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2.
Title: Plan B for 17-year olds.
Source: Medical Letter On Drugs and Therapeutics. 2009 May 18;51(1312):40.
Abstract: The FDA has announced that it will lower the age for over-the-counter access to the emergency contraceptive Plan B from 18 to 17 years old. In a randomized, controlled trial, the two 0.75-mg levonorgestrel tablets in Plan B, taken 12 hours apart beginning within 72 hours after unprotected intercourse, decreased the overall pregnancy rate to 1.1% (11/976) of women who requested emergency contraception. The sooner the drug is taken after coitus, the more effective it is. Nausea and vomiting can occur with Plan B. Fetal malformations have not been associated with pregnancies that occurred despite use of levonorgestrel-only emergency contraception. (full-text)
Language: English
Keywords:
UNITED STATES OF AMERICA | USFDA | ADOLESCENTS | EMERGENCY CONTRACEPTION | ADMINISTRATION AND DOSAGE | PROGRAM ACCESSIBILITY | Developed Countries | North America | Americas | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration
Document Number: 341625

Peer Reviewed

Title: ACOG Committee Opinion No. 427: Misoprostol for postabortion care.
Author: American College of Obstetricians and Gynecologists
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):465-8.
Abstract: The World Health Organization estimates that 67,000 women, mostly in developing countries, die each year from untreated or inadequately treated abortion complications. Postabortion care, a term commonly used by the international reproductive health community, refers to a specific set of services for women experiencing problems from all types of spontaneous or induced abortion. There is increasing evidence that misoprostol is a safe, effective, and acceptable method to achieve uterine evacuation for women needing postabortion care. To reduce maternal mortality, availability of postabortion care services must be increased. Misoprostol must be readily available especially for women who do not otherwise have access to postabortion care. Nurses and midwives can safely provide first-line postabortion care services, including in outpatient settings,provided they receive appropriate training and support. Access to contraception and safe abortion services prevents complications from unsafe abortion and decreases the need for postabortion care. It is much less expensive and far better for women's health to prevent the problem of unsafe abortion rather than to treat resulting complications.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | WOMEN | ABORTION | ABORTION, SPONTANEOUS | POSTABORTION CARE | MISOPROSTOL | HEALTH SERVICES | REPRODUCTIVE HEALTH | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | NEEDS ASSESSMENT | PROGRAM ACCESSIBILITY | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Mortality | Population Dynamics | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341050

Title: Creating healthy families in Nepal: sustaining family planning practices among marginalized groups.
Author: CORE Group
Source: CORE Group, Washington, D.C., 2009 Mar.
Abstract: This case study documents the sustainable activities and interventions of a USAID Flexible Fund Program, Valued Behavior for Healthy Families-A Model for Social Inclusion, that was implemented by the Johns Hopkins Bloomberg School of Public Health, Center for Communications Programs through Save the Children/US in Nepal. Sustainable activities are defined here as those activities or practices that have been continued or improved after the project ended. The Valued Behavior project aimed to help women and couples from disadvantaged groups in Nepal realize their reproductive intentions through: a) increased knowledge and interest in family planning services through NGO involvement; b) improved quality of family planning (FP) services delivered by providers in selected facilities and the community; c) increased community access to FP services; and d) improved social and policy environment for FP and reproductive health services and behavior.
Language: English
Keywords:
NEPAL | SUMMARY REPORT | KNOWLEDGE | FAMILY PLANNING | SOCIAL DEVELOPMENT | POLICY | PROGRAM ACCESSIBILITY | PROGRAM ACTIVITIES | Developing Countries | Asia, Southern | Asia | Sociocultural Factors | Economic Factors | Political Factors | Program Evaluation | Programs | Organization and Administration
Document Number: 328782

Title: Expanding access to injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] [2009]. 12 p.
Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt)
Language: English
Keywords:
GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 331838

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

10.

Title: A strategic approach: HIV & AIDS and education.
Author: UNAIDS. Inter-Agency Task Team on Education
Source: Paris, France, UNESCO, 2009 May. 53 p. Also available: http://unesdoc.unesco.org/images/0016/001627/162723f.pdf (French) and http://unesdoc.unesco.org/images/0016/001627/162723s.pdf (Spanish).
Abstract: This publication provides a strategic vision of the role that education must play in addressing HIV and AIDS. It targets decision-makers and practitioners in the education sector, as well as colleagues who work on HIV and AIDS responses in other sectors. It can be used as an advocacy tool to build commitment to the role of education in the HIV and AIDS response and to generate multisectoral partnerships for implementation.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | PERSONS LIVING WITH HIV/AIDS | EDUCATION | AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | SCHOOLS | HIV PREVENTION | AIDS PREVENTION | TREATMENT | HIV TESTING | HEALTH EDUCATION | HEALTH SERVICES | PROGRAM ACCESSIBILITY | PROGRAM ACTIVITIES | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Program Evaluation | Programs | Organization and Administration
Document Number: 342035

11.

Title: Integrating gender into HIV / AIDS programmes in the health sector: Tool to improve responsiveness to women�s needs.
Author: World Health Organization [WHO]. Department of Gender, Women and Health
Source: Geneva, Switzerland, WHO, 2009. [130] p.
Abstract: This hands-on WHO tool helps programme managers and health-care providers in the public and private sectors integrate gender into HIV / AIDS programmes they wish to set up, implement and evaluate so they are more responsive to women's needs. In addition to describing basic steps in gender-responsive programming, which can be applied to all HIV / AIDS programmes, the tool suggests practical actions to address key gender issues in four service delivery areas: HIV testing and counseling; Prevention of mother-to-child transmission of HIV; HIV / AIDS treatment and care; Home-based care and support for people living with HIV. The tool also provides examples of gender-responsive interventions from the field, and resources such as: counseling role plays for risk reduction and HIV treatment adherence; examples of gender-sensitive communication messages; and protocols for addressing the risk of violence among women as a result of HIV status disclosure.
Language: English
Keywords:
GLOBAL | MANUAL | HIV PREVENTION | AIDS PREVENTION | WOMEN'S HEALTH | GENDER ISSUES | INEQUALITIES | NEEDS | PROGRAM DESIGN | PROGRAM ACCESSIBILITY | HIV TESTING | COUNSELING | ANTIRETROVIRAL THERAPY | HOME CARE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV Infections | Viral Diseases | Diseases | AIDS | Health | Sociocultural Factors | Socioeconomic Factors | Economic Factors | Programs | Organization and Administration | Program Evaluation | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Clinic Activities | Program Activities | HIV | Care and Support | Disease Transmission Control | Prevention and Control
Document Number: 331798

12.

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

13.

Peer Reviewed

Title: Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission.
Author: Adair T
Source: Journal of Biosocial Science. 2009 Mar;41(2):269-78.
Abstract: In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | MULTIVARIATE ANALYSIS | URBAN POPULATION | WOMEN IN DEVELOPMENT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | KNOWLEDGE | CONTRACEPTION | NEEDS ASSESSMENT | BIRTH SPACING | POVERTY | ATTITUDES | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Data Analysis | Population Characteristics | Economic Development | Economic Factors | Disease Transmission Control | Prevention and Control | Diseases | Sociocultural Factors | Family Planning | Evaluation | Socioeconomic Factors | Psychological Factors | Behavior | Program Evaluation | Programs | Organization and Administration
Document Number: 331114

14.

Peer Reviewed

Title: Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda.
Author: Ahoua L; Guenther G; Pinoges L; Anguzu P; Chaix ML; Le Tiec C; Balkan S; Olson D; Olaro C; Pujades-Rodriguez M
Source: BMC Infectious Diseases. 2009;9:81.
Abstract: BACKGROUND: Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice. METHODS: Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/ml) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression. RESULTS: At 12 and 24 months of ART, 72% (n = 701) and 70% (n = 369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/ml). Risk factors for virological failure (>1,000 copies/ml) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations. CONCLUSION: Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | RURAL AREAS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | TREATMENT | ADMINISTRATION AND DOSAGE | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Program Evaluation
Document Number: 342064

16.

Peer Reviewed

Title: Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda.
Author: Amuron B; Namara G; Birungi J; Nabiryo C; Levin J; Grosskurth H; Coutinho A; Jaffar S
Source: BMC Public Health. 2009 Aug 11;9(1):290.
Abstract: ABSTRACT: BACKGROUND: In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4-12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates. METHODS: HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART). Eligible subjects were given information and counselling in 3 visits done over 4-6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression. RESULTS: 4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26%) did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28%) had died, 189 (30%) reported that they were on ART with a different provider, 158 (25%) were alive but said they were not on ART and 109 (17%) were lost to follow-up. Death rates (95% CI) per 100 person-years were 34 (22, 55) (n.18) within one month and 37 (29, 48) (n.33) within 3 months. 70/158 (44%) subjects seen at follow-up said they had not started ART because they could not afford transport. CONCLUSIONS: About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | SCREENING | AIDS PREVENTION | DEATH RATE | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | AIDS | Mortality | Population Dynamics | Demographic Factors | Population | Program Evaluation
Document Number: 342534

17.

Peer Reviewed

Title: Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda.
Author: Andia I; Kaida A; Maier M; Guzman D; Emenyonu N; Pepper L; Bangsberg DR; Hogg RS
Source: American Journal of Public Health. 2009 Feb;99(2):340-7.
Abstract: OBJECTIVES: We investigated whether the prevalence of contraceptive use among women who are HIV positive varied according to use of highly active antiretroviral therapy (HAART) in Mbarara, Uganda. METHODS: We used data from a cross-sectional survey of 484 women who were HIV positive (18-50 years) and were attending Mbarara University's HIV clinic, 45% of whom were receiving HAART. Multivariate logistic regression was used to investigate the association between HAART use and contraceptive use. Data were collected between November 2005 and June 2006. RESULTS: Overall, 45% of the women were sexually active in the previous 3 months. Of these, 85% reported using contraceptive methods, with 84% reporting use of barrier contraceptive methods. Women receiving HAART were more than twice as likely to use contraceptive methods (adjusted odds ratio [AOR] = 2.64; 95% confidence interval [CI] = 1.07, 6.49) and more than 3 times as likely to use barrier contraceptive methods (AOR = 3.62; 95% CI = 1.54, 8.55) than were women not receiving HAART. CONCLUSIONS: Our findings support the need for increased attention to better integration of reproductive health and HIV and AIDS services for women who are HIV positive.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN | CONTRACEPTIVE USAGE | ANTIRETROVIRAL THERAPY | REPRODUCTIVE HEALTH | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Contraception | Family Planning | HIV | Health | Program Evaluation | Programs | Organization and Administration
Document Number: 329768

18.

Title: Hormonal methods of contraception for youth. More effective strategies are needed to improve access and encourage consistent use.
Author: Aradhya K; Lebetkin E
Source: Research Triangle Park, North Carolina, Family Health International [FHI], Interagency Youth Working Group, 2009 May. [4] p. (YouthLens on Reproductive Health and HIV / AIDS No. 30)
Abstract: Youth, defined here as people ages 10 to 24 years old, need better access to contraception. The decreasing age of menarche and increasing age of marriage have created an ever-widening window of time for premarital sexual intercourse and pregnancies. Hormonal methods of contraception -- including oral contraceptive pills, injectables, and implants -- are among the most effective methods of preventing unintended pregnancies. They are generally well known among youth and, as an alternative to condoms, allow a young woman to control her risk of pregnancy. (Excerpts)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | YOUTH | ORAL CONTRACEPTIVES | INJECTABLES | CONTRACEPTIVE IMPLANTS | PREGNANCY, UNPLANNED | PREVENTION AND CONTROL | STIGMA | HEALTH FACILITIES | PROGRAM ACCESSIBILITY | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Reproductive Behavior | Fertility | Diseases | Social Problems | Sociocultural Factors | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration
Document Number: 331499

19.

Peer Reviewed

Title: Rapid scale-up of antiretroviral treatment in Ethiopia: successes and system-wide effects.
Author: Assefa Y; Jerene D; Lulseged S; Ooms G; Van Damme W
Source: PLoS Medicine. 2009 Apr 28;6(4):e1000056.
Abstract: There has been substantial expansion of access to ART and HIV counseling and testing in Ethiopia, whilst maintaining the performance of other health programs such as tuberculosis and maternal and child health services. Task shifting to the health officers, nurses, and health extension workers is thought to be responsible for these successes. However, HIV prevention interventions and management of chronic care patients are lagging behind. This may be due to lack of attention to these health care areas and to physicians leaving the public sector for NGOs, including AIDS-related NGOs. Prevention of HIV infection, retention of patients in chronic care, and retention of physicians in the public sector need urgent attention for effective and sustainable HIV/AIDS and health systems responses in the long term.
Language: English
Keywords:
ETHIOPIA | EVALUATION REPORT | ANTIRETROVIRAL THERAPY | PUBLIC HEALTH | PROGRAM ACCESSIBILITY | DECENTRALIZATION | HIV TESTING | HIV PREVENTION | AIDS PREVENTION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | HIV | HIV Infections | Viral Diseases | Diseases | Health | Program Evaluation | Programs | Organization and Administration | Political Factors | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | AIDS
Document Number: 341678

20.

Title: Demographic data for development in sub-Saharan Africa.
Author: Baldwin W; Diers J
Source: New York, New York, Population Council, 2009. 15 p. (Poverty, Gender, and Youth Working Paper No. 13)
Abstract: More demographic data are being collected throughout the developing world than ever before, but the effective use of that data to further development goals is often lacking. This paper summarizes case studies on the demand for data in four sub-Saharan African countries, namely Ethiopia, Ghana, Senegal, and Uganda. The project's objective was to create a detailed portrait of access and demand at the country level, and to determine whether policymakers are getting the data they need to develop sound policies. Common findings across the four countries include an increased external demand from international initiatives that has not necessarily translated into internal demand for data; a missing link between producers and users of data; and a need for data to be presented in user-friendly formats. One driver of internal demand for data is the decentralization and democratization process that is underway in all four countries; this demand highlighted the paucity of available data that can be disaggregated at the level to which policies were being devolved. Next steps are to support initiatives to establish data access as a right, encourage a culture of data-sharing among funders and producers of data, strengthen intermediaries between policymakers and data collectors, display data in accessible formats such as maps, and disaggregate available data to the most useful levels. (Author's abstract)
Language: English
Keywords:
ETHIOPIA | GHANA | SENEGAL | UGANDA | SUMMARY REPORT | DEMOGRAPHIC ANALYSIS | DATA COLLECTION | CASE STUDIES | DATA QUALITY | NEEDS | DECENTRALIZATION | DEMOCRACY | INFORMATION DISTRIBUTION | POVERTY | GENDER ISSUES | YOUTH | POLICY | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Western | Research Methodology | Studies | Data Analysis | Economic Factors | Political Factors | Sociocultural Factors | Political Systems | Communication | Socioeconomic Factors | Age Factors | Population Characteristics | Demographic Factors | Population | Program Evaluation | Programs | Organization and Administration
Document Number: 331433

21.
Peer Reviewed

Title: Loss to care and death before antiretroviral therapy in Durban, South Africa.
Author: Bassett IV; Wang B; Chetty S; Mazibuko M; Bearnot B; Giddy J; Lu Z; Losina E; Walensky RP; Freedberg KA
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):135-9.
Abstract: OBJECTIVE: To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Design: Retrospective cohort study. METHODS: We reviewed data from ART eligible adults (> or = 18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count < or = 200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. RESULTS: During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3-3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (< or = 100 cells/microL) and unemployment were independently associated with being lost. CONCLUSIONS: Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | PROGRAM ACCESSIBILITY | TIME FACTORS | MORTALITY | EMPLOYMENT STATUS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Program Evaluation | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors
Document Number: 341755

22.

Peer Reviewed

Title: Principles of contraceptive care: choice, acceptability and access.
Author: Belfield T
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):177-185.
Abstract: Unintended pregnancy, abortion and sexually transmitted infection rates are high in the UK. Research shows that women and men do know about contraception, but do not always use it or use it poorly and inconsistently. This chapter addresses the issues around contraceptive decision-making and choice, and the influences that affect uptake and use.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLIENTS | CONTRACEPTION | CONTRACEPTIVE METHODS | CONTRACEPTIVE MODE OF ACTION | INFORMATION | KNOWLEDGE | INFORMED CHOICE | PROGRAM ACCEPTABILITY | PROGRAM ACCESSIBILITY | Developed Countries | Europe, Western | Europe | Program Activities | Programs | Organization and Administration | Family Planning | Sociocultural Factors | Contraceptive Usage | Program Evaluation
Document Number: 329668

23.

24.
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

25.

Peer Reviewed

Title: Putting mental health on the agenda for HIV+ women: a review of evidence from sub-Saharan Africa.
Author: Brandt R
Source: Women and Health. 2009 Mar-May;49(2-3):215-28.
Abstract: This article reviews the scientific literature regarding mental health services for poor HIV-infected women in sub-Saharan Africa and argues that they should constitute part of the healthcare agenda for these women. Key evidence points to the growing feminization of the HIV epidemic, as well as the differential social and economic impact of HIV on women. Further, HIV and poverty, both disproportionately affecting women, contribute independently and cumulatively to the risk for poor mental health. The limited empirical evidence regarding the mental health of this population is discussed. Multi-level psychosocial services, integrated within general health provision, are required to ensure long-term psychological benefits for HIV-infected women in the region.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | MENTAL HEALTH | HEALTH SERVICES | POVERTY | PROGRAM ACCESSIBILITY | Africa | Developing Countries | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | HIV Infections | Viral Diseases | Diseases | Health | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 342427

26.

Peer Reviewed

Title: The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out.
Author: Chinkonde JR; Sundby J; Martinson F
Source: Reproductive Health Matters. 2009 May;17(33):143-151.
Abstract: Mother-to-child transmission of HIV constitutes a substantial burden of new HIV infections in sub-Saharan Africa, and losses to follow-up continue to undermine prevention of mother-to-child transmission of HIV (PMTCT) programmes. This qualitative study sought to clarify why some women who were enrolled in a PMTCT programme in Lilongwe, Malawi, did not fully participate in follow-up visits in the first six months after testing HIV-positive. Twenty-eight women, 14 who participated fully in the programme and 14 who dropped out, were purposively selected for in-depth interview at two clinics. Focus group discussions with 15 previously interviewed and 13 newly recruited women were also conducted. Discussions with 12 of the women's husbands were also carried out. Although the proportion of women being tested has reportedly increased, losses to follow-up have shifted and are occurring at every step after testing. Major emerging themes associated with dropping out of the PMTCT programme within six months after delivery were to avoid involuntary HIV disclosure and negative community reactions, unequal gender relations, difficulties accessing care and treatment, and lack of support from husbands. The whole approach to the delivery of the PMTCT programme and home visits must be reconsidered, to improve confidentiality and minimise stigmatization. Women need to be empowered economically and supported to access HIV treatment and care with their partners, to benefit their whole family.
Spanish Abstract: En �frica subsahariana, gran parte de nuevas infecciones por VIH se deben a la transmisi�n materno-infantil, y las p�rdidas de seguimiento contin�an socavando los programas de prevenci�n de la transmisi�n materno-infantil del VIH (PTMI). El objetivo de este estudio cualitativo era aclarar por qu� algunas de las mujeres inscritas en un programa de PTMI en Lilongwe, Malaui, no participaron al m�ximo en las consultas de control durante los primeros seis meses posteriores a haber sido diagnosticadas VIH-positivas. Se seleccionaron 28 mujeres para entrevistas a profundidad en dos cl�nicas: 14 participaron al m�ximo en el programa y 14 lo abandonaron. Adem�s, se realizaron discusiones en grupos focales con 15 mujeres entrevistadas anteriormente y 13 reci�n reclutadas, as� como discusiones con 12 de los esposos. Aunque la proporci�n de mujeres que se someten a la prueba del VIH ha aumentado, las p�rdidas de seguimiento contin�an ocurriendo en cada paso posterior a las pruebas. Los principales motivos emergentes asociados con abandonar el programa de PTMI dentro de los seis meses posteriores al parto fueron: para evitar la divulgaci�n involuntaria del estado de VIH y reacciones negativas de la comunidad, relaciones desiguales entre los sexos, dificultades accediendo a los servicios y el tratamiento, y la falta de apoyo del esposo. Para mejorar la confidencialidad y minimizar el estigma, es necesario reconsiderar la estrategia de ejecuci�n del programa y las visitas a domicilio. Las mujeres necesitan autonom�a econ�mica y apoyo para poder acceder al tratamiento y los servicios de VIH con sus parejas, a fin de beneficiar a toda su familia.
French Abstract: La transmission m�re-enfant du VIH repr�sente une part importante des nouvelles infections en Afrique subsaharienne et les pertes du suivi continuent de saper les programmes de pr�vention de la transmission m�re-enfant (PTME). Cette �tude qualitative souhaitait d�terminer pourquoi certaines participantes d'un programme de PTME � Lilongwe, Malawi, avaient manqu� des visites de suivi les six premiers mois apr�s avoir d�couvert leur s�ropositivit� lors d'un d�pistage. Vingt-huit femmes � 14 participant pleinement au programme et 14 l'ayant abandonn� � ont fait l'objet d'un entretien approfondi dans deux dispensaires. Des discussions en groupe avec 15 femmes interrog�es pr�c�demment et 13 nouvelles recrues ont aussi �t� organis�es, de m�me qu'avec 12 conjoints des femmes. Bien que la proportion d�clar�e de femmes se faisant d�pister ait augment�, les pertes pour le suivi ont �volu� et se produisent d�sormais � toutes les �tapes apr�s le test. Les principales raisons de l'abandon du programme de PTME dans les six mois apr�s l'accouchement �taient la crainte d'une r�v�lation involontaire de la s�ropositivit� et des r�actions communautaires n�gatives, le manque de parit� entre les sexes, les difficult�s d'acc�s aux soins et au traitement, et le soutien insuffisant des maris. Toute l'approche de l'application du programme de PTME et des visites � domicile doit �tre revue, pour am�liorer la confidentialit� et minimiser la stigmatisation. Il faut donner aux femmes les moyens �conomiques de s'autonomiser et les aider � avoir acc�s au traitement et aux soins du VIH avec leur partenaire et leurs enfants ce qui profitera � toute la famille.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | FOCUS GROUPS | PREGNANT WOMEN | DROPOUTS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | INTERVIEWS | HOME VISITS | FEAR | STIGMA | CONFIDENTIAL INFORMATION | GENDER RELATIONS | PROGRAM ACCESSIBILITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Programs | Organization and Administration | Disease Transmission Control | Prevention and Control | Diseases | Communication | Emotions | Psychological Factors | Behavior | Social Problems | Sociocultural Factors | Ethics | Gender Issues | Program Evaluation
Document Number: 342023

27.
Peer Reviewed

Title: Causes of maternal mortality decline in Matlab, Bangladesh.
Author: Chowdhury ME; Ahmed A; Kalim N; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):108-23.
Abstract: Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor of the maternal mortality decline in both the areas. Possible explanations for the maternal mortality decline in Matlab are: better access to comprehensive EmOC services, reduction in the total fertility rate, and improved education of women. To achieve the Millenium Development Goal 5 targets, policies that bring further improved comprehensive EmOC, strengthened family-planning services, and expanded education of females are essential.
Language: English
Keywords:
BANGLADESH | RURAL AREAS | RESEARCH REPORT | MATERNAL MORTALITY | MORTALITY DECLINE | CAUSES OF DEATH | RISK FACTORS | SAFE MOTHERHOOD | OBSTETRICS | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | FERTILITY DECLINE | EDUCATIONAL STATUS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Mortality | Population Dynamics | Demographic Factors | Health | Maternal Health | Medicine | Health Services | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration | Fertility Changes | Fertility | Socioeconomic Status | Socioeconomic Factors | Economic Factors
Document Number: 341939

28.

Peer Reviewed

Title: Estimating inequalities in ownership of insecticide treated nets: does the choice of socio-economic status measure matter?
Author: Chuma J; Molyneux C
Source: Health Policy and Planning. 2009 Mar;24(2):83-93.
Abstract: Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the Abuja targets. The validity of different SES measures has only been tested in a limited number of settings, however, and there is little information on how choice of welfare measure influences study findings, conclusions and policy recommendations. In this paper, we demonstrate that household SES classification can depend on the SES measure selected. Using data from a household survey in coastal Kenya (n = 285 rural and 467 urban households), we first classify households into SES quintiles using both expenditure and asset data. Household SES classification is found to differ when separate rural and urban asset indices, or a combined asset index, are used. We then use data on bednet ownership to compare inequalities in ownership within each setting by the SES measure selected. Results show a weak correlation between asset index and monthly expenditure in both settings: wider inequalities in bednet ownership are observed in the rural sample when expenditure is used as the SES measure [Concentration Index (CI) = 0.1024 expenditure quintiles; 0.005 asset quintiles]; the opposite is observed in the urban sample (CI = 0.0518 expenditure quintiles; 0.126 asset quintiles). We conclude that the choice of SES measure does matter. Given the practical advantages of asset approaches, we recommend continued refinement of these approaches. In the meantime, careful selection of SES measure is required for every study, depending on the health policy issue of interest, the research context and, inevitably, pragmatic considerations.
Language: English
Keywords:
KENYA | RESEARCH REPORT | LOW INCOME POPULATION | SOCIOECONOMIC STATUS | EXPENDITURES | BED NETS | MALARIA PREVENTION | HEALTH STATUS INDEXES | HEALTH POLICY | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Social Class | Socioeconomic Factors | Economic Factors | Financial Activities | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 331225

29.

Title: Access to medications and medical care after participation in HIV clinical trials: a systematic review of trial protocols and informed consent documents.
Author: Ciaranello AL; Walensky RP; Sax PE; Chang Y; Freedberg KA; Weissman JS
Source: HIV Clinical Trials. 2009 Jan-Feb;10(1):13-24.
Abstract: BACKGROUND: Expectations regarding receipt of medications and medical care after clinical trials conclude may inform decisions about trial participation. We describe the frequency with which these posttrial services are described in the protocols and informed consent forms (ICFs) of antiretroviral drug (ARV) trials. METHOD: We systematically reviewed protocols and ICFs from Phase 3 and 4 antiretroviral trials in adults (> or = 12 years) from 1987 to 2006. Pharmaceutical industry-sponsored trials were selected from US Food and Drug Administration (FDA) documentation and Clinicaltrials.gov. Trials administered by the AIDS Clinical Trials Group (ACTG) were selected from the ACTG online registry. ACTG- and industry-provided protocols and ICFs were reviewed in full. The primary outcome was any mention of posttrial services, defined as any text regarding posttrial medications or medical care. RESULTS: Complete trial documents were available for 31 (48%) of 65 trials meeting inclusion criteria. Documents from 14 trials (45%) mentioned any posttrial service: 12 (39%) mentioned medications, and 5 (16%) mentioned medical care. Payment for trial participation (74%) and for care for trial-related injury (94%) were mentioned more often than were posttrial services. CONCLUSIONS: Posttrial medications or medical care was mentioned in the trial documents of <50% of reviewed antiretroviral trials. Improved efforts are needed to clearly describe posttrial services in clinical trial protocols and ICFs.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | CLINICAL TRIALS | ADULTS | HUMAN VOLUNTEERS | ANTIRETROVIRAL DRUGS | INFORMED CONSENT | PARTICIPATION | ETHICS | ANTIRETROVIRAL THERAPY | PROGRAM ACCESSIBILITY | Clinical Research | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Social Behavior | Behavior | Sociocultural Factors | HIV | HIV Infections | Viral Diseases | Diseases | Program Evaluation | Programs | Organization and Administration
Document Number: 341817

30.

Peer Reviewed

Title: Trends in prenatal care settings: Association with medical liability.
Author: Coco AS; Cohen D; Horst MA; Gambler AS
Source: BMC Public Health. 2009 Jul 22;9(1):257.
Abstract: ABSTRACT: BACKGROUND: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate. METHODS: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454). To assess changes in rates of prenatal visits over time, we used the linear trend test. Multivariate logistic regression modeling was developed to determine characteristics associated with visits made to hospital outpatient departments. RESULTS: In regions of the country with high medical liability (N = 11,673), the relative number, or proportion, of all prenatal visits occurring in hospital outpatient departments increased from 11.8% in 1997-1998 to 19.4% in 2003-2004 (p < .001 for trend); the trend for complicated obstetrical visits (N = 3,275) was more pronounced, where the proportion of prenatal visits occurring in hospital outpatient departments almost doubled from 22.7% in 1997-1998 to 41.6% in 2003-2004 (p = .004 for trend). This increase did not occur in regions of the country with low medical liability (N = 9,781) where the proportion of visits occurring in hospital outpatient departments decreased from 13.3% in 1997-1998 to 9.0% in 2003-2004. CONCLUSIONS: There has been a shift in prenatal care from obstetrician's offices to safety net settings in regions of the country with high medical liability. These findings provide strong indirect evidence that the medical liability crisis is affecting patterns of obstetric practice and ultimately patient access to care.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | PHYSICIANS | HIGH RISK WOMEN | ETHNIC GROUPS | ANTENATAL CARE | MEDICAL LIABILITY | OBSTETRICS | PHYSICIAN'S OFFICE | HOSPITALS | PROGRAM ACCESSIBILITY | HEALTH INSURANCE | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Medicine | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Public Assistance | Grants
Document Number: 342287


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