| 1. Title: Incidence and diagnoses of HIV infection - Puerto Rico, 2006. Author: Centers for Disease Control and Prevention (CDC) Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 5;58(21):589-91. Abstract: In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection. To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >or=13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30-39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services. Language: English Keywords: PUERTO RICO | SUMMARY REPORT | INCIDENCE | MEN | HISPANICS | IV DRUG USERS | MEN HAVING SEX WITH MEN | HIV INFECTIONS | PROGRAM EVALUATION | Caribbean | Americas | Developed Countries | Measurement | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Drug Use and Abuse | Behavior | Sex Behavior | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 341589 |
2.  Title: Development of Assays to Estimate HIV Incidence. Meeting proceedings, Chapel Hill, North Carolina, May 13-14, 2009. Author: Meeting on the Development of Assays to Estimate HIV Incidence (2009: Chapel Hill) Source: [Research Triangle Park], North Carolina, Family Health International [FHI], 2009. [70] p. Abstract: Family Health International (FHI) convened a meeting on the Development of Assays to Estimate HIV Incidence on May 13-14, 2009 at the Carolina Inn in Chapel Hill, North Carolina. The purpose of this meeting was to assess how new and existing technologies and research could be applied to advance the development of assays to estimate HIV incidence. Nearly fifty leading experts including immunologists, epidemiologists, HIV transmission experts, assay developers, virologists, industry representatives, and potential users of assays participated in the meeting. The meeting was primarily supported by the Bill & Melinda Gates Foundation and in conjunction with and the support of the World Health Organization (WHO), the HIV Prevention Trials Network (HPTN), and the Center for HIV / AIDS Vaccine Immunology (CHAVI). (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | RESEARCH METHODOLOGY | VALIDITY | ESTIMATION TECHNIQUES | INCIDENCE | EPIDEMIOLOGY | STUDY DESIGN | HIV INFECTIONS | AWARENESS | TREATMENT | PROGRAM ACTIVITIES | PROGRAM EVALUATION | Measurement | Public Health | Health | Viral Diseases | Diseases | Knowledge | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Programs | Organization and Administration Document Number: 331753 |
| 3. Title: Celebrating life: The U.S. President's Emergency Plan for AIDS Relief. 2009 Annual Report to Congress. Author: United States. Office of the United States Global AIDS Coordinator Source: Washington, D.C., Office of the United States Global AIDS Coordinator, 2009. 64 p. Abstract: The fifth Annual Report celebrates life. In countless communities around the world, through partnerships with the American people, courageous individuals in nations devastated by HIV/AIDS are choosing life, saving the lives of their fellow countrymen and women, and creating hope for a future free of HIV/AIDS. Through the power of these partnerships, the American people and the dedicated men and women in nations devastated by HIV/ AIDS have proven that the seemingly impossible is possible. Language: English Keywords: DEVELOPING COUNTRIES | ANNUAL REPORT | EVALUATION | POLICYMAKERS | PROGRAM EVALUATION | AIDS PREVENTION | HIV PREVENTION | ANTIRETROVIRAL THERAPY | FOREIGN AID | INTERNATIONAL COOPERATION | TREATMENT | GOVERNMENT FINANCING | INTERVENTIONS | Administrative Personnel | Organization and Administration | Programs | AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Financial Activities | Economic Factors | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 328418 |
4.  Peer Reviewed Title: Home-based care for people living with HIV/AIDS in Plateau State, Nigeria: findings from qualitative study. Author: Agbonyitor M Source: Global Public Health. 2009;4(3):303-12. Abstract: As health-care services in Nigeria and other African countries are becoming overstrained with patients, home-based care has increasingly been touted as a possible solution. The faith-based organisation, Gospel Health and Development Services, provides a home-based care programme for people living with HIV/AIDS (PLWHA) residing in Plateau State, Nigeria. This paper assesses the challenges that PLWHA in the programme faced while maintaining their health and livelihoods. The frustrations that volunteers endured in performing their work are also described, as well as the benefits and weaknesses of the programme from the perspective of PLWHA and their volunteer caregivers. Focus groups and interviews were done with 30 PLWHA and 22 volunteers to learn about their experiences with the home-based care programme and possible areas for its improvement. From these discussions three major challenges facing PLWHA emerged: discrimination towards PLWHA; the lack of money, food, and transport to health-care centres; and the desire for closer antiretroviral drug access. Language: English Keywords: NIGERIA | RESEARCH REPORT | QUALITATIVE RESEARCH | PERSONS LIVING WITH HIV/AIDS | VOLUNTEERS AND VOLUNTARISM | FAITH-BASED ORGANIZATION | HOME CARE | PROGRAM EVALUATION | SOCIAL DISCRIMINATION | ANTIRETROVIRAL THERAPY | TRANSPORTATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | Care and Support | Health Services | Delivery of Health Care | Health | Programs | Social Problems | HIV | Economic Factors Document Number: 341391 |
| 5. Title: The quality of family planning services and client satisfaction in the public and private sectors in Kenya. Author: Agha S; Do M Source: International Journal For Quality In Health Care. 2009 Apr;21(2):87-96. Abstract: OBJECTIVE: To compare the quality of family planning services delivered at public and private facilities in Kenya. METHODS: Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. RESULTS: Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. CONCLUSIONS: Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities. Language: English Keywords: KENYA | RESEARCH REPORT | DATA ANALYSIS | CLIENTS | FAMILY PLANNING | SATISFACTION | PUBLIC SECTOR | PRIVATE SECTOR | QUALITY OF HEALTH CARE | HEALTH SERVICES | REPRODUCTIVE HEALTH | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Psychological Factors | Behavior | Macroeconomic Factors | Economic Factors | Health Services Evaluation | Delivery of Health Care | Health Document Number: 342098 |
| 6. Title: Determination of conversion coefficient to evaluate couple-year of protection (CYP) for tubectomy and vasectomy in urban and rural regions of Iran: IMES Study. Author: Alinejad F; Heidarzade A; Eslami M; Faraji R; Shatti M Source: Journal of Reproduction and Contraception. 2009 Jun;20(2):81-92. Abstract: Objective: To calculate couple-year of protection (CYP) by conversion coefficient (F) of tubectomy and vasectomy in urban and rural regions of Iran. Methods A total of 103 450 married women aged 10-49 years in 2005 across urban and rural regions of Iran were sampled by multi stage cluster sampling. The data were collected by household survey and direct interview and analyzed by STATA8.0 software and survey analysis commands. Results Mean age of the women at the time of tubectomy estimated 31.9 years and conversion coefficient of tubectomy was 17.1 ± 0.1. Mean age of women at the time of her husband vasectomy estimated 31.48 years and its conversion coefficient was 17.5 ± 0.1. Cluster analysis defined different regions of Iran on the basis of evaluated conversion coefficients of tubectomy and vasectomy which both of them presented seven clusters. Literacy of women and total coverage of family planning in a region had a direct relationship with this conversion coefficient (P<0.05). Language: English Keywords: IRAN | RESEARCH REPORT | COUPLES | CONTRACEPTION | FAMILY PLANNING | VASECTOMY | TUBAL LIGATION | PROGRAM EVALUATION | Middle East | Developing Countries | Family Characteristics | Family and Household | Sociocultural Factors | Male Sterilization | Sterilization, Sexual | Female Sterilization | Programs | Organization and Administration Document Number: 339900 |
| 7. Title: Women's perspective in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth. Author: Almeida CA; Tanaka OY Source: Revista De Saude Publica. 2009 Feb;43(1):98-104. Abstract: OBJECTIVE: To analyze the importance of inclusion, from women's perspective, in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth, carried out by the Brazilian Ministry of Health. METHODOLOGICAL PROCEDURES: This qualitative study was based on primary data collected in 2003 in an evaluation of the Program conducted in seven towns spread out among Brazil's five geographic regions. These sites were selected from a Federal Government data base utilized for quantitative analysis. Women attended by the Program were considered key informants when primary data was collected. Sixteen focal groups were performed in the primary care units. The Collective Subject Speech (CSS) method was used for qualitative analysis. The theoretical concepts of accessibility and Paideia Health within the framework of public health were used to interpret the findings. ANALYSIS OF RESULTS: The Program standardizes procedures to be taken in antenatal care and childbirth for all health services in the country, including the flow among these services. However, analysis of women's discourse in the focal groups elucidated the existence of dissonances between their needs and desires and many of the program's recommendations. Pregnant women thus choose among available services and professionals and try to set up their own schedules which, in turn, do not correspond to those set up by the program. This discrepancy damages the bond women establish with the health services and creates obstacles for the control of the activities actually provided by the health services to the women. CONCLUSIONS: Analysis of the Program based on women's perspective identified aspects that might result in more humanized and effective antenatal care, if they are taken into account in the redefinition or correction of the Program schedule Miolo abstract Miolo abstract Miolo abstract. Language: EnglishPortuguese Keywords: BRAZIL | RESEARCH REPORT | FOCUS GROUPS | PREGNANT WOMEN | ANTENATAL CARE | MATERNAL-CHILD HEALTH SERVICES | DELIVERY OF HEALTH CARE | NEEDS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Primary Health Care | Health Services | Health | Economic Factors | Programs | Organization and Administration Document Number: 341988 |
| 8. Peer Reviewed Title: [Opinions by physicians from the Family Health Program on four health care priorities proposed by the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality] Perspectivas de medicos do Programa Saude da Familia acerca das linhas de cuidado Author: Alves e Silva AC; Villar MA; Wuillaume SM; Cardoso MH Source: Cadernos De Saude Publica. 2009 Feb;25(2):349-58. Abstract: The aim of this study was to understand how physicians from a team in the Brazilian Family Health Program perceive their work in child health, as compared to the program's principles outlined in the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality, under the Ministry of Health. The backdrop was the strategy for implementation of primary care under the Unified National Health System (SUS). Semi-structured interviews were held, and the material was submitted to content analysis. According to the findings, in general the Agenda is being met. However, there are difficulties with referral and counter-referral; the measures proposed by the Family Health Program require medical and sociological competence and face problems inherent to biomedical training; the infrastructure and inputs are precarious; and the training provided does not prepare physicians sufficiently for a more comprehensive approach. In conclusion, the primary care model in Brazil requires adjustments to the country's reality, and partnerships that transcend the system are necessary. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | PHYSICIANS | CHILD HEALTH | SELF-PERCEPTION | INFANT MORTALITY | PRIMARY HEALTH CARE | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Health Personnel | Delivery of Health Care | Health | Perception | Psychological Factors | Behavior | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Programs | Organization and Administration Document Number: 342669 |
| 9. Title: Collecting reliable information about violence against women safely in household interviews: experience from a large-scale national survey in South Asia. Author: Andersson N; Cockcroft A; Ansari N; Omer K; Chaudhry UU; Khan A; Pearson L Source: Violence Against Women. 2009 Apr;15(4):482-96. Abstract: This article describes the first national survey of violence against women in Pakistan from 2001 to 2004 covering 23,430 women. The survey took account of methodological and ethical recommendations, ensuring privacy of interviews through one person interviewing the mother-in-law while another interviewed the eligible woman privately. The training module for interviewers focused on empathy with respondents, notably increasing disclosure rates. Only 3% of women declined to participate, and 1% were not permitted to participate. Among women who disclosed physical violence, only one third had previously told anyone. Surveys of violence against women in Pakistan not using methods to minimize underreporting could seriously underestimate prevalence. Language: English Keywords: PAKISTAN | RESEARCH REPORT | DATA COLLECTION | DATA QUALITY | RELIABILITY | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | SAFETY | INTERVIEWS | PROGRAM EVALUATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Data Analysis | Measurement | Crime | Social Problems | Sociocultural Factors | Public Health | Health | Programs | Organization and Administration Document Number: 341635 |
| 10. Peer Reviewed Title: Changes in sexual behavior following a sex education program in Brazilian public schools. Mudancas no comportamento sexual de adolescentes de escolas publicas no Brasil apos um programa de educacao sexual. Author: Andrade HH; de Mello MB; Sousa MH; Makuch MY; Bertoni N; Faundes A Source: Cadernos de Saude Publica. 2009 May;25(5):1168-1176. Abstract: This paper describes an evaluation of possible changes in sexual behavior in adolescents who participated in a school-based sex education program in selected public schools in four municipalities in the state of Minas Gerais, Brazil. The program, given within the context of reproductive rights, dealt with risks involved in unsafe sexual practices, and focused on the positive aspects of sexuality. A quasi-experimental design with pre- and post-tests and a nonequivalent control group was used to evaluate the intervention. A total of 4,795 questionnaires were included in this analysis. The program succeeded in more than doubling consistent condom use with casual partners and in increasing the use of modern contraceptives during last intercourse by 68%. The intervention had no effect on age at first intercourse or on adolescents' engagement in sexual activities. The sex education program was effective in generating positive changes in the sexual behavior of adolescents, while not stimulating participation in sexual activities. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | SECONDARY SCHOOLS | ADOLESCENTS | SEX EDUCATION | PARTICIPATION | CHANGES | SEX BEHAVIOR | REPRODUCTIVE RIGHTS | SEXUALITY | RISK REDUCTION BEHAVIOR | CONDOM USE | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Schools | Education | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Social Behavior | Behavior | Social Change | Sociocultural Factors | Human Rights | Political Factors | Personality | Psychological Factors | Programs | Organization and Administration Document Number: 340176 |
| 11. Peer Reviewed Title: Changes in sexual behavior following a sex education program in Brazilian public schools. Author: Andrade HH; Mello MB; Sousa MH; Makuch MY; Bertoni N; Faundes A Source: Cadernos De Saude Publica. 2009 May;25(5):1168-76. Abstract: This paper describes an evaluation of possible changes in sexual behavior in adolescents who participated in a school-based sex education program in selected public schools in four municipalities in the state of Minas Gerais, Brazil. The program is inserted within the context of reproductive rights, deals with risks involved in unsafe sexual practices and focuses on the positive aspects of sexuality. A quasi-experimental design with pre and post-tests and a non-equivalent control group was used to evaluate the intervention. A total of 4,795 questionnaires were included in this analysis. The program succeeded in more than doubling consistent condom use with casual partners and in increasing the use of modern contraceptives during last intercourse by 68%. The intervention had no effect on age at first intercourse or on adolescents' engagement in sexual activities. The sex education program was effective in generating positive changes in the sexual behavior of adolescents, while not stimulating participation in sexual activities. Language: English Keywords: BRAZIL | RESEARCH REPORT | ADOLESCENTS | SEX BEHAVIOR | SEX EDUCATION | SCHOOLS | REPRODUCTIVE RIGHTS | RISK BEHAVIOR | INTERVENTIONS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Education | Human Rights | Political Factors | Sociocultural Factors | Programs | Organization and Administration Document Number: 342612 |
| 12. Title: Seeking safety and empathy: adolescent health seeking behavior during pregnancy and early motherhood in central Uganda. Author: Atuyambe L; Mirembe F; Annika J; Kirumira EK; Faxelid E Source: Journal of Adolescence. 2009;32:781-796. Abstract: Purpose: To explore adolescent health seeking behavior during pregnancy and early motherhood in order to contribute to health policy formulation and improved access to health care. This will in long-term have an impact on the reduction of morbidity and mortality among adolescent mothers and their newborns. Methods: This was a qualitative study that employed focus group discussions (FGDs) among adolescent girls (10-19 years) and key informant (KI) interviews with health workers. Age for FGD participants ranged from 16 to 19 years. The FGD participants were recruited while seeking antenatal care for their first pregnancy or immunization service for their first child, not being older than 6 months. Six health facilities were selected. Key informants were purposefully selected on the basis of being in-charge of maternity units. Thirteen FGDs comprising of a total of 92 adolescent girls were conducted. The FGDs were held with homogeneously constituted categories; married pregnant adolescents (5), unmarried pregnant adolescents (3) and married or not married adolescents with children (5). Semi structured interviews were held with six KIs who were in-charge of maternity units of health facilities. Latent content analysis technique was used for data analysis. Results: Two main themes emerged; ?feeling exposed and powerless?, and ?seeking safety and empathy?. The categories identified in the first theme were ?the dilemma of becoming an adolescent mother? and ?lack of decision power?. In the second theme the following categories were identified: ?cultural practices and beliefs about birth?, ?expectations and experiences?, ?transport, a key determinant to health seeking?, and ?dealing with constraints?. Adolescents felt exposed and powerless due to the dilemma of early motherhood and lack of decision making power. The adolescent mothers seemed to be in continuous quest for safety and empathy. In so doing they are part of cultural practices and beliefs about birth. They had expectations about the health care services but their experiences of the services were rather negative. Transport was a key determinant for health seeking and adolescents to some extent had learnt how to cope with constraints they face. Conclusion and implications: Pregnant adolescents seek health care in both modern and traditional health sectors in order to get safety and empathy. However, our findings indicate that they mostly utilize the traditional sector because it is most accessible in terms of distance, cost and cultural context. Adolescent mothers are disempowered in decision making because of their pregnancy state which often puts them in dilemma. We therefore suggest that policy makers need to improve health systems (including the traditional sector) especially maternal health services for adolescent girls. Improved infrastructure and attitudes of health worker as well as training in delivery of adolescent health services is critical. Language: English Keywords: UGANDA | RESEARCH REPORT | QUALITATIVE RESEARCH | ADOLESCENTS | YOUTH | PREGNANCY | SAFETY | SAFE MOTHERHOOD | MATERNAL HEALTH | HEALTH SERVICES | UTILIZATION OF HEALTH CARE | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Reproduction | Public Health | Health | Delivery of Health Care | Programs | Organization and Administration Document Number: 340225 |
| 13. Peer Reviewed Title: Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. Author: Barnighausen T; Tanser F; Newell ML Source: AIDS Research and Human Retroviruses. 2009 Apr;25(4):405-9. Abstract: To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in age-stratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p > or = 0.338) and jointly insignificant (p = 0.764 and p = 0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p > or = 0.387) and jointly insignificant (p = 0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | RURAL POPULATION | HIV INFECTIONS | HIV PREVENTION | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 341543 |
| 14. Title: Worldwide: Incentives for tuberculosis diagnosis and treatment. Author: Beith A; Eichler R; Weil D Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :237-56. Abstract: Many tuberculosis programs incorporate material (food) and financial performance-based incentives for patients, providers, or both. Findings from a combination of rigorous evaluations and data from routine program monitoring suggest that performance incentives can improve both case detection and treatment adherence. Performance incentives applied to tuberculosis contain lessons for treatment of other extended-duration and chronic conditions. Language: English Keywords: GLOBAL | RESEARCH REPORT | CLIENTS | TUBERCULOSIS | INCENTIVES | EXAMINATIONS AND DIAGNOSES | TREATMENT | DIRECTLY OBSERVED THERAPY SHORT-COURSE (DOTS) | EVALUATION | FOOD AND BEVERAGE | PROGRAM EVALUATION | Program Activities | Programs | Organization and Administration | Infections | Diseases | Policy | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Nutrition Document Number: 331459 |
| 15. Title: The President's Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes. Author: Bendavid E; Bhattacharya J Source: Annals of Internal Medicine. 2009 May 19;150(10):688-95. Abstract: BACKGROUND: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown. OBJECTIVE: To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa. DESIGN: Comparison of trends before and after the initiation of PEPFAR's activities. SETTING: 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations). INTERVENTION: A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003. MEASUREMENTS: HIV-related deaths, the number of people living with HIV, and HIV prevalence. RESULTS: Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis. LIMITATION: The selection of the focus countries was not random, which limits the generalizability of the results. CONCLUSION: After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. Language: English Keywords: AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | CAUSES OF DEATH | HIV INFECTIONS | AIDS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | Developing Countries | Studies | Research Methodology | Measurement | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 341612 |
| 16. Peer Reviewed Title: Maternal healthcare financing: Gujarat's Chiranjeevi Scheme and its beneficiaries. Author: Bhat R; Mavalankar DV; Singh PV; Singh N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):249-58. Abstract: Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available. Language: English Keywords: INDIA | RESEARCH REPORT | PILOT PROJECTS | LOW INCOME POPULATION | MATERNAL HEALTH SERVICES | FINANCIAL ACTIVITIES | OBSTETRICS | EMERGENCY SERVICES | PROGRAM EVALUATION | MATERNAL MORTALITY | QUALITY OF HEALTH CARE | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Medicine | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Health Services Evaluation Document Number: 341931 |
| 17. Peer Reviewed Title: Sexual behaviour among Italian adolescents: Knowledge and use of contraceptives. Author: Capuano S; Simeone S; Scaravilli G; Raimondo D; Balbi C Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr 18;:1-5. Abstract: Background Comprehensive data concerning the sexual behaviour of Italian adolescents are lacking; the planning of prevention programmes is therefore difficult. Methods The current study evaluates the knowledge of Italian adolescents about sexuality and their use of methods to prevent pregnancy and sexually transmitted infections. The age at first intercourse in the current sample was compared to that found in past samples to ascertain whether sex education was needed at an earlier age. The efficacy of one school-based sex education programme was analysed. Results Overall 630 students in three Italian cities were surveyed. Just over half the students were sexually active. Among these, the mean age at first intercourse was 15.6 years (SD +/- 1.3). The contraception most widely used was the condom although 'coitus interruptus', 'natural family planning' and 'no method' were also mentioned. The knowledge among students from Latina, after they had received sex education, was significantly better. Conclusion Our data show a lower mean age at first intercourse than has been reported for earlier periods by other authors. School-based sexual education is effective in improving knowledge. Sexual health services for young people must be available and counselling services improved. Language: English Keywords: ITALY | RESEARCH REPORT | KAP SURVEYS | ADOLESCENTS | KNOWLEDGE | SEX BEHAVIOR | CONTRACEPTIVE USAGE | CONTRACEPTION | SEXUALITY | SEXUALLY TRANSMITTED DISEASE PREVENTION | FIRST INTERCOURSE | AGE FACTORS | SEX EDUCATION | PROGRAM EVALUATION | Developed Countries | Europe, Southern | Europe | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Behavior | Family Planning | Personality | Psychological Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Education | Programs | Organization and Administration Document Number: 331123 |
| 18. Title: Evolution of the nourishing condition on children submitted to additional feeding program in county of state of Sao Paulo, Brazil. Evolucao do estado nutricional de criancas submetidas a um programa de suplementacao alimentar em municipio do estado de Sao Paulo. Author: Carvalho LG; Saldiva SR; da Costa Rosa TE; Lei DL Source: Revista de Nutricao / Brazilian Journal of Nutrition. 2009 Mar-Apr;22(2):207-217. Abstract: The objective of this study was to assess the impact of the Program Incentive to Fight Nutritional Deficiencies in the city of Assis, state of Sao Paulo. Methods A total of 132 children under 24 months who participated in the Program Incentive to Fight Nutritional Deficiencies for one year were followed. Their nutritional status was determined by comparing their weight-for-age in z-scores at baseline and after 2, 6, 9 and 12 months of follow-up to that of the reference population median given by the National Center for Health Statistics. Results Most (70%) of the children were classified as undernourished or at risk or malnutrition when they joined the Program Incentive to Fight Nutritional Deficiencies. After 12 months in the program, 64% of the children presented an increase in their weight-for-age z-score. Analysis of the mean weight-for-age z-score variation over time, according to age group and nutritional status at baseline, showed that children under 12 months of age had a significant increase in weight-for-age z-score. Conclusion Malnourished children under one year of age were the ones who benefited most from the Program Incentive to Fight Nutritional Deficiencies. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | DATA ANALYSIS | CHILDREN | DEFICIENCY DISEASES | NUTRITION DISORDERS | MALNUTRITION | NUTRITION INDEXES | INFANT NUTRITION | BODY WEIGHT | IMPACT | NUTRITION PROGRAMS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Nutrition | Health | Physiology | Biology | Communication | Primary Health Care | Health Services | Delivery of Health Care | Programs | Organization and Administration Document Number: 340199 |
| 19. Peer Reviewed Title: Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda. Author: Chang LW; Alamo S; Guma S; Christopher J; Suntoke T; Omasete R; Montis JP; Quinn TC; Juncker M; Reynolds SJ Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Mar 1;50(3):276-82. Abstract: BACKGROUND: There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. METHODS: We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected. RESULTS: Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately 2 years later. Viral load testing demonstrated that 86% of active patients (211/246 tested) had a viral load <400 copies per milliliter. The median CD4 increase for active patients was 197 cells per cubic millimeter (interquartile range, 108-346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at 1 year and 82% at 2 years. World Health Organization stage 4 was predictive of both not sustaining therapy and increased mortality. CONCLUSIONS: A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a 2-year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care. Language: English Keywords: UGANDA | RESEARCH REPORT | COHORT ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HEALTH PERSONNEL | ANTIRETROVIRAL THERAPY | AIDS | HEALTH SERVICES | USER COMPLIANCE | TREATMENT | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Delivery of Health Care | Health | HIV | Behavior | Medical Procedures | Medicine Document Number: 330892 |
| 20. Peer Reviewed Title: Project AID Khmer: addressing the health impact of HIV/AIDS on Cambodia through rural capacity building. Author: Chang M; Kong NB; Phal V; Pugatch D; Allen S Source: Global Public Health. 2009 May 27;:1-12. Abstract: HIV/AIDS prevention efforts in Cambodia have largely focussed on urban populations. This focus, however, has diverted attention from the impact of the disease on rural communities, where poverty and a lack of basic infrastructure forced many to migrate to urban areas. Rural communities thus play a crucial part in the understanding of HIV/AIDS transmission dynamics in Cambodia. This paper will provide an analysis of socio-economic and health-related needs of rural communities in Cambodia, giving a different context for understanding the national burden of HIV/AIDS. These concepts will be illustrated with experiences from Project AID Khmer, a Cambodian non-governmental organisation that is working to improve Cambodian health through education programmes and community capacity building in rural Takeo province. Language: English Keywords: CAMBODIA | RESEARCH REPORT | EVALUATION | RURAL POPULATION | NONGOVERNMENTAL ORGANIZATIONS | CAPACITY BUILDING | HIV PREVENTION | SOCIOECONOMIC FACTORS | PROGRAM EVALUATION | POVERTY | AGRICULTURE | LAND TENURE | RURAL-URBAN MIGRATION | HIV TRANSMISSION | RISK FACTORS | Developing Countries | Asia, Southeastern | Asia | Population Characteristics | Demographic Factors | Population | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Economic Factors | Macroeconomic Factors | Migration | Population Dynamics | Health Document Number: 341470 |
| 21. Peer Reviewed Title: National expansion of antiretroviral treatment in Thailand, 2000-2007: program scale-up and patient outcomes. Author: Chasombat S; McConnell MS; Siangphoe U; Yuktanont P; Jirawattanapisal T; Fox K; Thanprasertsuk S; Mock PA; Ningsanond P; Lertpiriyasuwat C; Pinyopornpanich S Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Apr 15;50(5):506-12. Abstract: OBJECTIVE: Thailand began a national antiretroviral (ARV) treatment program in 2000, and all government and some private and university hospitals now provide treatment to eligible HIV-infected patients. We describe program scale-up and patient outcomes from 2000 to 2007. METHODS: Data from 839 hospitals in all 76 provinces of Thailand were included in this analysis. Outcomes were assessed for patients initiating ARV treatment from January 2000 to December 2005. Follow-up data through March 2007 were included; lost to follow-up was defined as >3 months late for a follow-up visit. A Cox proportional hazard model was used to assess risk factors for death; the Kaplan-Meier method was used to estimate survival probabilities. RESULTS: Outcome data are reported for 58,008 patients. Among these, 52.2% were male; at treatment initiation, the median age was 34 years, the median CD4 count was 41 cells per cubic millimeter, and 50.5% had AIDS. The initial regimen was nevirapine and 2 nonnucleoside reverse transcriptase inhibitors for 92.4% of patients; median follow-up time was 1.6 years (interquartile range = 0.8-2.4 years). Lost to follow-up occurred in 8.8% of patients. Overall 1-year survival was 0.89 (95% confidence interval = 0.88 to 0.89). Death was significantly associated with male sex, age >40 years, baseline CD4 count <100 cells per cubic millimeter, symptomatic HIV or AIDS, receipt of services at a district or community hospital, and treatment initiation before 2005. CONCLUSIONS: National ARV treatment programs can be scaled up rapidly with good patient outcomes. Treatment outcomes among patients in Thailand are comparable to those reported in smaller cohorts in other countries, and survival rates have improved since 2004. Language: English Keywords: THAILAND | RESEARCH REPORT | DATA ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | TREATMENT | PROGRAM EVALUATION | Developing Countries | Asia, Southeastern | Asia | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration Document Number: 331223 |
| 22. Title: Evaluating the impact of community-based interventions on schooling outcomes among orphans and vulnerable children in Lusaka, Zambia. Author: Chatterji M; Hutchinson P; Murray N; Buek K; Mulenga Y Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Apr. 34 p. (MEASURE Evaluation Working Paper Series WP-09-110USAID Cooperative Agreement No. GPO-A-00-03-00003-00USAID Task Order GHS-I-00-07-00002-00) Abstract: This paper evaluates the impact of a community-based program implemented by a Zambian nongovernmental agency (NGO) on educational outcomes among orphans and vulnerable children (OVC) in Lusaka, Zambia. These outcomes included school enrollment and being at the correct age-for-grade. The study design included two rounds of post-intervention data collection, in 2003 and 2006. There were 2,302 children, ages 6-19, interviewed in 2003; and 3,105 children or young adults, ages 8-22, interviewed in 2006. A sub-sample of 2,922 orphans and vulnerable children, ages 8-19, was used. The effectiveness of Bwafwano Community Home-Based Care Organization, an NGO working in Lusaka, was evaluated, first using the individual cross-sectional samples and then using a differences-in-differences model on the pooled sample. Both cross-sectional analyses found positive and statistically significant effects of the intervention on school enrollment, with marginal effects of 0.104 and 0.168 respectively. The differences-in-differences estimates for school enrollment were positive, but small and not statistically significant. For the estimations of the effects of Bwafwano on the outcome of appropriate age-for-grade, only the difference-in-difference models showed positive program effect, with participation in the program being associated with a 15.7 percentage point increase in appropriate age-for-grade for intervention children, relative to control children. This study suggests that the Bwafwano program is a promising approach to improving educational outcomes among orphans and vulnerable children in urban Zambia. Language: English Keywords: ZAMBIA | RESEARCH REPORT | ORPHANS AND VULNERABLE CHILDREN | EDUCATIONAL STATUS | PRIMARY SCHOOLS | INTERVENTIONS | HIV PREVENTION | HOME CARE | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Schools | Education | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Care and Support | Health Services | Delivery of Health Care | Health Document Number: 339995 |
| 23. Title: [Characterization of tuberculosis among HIV/AIDS patients at a referral center in Mato Grosso do Sul] Caracterizacao da tuberculose em portadores de HIV/AIDS em um servico de Author: Cheade Mde F; Ivo ML; Siqueira PH; Sa RG; Honer MR Source: Revista Da Sociedade Brasileira De Medicina Tropical. 2009 Mar-Apr;42(2):119-25. Abstract: Tuberculosis was investigated regarding its clinical presentation, treatment outcome and sociodemographic profile among HIV patients attended at a referral center in Mato Grosso do Sul, in 2003-2005. Sixty-six medical files on patients over 14 years of age and data from the Brazilian National Information System for Notifiable Diseases relating to tuberculosis and from the Mortality Information System were analyzed. Most of the patients were male, white, of low schooling level and from urban areas. Increased extrapulmonary clinical presentation was found and it correlated with the degree of immunological competence. The main reasons for ceasing treatment were cure (reached after longer-than-expected follow-up) and death (of six patients at the beginning of the tuberculosis treatment). Information gaps were found in the tuberculosis notification records and medical files. The study revealed the need for early diagnosis of tuberculosis among HIV-positive patients, improvements in medical records and follow-up beyond the recommended duration, because of changes to the clinical evolution of tuberculosis in cases of comorbidity with HIV. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | CLINIC ACTIVITIES | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | SOCIOECONOMIC STATUS | TREATMENT | DATA COLLECTION | RECORDS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Infections | Socioeconomic Factors | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Research Methodology | Information Processing | Information Document Number: 342168 |
| 24. Title: Combating cross-generational sex in Uganda. Author: Clifton D Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Feb. [3] p. Abstract: Cross-generational sex -- or Sugar Daddy syndrome -- is a pattern of sexual behavior between young women and much older men that brings increased health risks and consequences for young women. In most cases of cross-generational sex, the women are ages 15 to 19 and unmarried; their male partners are at least 10 years older. Although most cross-generational sex is based on the exchange of favors or material goods, it is different from commercial sex or prostitution. Sadly, few large-scale interventions have been undertaken to combat this risky behavior and even fewer have been evaluated to show how well they actually work. However, in Uganda, an important collaboration between the government, local organizations, and USAID may be leading the way. The association of cross-generational sex with unsafe behaviors and HIV risk makes the practice a priority for attention in Africa. While there is much work to be done, this program has successfully involved the community in its efforts. In one year, audiences sent in more than 900 letters with questions and comments about the radio dramas and related materials. Y.E.A.H. has obviously struck a resonant chord in Uganda -- one that could possibly be replicated in other countries in sub-Saharan Africa. (Excerpts) Language: English Keywords: UGANDA | SUMMARY REPORT | YOUTH | WOMEN | SUGAR DADDIES | TRANSACTIONAL SEX | RISK BEHAVIOR | SEX BEHAVIOR | INTERVENTIONS | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Programs | Organization and Administration Document Number: 331482 |
| 25. Peer Reviewed Title: High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits. Author: Cohee L; Mills LA; Kagaayi J; Jacobs I; Galiwango R; Ludigo J; Ssekasanvu J; Reynolds SJ Source: Malaria Journal. 2009;8:76. Abstract: BACKGROUND: Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized. METHODS: 142 randomly selected adults were interviewed in July-August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda. RESULTS: Among all participants, 102 (72%, CI: 65%-79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given >or= 1 ITN, 128 (98%, CI: 96%-100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%-96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%-94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes. CONCLUSION: There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | HOUSEHOLDS | RURAL POPULATION | PESTICIDES | BED NETS | HOME VISITS | HIV INFECTIONS | MALARIA PREVENTION | KNOWLEDGE | PARTICIPATION | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Ingredients and Chemicals | Parasite Control | Public Health | Health | Communication | Malaria | Parasitic Diseases | Social Behavior | Behavior | Programs | Organization and Administration Document Number: 341152 |
| 26. Title: Meeting women's contraceptive needs in the Philippines. Author: Darroch JE; Singh S; Bal H; Cabigon JV Source: Issues In Brief. 2009;(1):1-8. Abstract: The ability to practice contraception is essential to protecting Filipino women's health and rights. Yet low levels of use have led to high levels of unintended pregnancy in the Philippines, for which women and society pay dearly-- in lives, family well-being and public funds. Language: English Keywords: PHILIPPINES | SUMMARY REPORT | WOMEN | CONTRACEPTIVE USAGE | PREGNANCY, UNPLANNED | NEEDS | CONTRACEPTION | WOMEN'S HEALTH | PROGRAM EVALUATION | Developing Countries | Asia, Southeastern | Asia | Demographic Factors | Population | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Economic Factors | Health | Programs | Organization and Administration Document Number: 341664 |
| 27. 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 |
| 28. Title: Haiti: Going to scale with a performance incentive model. Author: Eichler R; Auxila P; Antoine U; Desmangles B Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :165-188. Abstract: Rewarding NGOs for increasing access to a package of basic services and paying them for achieving population-based performance targets can result in significant increases in essential services such as immunizations and assisted deliveries. Paying NGOs for results strengthens institutional capacity to deliver services from the bottom up. Changes in the design throughout the six years offer lessons for other contexts. Language: English Keywords: HAITI | RESEARCH REPORT | PILOT PROJECTS | MATERNAL HEALTH | CHILD HEALTH | REPRODUCTIVE HEALTH | FAMILY PLANNING | MEASUREMENT | PERFORMANCE IMPROVEMENT | PROGRAM ACTIVITIES | NONGOVERNMENTAL ORGANIZATIONS | ORGANIZATION AND ADMINISTRATION | PROGRAM EVALUATION | MONITORING | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Health | Management | Programs | Organizations | Political Factors | Sociocultural Factors | Evaluation Document Number: 331456 |
| 29. Peer Reviewed Title: Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men. Author: Exner TM; Mantell JE; Adeokun LA; Udoh IA; Ladipo OA; Delano GE; Faleye J; Akinpelu K Source: Health Education Research. 2009 Apr 9; Abstract: This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective. Language: English Keywords: NIGERIA | RESEARCH REPORT | KAP SURVEYS | CASE CONTROL STUDIES | MEN | SEXUAL PARTNERS | MEN'S INVOLVEMENT | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONDOM USE | CONTRACEPTIVE USAGE | WORKSHOPS | PARTNER COMMUNICATION | PROGRAM EVALUATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Risk Reduction Behavior | Contraception | Family Planning | Education | Interpersonal Relations Document Number: 341487 |
| 30. Title: Reducing neonatal mortality in developing countries: low-cost interventions are the key determinants [letter] Author: Garg P; Gogia S Source: Journal of Perinatology. 2009 Jan;29(1):74-5; author reply 75. Abstract: We read with great interest the recent editorial and the original article published in the May issue of the journal. Dr Gadzinowski, even though realizing that the results of the article will be challenging to the neonatologists outside North America, asserts that 'Improvements in the survival of newborns on the threshold of viability contributes to improved Neonatal mortality rates (NMRs) on an international scale'. However, 98% of neonatal deaths occur in developing countries. NMR are the highest in the Sub-Saharan regions of western, middle and eastern Africa and South-Central Asia with rates between 42 and 49 per 1000 live births. More than two-thirds of the causes of neonatal deaths in these countries are due to causes not attributable to prematurity, and an even much smaller proportion can be attributed to extreme prematurity. For example, in India extremely low birth weight neonates contribute only 14.5% of neonatal deaths (3680), in live births at 18 network institutions across all regions of India. Though, many of us are now saving very and extremely low birth weight preterm neonates in developing countries, the advancement of neonatal care is hampered by marked heterogeneity within and between states, rural and urban gaps and within urban differences. Social exclusion, caste, maternal literacy, negative parental attitudes arising from social environment, gender bias, ability to pay, and lack of basic prenatal, natal and postnatal care are the main determinants of newborn survival in developing countries. Global scientific communities have increasingly realized the importance of cost-effective interventions for reducing neonatal mortality in developing countries. Sri Lanka is a shining example in South Asia with NMR of 11 per 1000 live births without hi-tech neonatal intensive care infrastructure.3 In India also the effectiveness of community- and home-based neonatal care has been shown in field trials. It is estimated that 16 low-cost effective interventions can save 0.59-1.08 million lives in South Asia and 0.45-0.8 million lives in sub-Saharan Africa. It is important for developing countries like India to keep their focus on providing essential and level II newborn care (low-cost) services for the majority of population, which would have a far greater chance for improvement on newborn survival rather than getting swayed by providing high-tech services to few babies at thresholds of viability. (full-text) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | NEONATAL MORTALITY | INTERVENTIONS | PREVENTION AND CONTROL | PROGRAM EVALUATION | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration | Diseases Document Number: 331177 |
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