTIVE: To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaounde, Cameroon. METHODS: Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaounde) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months. FINDINGS: Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/microl; P = 0.04). CONCLUSION: Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection. Language: English Keywords: CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | FEES | ANTIRETROVIRAL THERAPY | OBSTACLES | TREATMENT | ANTIRETROVIRAL DRUGS | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Financial Activities | Economic Factors | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation Document Number: 342978 |
5.  Title: Placing learning needs in context: distance learning for clinical officers in Tanzania. Author: Brigley S; Hosein I; Myemba I Source: Medical Teacher. 2009 Apr;31(4):e169-76. Abstract: BACKGROUND: Poor public health indicators in Tanzania have led to the upgrading of nursing and clinical personnel who currently have just core training. Clinical officers (COs) have 3 years training in basic and applied medicine and are responsible for healthcare of large and dispersed rural populations. AIMS: UNESCO-Wales has funded colleagues in Wales (UK) to assist the upgrade of COs. An inquiry into their learning needs and the Tanzanian context has produced a framework for design of a module for COs on sexually transmissible infections and HIV & AIDS by distance learning. METHODS: Face-to-face discussions were held with the Ministry of Health, healthcare workers, educators and administrators in Tanzania; a review of training documents was carried out; and a follow-up questionnaire issued to COs. RESULTS: The discussions and review highlighted teacher-centred approaches, and management, infrastructure and resources obstacles to curriculum change. Principal learning needs of COs around STIs were: counselling, syndromic management, drugs management, laboratory diagnosis, health education, resources, staffing and service morale. CONCLUSIONS: Placing learning needs in context in dialogue with Tanzanian colleagues was an advance on simple transfer of educational technologies and expertise. The inquiry resulted in a draft study guide and resources pack that were positively reviewed by Tanzanian tutors. Management and resources issues raised problems of sustainability in the module implementation. Language: English Keywords: TANZANIA | SUMMARY REPORT | HEALTH PERSONNEL | DISTANCE EDUCATION | TRAINING PROGRAMS | NEEDS | UNESCO | CURRICULUM | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | AIDS | TREATMENT | OBSTACLES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Education | Economic Factors | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Organization and Administration Document Number: 341949 |
| 6. Title: Chronic viral hepatitis may diminish the gains of HIV antiretroviral therapy in sub-Saharan Africa. Author: Cooper CL; Mills E; Wabwire BO; Ford N; Olupot-Olupot P Source: International Journal of Infectious Diseases. 2009 May;13(3):302-6. Abstract: There is a heavy burden of HIV-hepatitis B virus (HBV) and HIV-hepatitis C virus (HCV) co-infection in many regions of the developing world. An often unmentioned illness, issues of poverty, socio-economic status, nutrition, access to medical care, and mistrust of Western-style medicine conspire to reduce the opportunity to receive clinical work-up and treatment for chronic viral hepatitis. We discuss key issues specific to the treatment of viral hepatitis and obstacles to success with this endeavor in the context of HIV co-infection in Africa. We predict that provision of viral hepatitis antiviral therapy will become a more pressing issue as more HIV-infected patients receive lifesaving combination antiretroviral therapy only to succumb thereafter from viral hepatitis-induced liver disease. Given the lessons learned from combination antiretroviral rollout in sub-Saharan Africa, establishing expertise and infrastructure for viral hepatitis care and antiviral therapy is relevant. Failure to act now may diminish the milestones and the gains made with antiretroviral therapy in the developing world. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | HEPATIC EFFECTS | TOXICITY | HEPATITIS | ANTIVIRAL DRUGS | OBSTACLES | SCREENING | Africa | Developing Countries | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Drugs | Organization and Administration | Examinations and Diagnoses Document Number: 342111 |
| 7. Peer Reviewed Title: Task shifting for emergency obstetric surgery in district hospitals in Senegal. Author: De Brouwere V; Dieng T; Diadhiou M; Witter S; Denerville E Source: Reproductive Health Matters. 2009 May;17(33):32-44. Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care. Spanish Abstract: Debido a la prolongada escasez de obstetras, el Ministerio de Salud de Senegal y el Departamento Obstétrico de la Universidad de Dakar acordaron, en 1998, capacitar a equipos distritales integrados por un anestesista, un médico general y un auxiliar quirúrgico en cirugía obstétrica de emergencia. En 2006, se realizó una evaluación de la política en tres distritos, donde se examinaron las tendencias en las tasas de intervenciones obstétricas importantes, los resultados en recién nacidos y madres, y los puntos de vista de informantes clave, miembros de la comunidad y estudiantes de medicina en su último año académico. Del 2000 al 2006, 11 equipos quirúrgicos fueron capacitados, pero sólo seis funcionaban en 2006. El ritmo actual de capacitación no es suficientemente rápido para abarcar todos los distritos al cabo del 2015. Se observó un aumento en el índice de intervenciones tan pronto se establecía un equipo, pero la necesidad insatisfecha persistió. Las autoridades decisorias centrales estimaron que esta política era más viable que capacitar ginecólogos en los hospitales distritales. Entre los obstáculos figuraban la resistencia de los médicos académicos sénior, la percibida falta de ascenso profesional entre los médicos capacitados y la falta de coordinación del programa. Los médicos estimaron el trabajo valioso, pero se quejaban de la baja paga adicional y de no ser sustituidos durante la capacitación. Las comunidades estaban agradecidas porque los servicios salvaron vidas y ahorraron dinero, pero solicitaron mejor información y mayor continuidad de servicios. French Abstract: Face au manque d'obstétriciens à long terme, le Ministère sénégalais de la santé et le Département d'obstétrique de l'Université de Dakar ont convenu en 1998 de former des équipes de district composées d'un anesthésiste, d'un médecin généraliste et d'un assistant en chirurgie obstétricale d'urgence. En 2006, une évaluation de la politique a été menée dans trois districts pour analyser les tendances des principales interventions obstétricales, les résultats pour les nouveau-nés et les mères et les opinions des informateurs clés, des membres des communautés et des étudiants en dernière année de médecine. De 2001 à 2006, 11 équipes chirurgicales ont été formées mais six seulement fonctionnaient encore en 2006. Le rythme actuel de formation n'est pas assez rapide pour couvrir tous les districts d'ici à 2015. Une augmentation du taux d'interventions a été notée dès la mise en place d'une équipe, mais les besoins insatisfaits demeuraient. Pour les décideurs centraux, cette politique était plus viable que la formation de gynécologues pour les hôpitaux de district, mais elle se heurtait à la résistance des professeurs cliniciens, à un manque perçu de possibilités d'avancement pour les médecins formés et à une coordination insuffisante entre programmes. Les praticiens estimaient que le travail était utile, mais déploraient la faible rémunération complémentaire et regrettaient de ne pas être remplacés pendant la formation. Les communautés se félicitaient que les services sauvent des vies et économisent de l'argent, mais demandaient davantage d'information et une plus grande continuité des soins. Language: English Keywords: SENEGAL | RESEARCH REPORT | HEALTH PERSONNEL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | HOSPITALS | CESAREAN SECTION | TRAINING PROGRAMS | PROGRAM EVALUATION | HEALTH POLICY | OBSTACLES | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Health Services | Surgery | Treatment | Medical Procedures | Medicine | Health Facilities | Education | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors Document Number: 342013 |
| 8. Title: Sex trafficking, violence victimization, and condom use among prostituted women in Nicaragua. Author: Decker MR; Mack KP; Barrows JJ; Silverman JG Source: International Journal of Gynaecology and Obstetrics. 2009 Jul 2; Abstract: The present study concerning disempowerment-related STI/HIV vulnerabilities among prostituted women in Nicaragua identified extensive experiences of trafficking, as well as violence and powerrelated barriers to condom use. Findings strongly indicate the need for further efforts to evaluate and address these forms of disempowerment and their implications for STI/HIV risk among prostituted women in the region. Language: English Keywords: NICARAGUA | RESEARCH REPORT | SAMPLING STUDIES | SEX WORKERS | SEXUAL TRAFFICKING | VIOLENCE AGAINST WOMEN | CONDOM USE | OBSTACLES | POWER | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | Developing Countries | Central America | Latin America | Americas | Studies | Research Methodology | Sex Behavior | Behavior | Crime | Social Problems | Sociocultural Factors | Domestic Violence | Risk Reduction Behavior | Organization and Administration | Political Factors | Reproductive Tract Infections | Infections | Diseases | Viral Diseases Document Number: 341975 |
| 9. Peer Reviewed Title: HIV vaccine preparedness studies in the non-organization for economic co-operation and development (non-OECD) countries. Author: Dhalla S; Nelson KE; Singer J; Poole G Source: AIDS Care. 2009 Mar;21(3):335-48. Abstract: HIV vaccine development remains an urgent priority. Vaccine preparedness studies to assess feasibility are an important precursor to HIV vaccine trials. Studies such as these have taken place in many non-Organization for Economic Co-operation and Development (non-OECD) countries using diverse cohorts. This article is a systematic review of retention rates and willingness to participate (WTP) in HIV vaccine trials. Studies took place in Brazil, the Democratic Republic of Congo, Haiti, India, Russia, Thailand, and several sub-Saharan African countries. Studies generally reported recruitment of high-risk individuals. Of 33 studies we identified, retention was assessed in 16 studies, and the 12-month retention ranged from 77 to 85%. Willingness to participate was assessed in 21 studies. Willingness to participate ranged from 23 to 100%, and increased knowledge was associated with an increased WTP. Vaccine preparedness studies have taken place using diverse cohorts in the non-OECD countries. In general, retention rates and WTP have been adequate to conduct HIV vaccine trials. Educational programs to improve knowledge about HIV vaccines may contribute to better follow-up and an increased WTP in these countries. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL TRIALS | RESEARCH ACTIVITIES | HIV PREVENTION | VACCINES | EPIDEMIOLOGY | PARTICIPATION | MOTIVATION | OBSTACLES | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Public Health | Social Behavior | Behavior | Psychological Factors | Organization and Administration Document Number: 341856 |
| 10. Title: Guatemala: Using supply chain modeling and simulation to analyze the Ministry of Health supply chain. Author: Gibney J; Sanchez A; Lamadrid C Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Mar. 38 p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: This activity analyzed the characteristics of the integrated logistics system in three departments in Guatemala: Sololá, Totonicapán, and Jutiapa. This paper identifies some of the obstacles to achieving contraceptive availability for the underserved and vulnerable populations; it also offers options for improving equity in access for family planning commodities. The study identifies elements in the Ministry of Public Health and Social Welfare’s (MSPAS) logistics system that could impede the availability and accessibility of contraceptives. By using supply chain simulation and optimization modeling software, with geographic information system tools, the authors propose system-related solutions that could improve the performance of the overall MSPAS. Language: English Keywords: GUATEMALA | RECOMMENDATIONS | GOVERNMENT AGENCIES | LOGISTICS | HEALTH SERVICES EVALUATION | CONTRACEPTIVE AVAILABILITY | OBSTACLES | NEEDS | CONTRACEPTIVE DISTRIBUTION | PERFORMANCE IMPROVEMENT | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | TRANSPORTATION | Central America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Evaluation | Programs | Contraception | Family Planning | Economic Factors | Distributional Activities | Program Activities | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information Document Number: 331663 |
| 11. Title: Early treatment of HIV: implications for resource-limited settings. Author: Hobbs CV; Essajee SM Source: Current Opinion In HIV and AIDS. 2009 May;4(3):222-31. Abstract: PURPOSE OF REVIEW: We review the current literature supporting adoption of higher CD4 thresholds for initiation of antiretroviral treatment and survey progress in adoption of early treatment policies in resource-limited settings. We highlight some of the challenges and opportunities implementation of early treatment will bring. RECENT FINDINGS: The initial success of combination antiretroviral treatment resulted in the recommendation to treat early all individuals with HIV. However, the gradual realization that antiretroviral treatment was associated with toxicity led to a more tempered approach. Recent cohort studies and some clinical trials have shown that delaying treatment is associated with increased morbidity and mortality. SUMMARY: Early treatment is routinely practiced in developed countries. Now, early treatment is being adopted as a strategy in many resource-limited settings. The implications of this policy shift are not known, but we predict early treatment will have important consequences for the health system, the individual, and the community. Whereas these consequences will bring significant challenges, the increased numbers of HIV-infected individuals on treatment will result in many new opportunities - antiretroviral treatment will become less expensive, systems to deliver chronic care will be strengthened, and the policy shift will focus greater attention on pregnant women and children. Finally, some authors postulate that early treatment may impact HIV transmission. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | HIV INFECTIONS | AIDS | ANTIRETROVIRAL THERAPY | IMPLEMENTATION | OBSTACLES | TIME FACTORS | MORTALITY | IMMUNOLOGICAL EFFECTS | HEALTH POLICY | WHO | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Policy | Political Factors | Sociocultural Factors | UN | International Agencies | Organizations Document Number: 342344 |
| 12. Peer Reviewed Title: Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. Author: Iyengar K; Iyengar SD; Suhalka V; Dashora K Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):293-302. Abstract: In 2002-2003, all deaths (n=156) of women aged 15-49 years in a block of southern Rajasthan were investigated to determine the cause of death and care-seeking behaviour. Family members of 156 (98%) of 160 deceased women were interviewed following the comprehensive listing of all deaths among women of reproductive age. Of the 156 deaths, 31 (20%) were pregnancy-related; 77% of these women died during the postpartum period, and 74% of the deaths occurred in the home. Direct and indirect obstetric causes were responsible for 58% and 29% of the deaths respectively; 12% were injury-related deaths. Medical care was sought for 65% of the women, and 29% were hospitalized. Family perception of not being able to afford treatment at distant hospitals was a major barrier to seeking care, and 60% of those who sought care had to borrow money for treatment. Lack of skilled attendance and immediate postpartum care were major factors contributing to deaths. Improved access to emergency obstetric care facilities in rural areas and steps to eliminate costs at public hospitals would be crucial to prevent pregnancy-related deaths. Language: English Keywords: INDIA | RURAL AREAS | RESEARCH REPORT | CASE HISTORIES | LOW LITERATES | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | AUTOPSY | CAUSES OF DEATH | RURAL HEALTH SERVICES | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | OBSTACLES | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Data Collection | Research Methodology | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Organization and Administration Document Number: 341928 |
| 13. Peer Reviewed Title: The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya. Author: Izugbara C; Ezeh A; Fotso JC Source: Health Policy and Planning. 2009 Jan;24(1):36-45. Abstract: Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants' (TBAs) accounts of the persistence of homebirths and the key challenges they present. TBAs associated the continued demand for homebirths with the wide-ranging character and quality of their services. They did not consider their lack of formal training on matters of pregnancy and birthing to be a particular challenge to their work. Rather, they identified the non-cooperative and disrespectful attitudes of their counterparts in hospital settings as the most important issue. Further efforts are needed to make TBAs realize how much better their services could become if they adopted more modern ways of assisting in deliveries, unlearnt their belief in the superiority of their particular type of practice, and understood how their lack of formal training is a key issue. Language: English Keywords: KENYA | RESEARCH REPORT | FOCUS GROUPS | TRADITIONAL BIRTH ATTENDANTS | CHILDBIRTH | OBSTACLES | QUALITY OF HEALTH CARE | MATERNAL HEALTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Organization and Administration | Health Services Evaluation | Program Evaluation | Programs Document Number: 330475 |
| 14. Peer Reviewed Title: Breastfeeding knowledge and practices amongst mothers in a rural population of North India: a community-based study. Author: Kishore MS; Kumar P; Aggarwal AK Source: Journal of Tropical Pediatrics. 2009 Jun;55(3):183-8. Abstract: BACKGROUND: National family health survey-3 of India has revealed startling lower exclusive breastfeeding (EBF) rates (16.9%) in the state of Haryana compared with national data (46%). The barriers to breastfeeding in this population are not clearly known. Therefore, a study was conducted in a rural population of the state to study their breastfeeding practices, knowledge regarding usefulness of breastfeeding and factors influencing the breastfeeding practices. METHODS: In six villages of Panchkula district of Haryana, all the mothers of infants between 0-6 months were interviewed using a pretested semi-structured questionnaire. Time at initiation of breastfeeding, duration of EBF and their understanding about the usefulness of breastfeeding were assessed. Position of the baby during breastfeeding and attachment of the baby's mouth to the breast were assessed by direct observation while feeding. Breastfeeding knowledge of the mother was evaluated. RESULTS: Out of the 77 mothers, 30% and 10% exclusively breastfed their infants till 4 and 6 months of age, respectively. There was 'good attachment' in 42% mother-infant pairs and infants were held in 'correct position' by 60% mothers. Thirty-nine percent of the mothers had 'satisfactory' breastfeeding knowledge. On multivariate logistic regression analysis, lack of breastfeeding counseling was significantly associated with decreased rates of EBF at 4 months and 6 months (p-value 0.01 and 0.002, respectively) and 'full' breastfeeding (FBF) at 6 months of age (p-value 0.002). CONCLUSIONS: EBF/FBF practices and breastfeeding knowledge are suboptimal among the rural North Indian mothers. Breastfeeding counseling with emphasis on correct technique can improve the EBF/FBF rates. Language: English Keywords: INDIA | RESEARCH REPORT | SAMPLING STUDIES | RURAL POPULATION | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | KNOWLEDGE | OBSTACLES | LITERACY | COUNSELING | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Organization and Administration | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Clinic Activities | Program Activities | Programs Document Number: 341968 |
| 15. Title: Innovative pediatric palliative care programs in four countries. Author: Knapp C; Madden V; Marston J; Midson R; Murphy A; Shenkman E Source: Journal of Palliative Care. 2009 Summer;25(2):132-6. Abstract: Over the past three decades, pediatric palliative care programs have been developed and refined throughout the world. The purpose of this study was to provide information on experiences from four of those programs, yet we acknowledge that there are many other innovative programs that deserve recognition for the services they provide to children and families. This study is limited in that it is unable to compare outcomes from the four programs, such as patient-reported quality of life, that might help to better understand the impact of pediatric palliative care. Nonetheless, information sharing can inspire and educate others with the overarching goal of globally advancing pediatric palliative care. Language: English Keywords: AUSTRALIA | SOUTH AFRICA | UNITED KINGDOM | UNITED STATES OF AMERICA | SUMMARY REPORT | CHILD HEALTH SERVICES | CARE AND SUPPORT | DELIVERY OF HEALTH CARE | IMPLEMENTATION | PROGRAM DESIGN | OBSTACLES | COUNSELING | REFERRAL AND CONSULTATION | FUNDS | Oceania | Developed Countries | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Europe, Western | Europe | North America | Americas | Maternal-Child Health Services | Primary Health Care | Health Services | Health | Programs | Organization and Administration | Clinic Activities | Program Activities | Financial Activities | Economic Factors Document Number: 342874 |
| 16. Title: Emergency contraception: Knowledge, attitude and prescription practice among doctors in different specialties in Hong Kong. Author: Lo SS; Kok WM; Fan SY Source: Journal of Obstetrics and Gynaecology Research. 2009 Aug;35(4):767-74. Abstract: Aim: Few studies have evaluated doctors' knowledge, attitudes and practices as regards emergency contraception (EC). Some studies have reported inadequate knowledge, bias and wrong prescriptions by doctors. This article compares the prescription pattern, attitude and knowledge of EC in Hong Kong doctors in different specialties. Methods: Questionnaires were mailed to family physicians, obstetrician-gynecologists and doctors working in family planning clinics to ascertain their attitudes to EC. Those who provided EC described the types of EC used, whether drugs were given in advance and answered a 12-question knowledge test. Those who did not provide EC stated why. Results: A total of 443 completed questionnaires were analyzed: 70.9% of doctors agreed that the benefits of EC outweigh its risks and 61.2% agreed that doctors should discuss it with clients. Advanced provision was supported by 54.2% of doctors but reduced to 32.5% if the target client was a girl aged 16 or below. Even fewer doctors (40.2%) supported the over-the-counter sales of EC pills. In the knowledge test, family planning doctors scored 10.45 out of 12 and obstetrician-gynecologists in private practice had the lowest score of 6.08. Family planning doctors used levonorgestrel pills while private family physicians and obstetrician-gynecologists used Yuzpe. Among 352 doctors who provided EC, only 21.7% of private family physicians and 15.9% of private obstetrician-gynecologists prescribed it in advance. Conclusions: Only doctors working in family planning clinics were competent in their knowledge of emergency contraception and up to date with current practice. Although half of the doctors supported advanced provision, few implemented it. Most doctors did not support advanced provision to young girls nor the over-the-counter sales of EC pills. Language: English Keywords: HONG KONG | RESEARCH REPORT | KAP SURVEYS | PHYSICIANS | EMERGENCY CONTRACEPTION | PRESCRIPTIONS | CONTRACEPTIVE DISTRIBUTION | OBSTACLES | LEVONORGESTREL | ETHINYL ESTRADIOL | IUD | QUESTIONNAIRES | AGE FACTORS | Developed Countries | Asia, Eastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Family Planning | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Contraceptive Methods | Population Characteristics | Demographic Factors | Population Document Number: 342776 |
| 17. Title: Katine's HIV patients face transport hurdle to access drugs. Author: Malinga J Source: Guardian. 2009 Apr 28;:[1] p. Abstract: A case study from the Katine parish in Uganda where the challenge of accessing antiretroviral drugs is exacerbated by abject poverty in the region. The article highlights the needs of the community members with HIV / AIDS in the region and the response of AMREF (the NGO working in the region) to addressing these issues. Language: English Keywords: UGANDA | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | OBSTACLES | TREATMENT | POVERTY | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | HIV | Behavior | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors | Program Evaluation | Programs Document Number: 331359 |
| 18. Peer Reviewed Title: Barriers and facilitators to maternal communication with preadolescents about age-relevant sexual topics. Author: Miller KS; Fasula AM; Dittus P; Wiegand RE; Wyckoff SC; McNair L Source: AIDS and Behavior. 2009 Apr;13(2):365-74. Abstract: The present study examined factors that promote parent-child discussions about sex topics. A sample of 1,066 dyads of African American mothers and their 9-12-year-old children participated completing computer-administered surveys. After controlling for all other covariates, mother's sexual communication responsiveness (i.e., knowledge, comfort, skills, and confidence) was the most consistent predictor of discussions. Mothers with higher responsiveness had significantly increased odds of discussions about abstinence, puberty, and reproduction, based on both mother and child reports. In addition, child's age, pubertal development, readiness to learn about sex, and being female were positively associated with an increase in the odds of discussions in most models. Findings indicate that encouraging parents to talk with their children early may not be sufficient to promote parent-child sex discussions. Parents also need the knowledge, comfort, skills, and confidence to communicate effectively and keep them from avoiding these often difficult and emotional conversations with their children. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | BLACKS | MOTHERS | CHILDREN | SEXUALITY | INTERPERSONAL COMMUNICATION | OBSTACLES | SEX EDUCATION | PARENTAL INVOLVEMENT | ATTITUDES | SEX FACTORS | Developed Countries | North America | Americas | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Personality | Psychological Factors | Behavior | Communication | Organization and Administration | Education | Child Rearing Document Number: 342862 |
| 19. Title: Readiness of youth in rural Ethiopia to seek health services for sexually transmitted infections. Author: Molla M; Emmelin M; Berhane Y; Lindtjorn B Source: African Journal of AIDS Research. 2009;8(2):135-146. Abstract: The authors performed a cross-sectional survey among 3,743 randomly selected youths ages 15–24 years in 2004, and in-depth interviews with 10 health care providers in 2006. Less than 38% of the youths knew the common STIs. Among the sexually active youths (n = 802), 3.9% reported having at least one STI symptom in the past 12 months, and half of those who had had an STI symptom did not seek care from any source. The healthcare providers reported that the stigma associated with premarital sexual activity, the shamefulness of having an STI, and a perceived lack of confidentiality and uneasiness with the public health services were impediments to treatment-seeking in the study area. The youths in this study preferred to consult with health care providers of the same gender who were young, friendly, and had a reputation for being empathetic. Embarrassment about having an STI and fear of being noticed by a familiar individual were perceived barriers to seeking healthcare. The results suggest that young people are vulnerable to HIV exposure due to lack of knowledge about STIs and especially as a result of having an untreated STI. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | YOUTH | PROVIDERS WITH CLIENTS | SEXUALLY TRANSMITTED DISEASES | UTILIZATION OF HEALTH CARE | OBSTACLES | KNOWLEDGE | PERCEPTION | STIGMA | FEAR | CONFIDENTIAL INFORMATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Diseases | Organization and Administration | Sociocultural Factors | Psychological Factors | Behavior | Social Problems | Emotions | Ethics Document Number: 339894 |
| 20. Title: Update on successes and challenges regarding mother-to-child transmission of HIV. Author: Paintsil E; Andiman WA Source: Current Opinion In Pediatrics. 2009 Feb;21(1):94-101. Abstract: PURPOSE OF REVIEW: There is an unprecedented global commitment to reverse the pediatric HIV epidemic by making prevention of mother-to-child transmission (PMTCT) services accessible in all countries. This review outlines the successes made and the challenges that remain. RECENT FINDINGS: In resource-rich countries, mother-to-child transmission rates of HIV as low as 1% have been achieved. The efficacy of short-course antiretrovirals for PMTCT in Africa is estimated at 50%. Coinfections with herpes simplex virus type 2, other sexually transmitted infections resulting in genital ulcers, and endemic infectious diseases (e.g., malaria) may increase the risk of mother-to-child transmission of HIV. Vertical transmission of drug-resistant viruses has been reported; the prevalence and effect of transmitted resistant virus on treatment outcomes are under investigation. Obstacles facing PMTCT in resource-limited countries include the lack of healthcare infrastructure, limited manpower, and competing public health priorities with the limited healthcare budget. SUMMARY: Although the birth of an HIV-infected child in a resource-rich country is now a sentinel health event, in most resource-limited countries the birth of an HIV-infected child continues to be the status quo. Comprehensive PMTCT, including antiretroviral treatment for HIV-infected women and children, should be paramount in resource-limited countries. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | MOTHERS | INFANT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | HIV PREVENTION | TREATMENT | OBSTACLES | Developed Countries | North America | Americas | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Organization and Administration Document Number: 341550 |
| 21. Peer Reviewed Title: The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal. Author: Powell-Jackson T; Morrison J; Tiwari S; Neupane BD; Costello AM Source: BMC Health Services Research. 2009;9:97. Abstract: BACKGROUND: Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake. METHODS: We conducted in ten study districts a series of key informant interviews and focus group discussions with staff from health facilities and the district health office and other stakeholders involved in implementation. Manual content analysis was used to categorise data under emerging themes. RESULTS: Problems at the central level imposed severe constraints on the ability of district-level actors to implement the programme. These included bureaucratic delays in the disbursement of funds, difficulties in communicating the policy, both to implementers and the wider public and the complexity of the programme's design. However, some district implementers were able to cope with these problems, providing reasons for why uptake of the programme varied considerably between districts. Actions appeared to be influenced by the pressure to meet local needs, as well individual perceptions and acceptance of the programme. The experience also sheds light on some of the adverse effects of the programme on the wider health system. CONCLUSION: The success of conditional cash transfer programmes in Latin America has led to a wave of enthusiasm for their adoption in other parts of the world. However, context matters and proponents of similar programmes in south Asia should give due attention to the challenges to implementation when capacity is weak and health services inadequate. Language: English Keywords: NEPAL | LATIN AMERICA | RESEARCH REPORT | FOCUS GROUPS | CHILDBIRTH | HEALTH SERVICES | OBSTACLES | ORGANIZATION AND ADMINISTRATION | HEALTH POLICY | IMPLEMENTATION | Developing Countries | Asia, Southern | Asia | Americas | Data Collection | Research Methodology | Pregnancy Outcomes | Pregnancy | Reproduction | Delivery of Health Care | Health | Policy | Political Factors | Sociocultural Factors | Programs Document Number: 342432 |
| 22. Title: Making family planning accessible in resource-poor settings. Author: Prata N Source: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 2009 Oct 27;364(1532):3093-9. Abstract: It is imperative to make family planning more accessible in low resource settings. The poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet need for contraception. It is also in the low resource settings where maternal and child mortality is the highest. Family planning can contribute to improvements in maternal and child health, especially in low resource settings where overall access to health services is limited. Four critical steps should be taken to increase access to family planning in resource-poor settings: (i) increase knowledge about the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (iii) ensure supply of contraceptives by making family planning a permanent line item in healthcare system's budgets and (iv) take immediate action to remove barriers hindering access to family planning methods. In Africa, there are more women with an unmet need for family planning than women currently using modern methods. Making family planning accessible in low resource settings will help decrease the existing inequities in achieving desired fertility at individual and country level. In addition, it could help slow population growth within a human rights framework. The United Nations Population Division projections for the year 2050 vary between a high of 10.6 and a low of 7.4 billion. Given that most of the growth is expected to come from today's resource-poor settings, easy access to family planning could make a difference of billions in the world in 2050. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | FAMILY PLANNING PROGRAMS | PROGRAM ACCESSIBILITY | NEEDS | OBSTACLES | POVERTY | INEQUALITIES | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | POPULATION GROWTH | MATERNAL MORTALITY | Family Planning | Program Evaluation | Programs | Organization and Administration | Economic Factors | Socioeconomic Factors | Contraceptive Usage | Contraception | Population Dynamics | Demographic Factors | Population | Mortality Document Number: 342846 |
| 23. Title: Foot soldiers of global health: teaching and preaching AIDS science and modern medicine on the frontline. Author: Robins S Source: Medical Anthropology. 2009 Jan-Mar;28(1):81-107. Abstract: This article investigates the ways in which global health messages and forms of health citizenship are mediated by AIDS activists in rural South Africa. It focuses on how these activists and treatment literacy practitioners are not only concerned with changing the lives of people living with AIDS to better manage biological conditions associated with their seropositive status, but also with how they are also committed to recruiting new members into their biopolitical projects and epistemic communities. These mobilization processes involve translating and mediating biomedical ideas and practices into vernacular forms that can be easily understood and acted on by the "targets" of these recruitment strategies. However, these processes of "vernacularization" of biomedical knowledge often occur in settings where even the most basic scientific understandings and framings of medicine cannot be taken for granted. This ethnographic case study shows that global health programs and their local mediators often encounter "friction" from the most powerful national actors as well as the most marginalized local ones. Language: English Keywords: SOUTH AFRICA | RURAL AREAS | CRITIQUE | CASE STUDIES | NONGOVERNMENTAL ORGANIZATIONS | GOVERNMENT OFFICIALS | HIV INFECTIONS | AIDS | ANTIRETROVIRAL THERAPY | IMPLEMENTATION | ADVOCACY | MESSAGE DEVELOPMENT | OBSTACLES | POLITICAL FACTORS | BELIEFS | TRADITIONAL MEDICINE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Studies | Research Methodology | Organizations | Sociocultural Factors | Administrative Personnel | Organization and Administration | Viral Diseases | Diseases | HIV | Programs | Communication | Culture | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342376 |
| 24. Title: 2004-09. The Guyana HIV / AIDS Reduction and Prevention Project. GHARP. Author: Russell H Source: Arlington, Virginia, Family Health International [FHI], 2009. 54 p. (USAID Contract No. 504-C-00-04-00109-00) Abstract: This report outlines the major activities and achievements of the Guyana HIV / AIDS Reduction and Prevention (GHARP) Project (2004-09). A joint project of the Government of Guyana and the US Government, GHARP was funded by PEPFAR through USAID and implemented by Family Health International, Cicatelli Associates Inc., Howard Delafield International, Management Sciences for Health, and The Caribbean Conference of Churches. Language: English Keywords: GUYANA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | MOTHERS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | AIDS PREVENTION | IMPACT | OBSTACLES | PROGRAM EVALUATION | Developing Countries | South America, Northern | South America | Latin America | Americas | Family and Household | Sociocultural Factors | Parents | Family Relationships | Family Characteristics | Disease Transmission Control | Prevention and Control | Diseases | Viral Diseases | AIDS | Communication | Organization and Administration | Programs Document Number: 331504 |
| 25. Peer Reviewed Title: Barriers to adolescents' getting emergency contraception through pharmacy access in California: differences by language and region. Author: Sampson O; Navarro SK; Khan A; Hearst N; Raine TR; Gold M; Miller S; de Bocanegra HT Source: Perspectives On Sexual and Reproductive Health. 2009 Jun;41(2):110-8. Abstract: CONTEXT: In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas. METHODS: In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified. RESULTS: Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents. CONCLUSIONS: Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | ADOLESCENTS | HISPANICS | LANGUAGE | EMERGENCY CONTRACEPTION | OBSTACLES | PHARMACY DISTRIBUTION | PROGRAM ACCESSIBILITY | Developed Countries | North America | Americas | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Ethnic Groups | Cultural Background | Communication | Contraception | Family Planning | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Program Evaluation Document Number: 341529 |
| 26. Peer Reviewed Title: Improving control of African schistosomiasis: towards effective use of rapid diagnostic tests within an appropriate disease surveillance model. Author: Stothard JR Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Apr;103(4):325-32. Abstract: Contemporary control of schistosomiasis is typically reliant upon large-scale administration of praziquantel (PZQ) to school age children. Whilst PZQ treatment of each child is inexpensive, the direct and indirect costs of preventive chemotherapy for the whole school population are more substantive and, at the national level where many schools are targeted, maximising cost effectiveness and the health impact are essential requirements for ensuring longer-term sustainability (i.e. >5 years). To this end, the WHO has issued a set of treatment guidelines, inclusive of re-treatment schedules, such that, where possible, treatment decisions by school are based upon local disease prevalence as determined by parasitological and/or questionnaire methods. As each diagnostic method has known shortcomings, presumptive treatment of at-risk schools may initially be preferred, especially if the existing infrastructure for disease surveillance is poor. It is against this background of school-based preventive chemotherapy that a rapid diagnostic test (RDT) for schistosomiasis is most urgently needed, not only to improve initial disease surveillance but also to focus drug delivery better through time. In this paper, the development, evaluation and application of selected diagnostic tests are reviewed to identify barriers that impede progress, foremost of which is that a new disease surveillance and evaluation model is required where the in-country price of each RDT ideally needs to be less than US$1 to be cost effective both in the short- and long-term perspective. Language: English Keywords: AFRICA, SUB SAHARAN | TECHNICAL REPORT | SCHISTOSOMIASIS | PREVENTION AND CONTROL | DRUGS | COST EFFECTIVENESS | PREVALENCE | EXAMINATIONS AND DIAGNOSES | ANTIGENS | WHO | OBSTACLES | Africa | Developing Countries | Parasitic Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation Indexes | Quantitative Evaluation | Evaluation | Measurement | Research Methodology | Immunologic Factors | Immunity | Immune System | Physiology | Biology | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Organization and Administration Document Number: 342377 |
| 27. Peer Reviewed Title: Male involvement in PMTCT services in Mbeya Region, Tanzania. Author: Theuring S; Mbezi P; Luvanda H; Jordan-Harder B; Kunz A; Harms G Source: AIDS and Behavior. 2009 Jun;13(Suppl 1):S92-S102. Abstract: Throughout all stages of programmes for the prevention of mother-to-child-transmission of HIV (PMTCT), high dropout rates are common. Increased male involvement and couples' joint HIV counselling/testing during antenatal care (ANC) seem crucial for improving PMTCT outcomes. Our study assessed male attitudes regarding partner involvement into ANC/PMTCT services in Mbeya Region, Tanzania, conducting 124 individual interviews and six focus group discussions. Almost all respondents generally supported PMTCT interventions. Mentioned barriers to ANC/PMTCT attendance included lacking information/knowledge, no time, neglected importance, the services representing a female responsibility, or fear of HIV-test results. Only few perceived couple HIV counselling/testing as disadvantageous. Among fathers who had refused previous ANC/PMTCT attendance, most had done so even though they were not perceiving a disadvantage about couple counselling/testing. The contradiction between men's beneficial attitudes towards their involvement and low participation rates suggests that external barriers play a large role in this decision-making process and that partner's needs should be more specifically addressed in ANC/PMTCT services. Language: English Keywords: TANZANIA | RESEARCH REPORT | FOCUS GROUPS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTENATAL CARE | MEN'S INVOLVEMENT | PARTICIPATION | ATTITUDES | UTILIZATION OF HEALTH CARE | VOLUNTARY COUNSELING AND TESTING | OBSTACLES | INTERVIEWS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Disease Transmission Control | Prevention and Control | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Social Behavior | Behavior | Psychological Factors | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 341905 |
| 28. Peer Reviewed Title: The International Classification of Function Disability and Health (ICF) in adults visiting the HIV outpatient clinic at a regional hospital in Johannesburg, South Africa. Author: Van As M; Myezwa H; Stewart A; Maleka D; Musenge E Source: AIDS Care. 2009 Jan;21(1):50-8. Abstract: In 2005, 16.6% of South Africans between 15 and 49 years of age were HIV positive. The advent of anti-retroviral therapy has led to improved longevity, CD4 counts and clinical well-being of people living with HIV/AIDS (PLWHA). Physical impairments, activity limitations and participation restrictions of PLWHA have profound effects on the Health-related Quality of Life and functional abilities of those with the disease, and understanding thereof may assist in the formulation of rehabilitation protocols, health care interventions as well as vocational and legislative policies. The International Classification of Function, Disability and Health (ICF) is a standardised tool, endorsed by the World Health Assembly for international use, which aims to classify functioning and disability. It is structured to assess body functions and structure, functional activities and associated personal and environmental factors.This study aimed to develop a profile of the level of functional activity, using the ICF Checklist, of an urban cohort of 45 South African individuals who are HIV positive attending an outpatient clinic at the Helen Joseph Memorial Hospital, Gauteng, South Africa. The results showed a high prevalence of physical impairments, participation restrictions and selective activity limitations and that environmental factors influence their level of ability. Specific impairments where patients had problems were mental functions (69% (n=31), sensory and pain -- 71% (n=32), digestive and metabolic functions 45% (n=20) and neuromuscular 27% (n=12). Activity limitations included major life areas' 58% (n=26), interpersonal relationships 56% (n=25), mobility 40% (n=18) and general tasks and demands 38% (n=17). Limitations in mobility were significantly associated with problems of sensory functions (p=0.05), pain (p=0.006), neuromusculoskeletal and movement-related functions (p=0.006), muscle power (p=0.006) as well as energy and drive functions (p=0.001). The study identifies the level of function and ability of PLWHA, clinical markers, and how these affect the physical, psychological and social functioning of this population. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | SOCIAL BEHAVIOR | OBSTACLES | INTERPERSONAL RELATIONS | PSYCHOLOGICAL FACTORS | QUALITY OF LIFE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | Behavior | Organization and Administration | Social Welfare | Economic Factors Document Number: 331212 |
| 29. Title: The global fight against HIV/AIDS, tuberculosis, and malaria: current status and future perspectives. Author: Vitoria M; Granich R; Gilks CF; Gunneberg C; Hosseini M; Were W; Raviglione M; De Cock KM Source: American Journal of Clinical Pathology. 2009 Jun;131(6):844-8. Abstract: HIV/AIDS, tuberculosis, and malaria are 3 major global public health threats and cause substantial morbidity, mortality, negative socioeconomic impact, and human suffering. Despite the significant increase in financial support and recent progress in addressing these 3 diseases, important obstacles and unmet priorities remain. Disease-specific interventions have had a considerable impact on improving health systems. However, despite considerable investment, weak health systems, inadequate human resources, and poor laboratory infrastructure continue to be major obstacles to expanding health services. Health system strengthening should be addressed in an integrated approach that includes HIV-, tuberculosis-, and malaria-specific interventions. Investment in strategic information and public health laboratory network capacity strengthening are key actions to expand services to successfully address those diseases in heavily impacted countries. Language: English Keywords: GLOBAL | CRITIQUE | AIDS | HIV INFECTIONS | TUBERCULOSIS | MALARIA | INTERNATIONAL COOPERATION | FOREIGN AID | INTERVENTIONS | GOALS | OBSTACLES | HUMAN RESOURCES | Viral Diseases | Diseases | Infections | Parasitic Diseases | Political Factors | Sociocultural Factors | Financial Activities | Economic Factors | Programs | Organization and Administration | Planning Document Number: 341769 |
| 30. Title: "Tell me so I know you understand": pharmacists' verification of patients' comprehension of antiretroviral dosage instructions in a cross-cultural context. Author: Watermeyer J; Penn C Source: Patient Education and Counseling. 2009 May;75(2):205-13. Abstract: OBJECTIVE: Patient comprehension of dosage instructions is an essential condition for adherence to treatment regimens, but previous studies show that pharmacists do not generally check understanding. This study aims to describe and discuss the effectiveness of various strategies for verifying patients' understanding of ARV dosage instructions in a cross-cultural context. METHODS: Twenty-six cross-cultural pharmacist-patient interactions in an ARV pharmacy in South Africa were analysed using Conversation Analysis techniques. Interviews with participants were analysed using Thematic Content Analysis. RESULTS: Various strategies for verifying patient understanding were identified in the data, including eliciting a demonstration of understanding, using specific questions to verify understanding, using response solicitations and monitoring patients' verbal and non-verbal responses. These strategies are illustrated with relevant data extracts. Interviews revealed that patients appeared to have good understanding of ARV-related concepts. CONCLUSION: These strategies for verification of patient understanding appear to be effective tools which enable pharmacists to identify misunderstandings or initiate clarification sequences. PRACTICE IMPLICATIONS: The strategies are felt to be particularly useful in cross-linguistic pharmacy interactions and have implications for other professionals. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PHARMACISTS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | INTERPERSONAL COMMUNICATION | OBSTACLES | CULTURE | LANGUAGE | USER COMPLIANCE | MONITORING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Health Personnel | Delivery of Health Care | Health | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Drugs | Communication | Organization and Administration | Sociocultural Factors | Behavior | Evaluation Document Number: 342197 |
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