1.  Title: USAID | DELIVER Project. No product? No program. Logistics for health. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Aug. [2] p. Abstract: The USAID | DELIVER PROJECT, a U.S. Agency for International Development (USAID)-funded project, works with national and international partners to increase the availability of essential health commodities for customers around the world. The project strengthens in-country supply chains and the host country's ability to manage them; works with partners to create a supportive policy environment for health commodities; and, upon request, procures and delivers health commodities. We work with a wide range of health products -- contraceptives and condoms; essential drugs; and select commodities for HIV and AIDS, laboratories, malaria, maternal and child health, infectious diseases, and avian influenza (AI). (Excerpt) Language: English Keywords: GLOBAL | SUMMARY REPORT | USAID | DELIVERY OF HEALTH CARE | LOGISTICS | TRANSPORTATION | CONDOMS | DRUGS | INFLUENZA | MALARIA PREVENTION | BED NETS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Health | Management | Organization and Administration | Economic Factors | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases | Malaria | Parasitic Diseases | Parasite Control | Public Health Document Number: 331661 |
2.  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 |
| 3. Title: Malawi. Laboratory services and supply chain assessment. Author: Butao D; Felling B; Msipa P Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Feb. [95] p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: In January and February 2009, the Ministry of Health (MOH), with technical assistance from the USAID | DELIVER PROJECT, Task Order 1, conducted an assessment of laboratory services and the management of the supply chain for laboratory commodities and equipment in government and Christian Health Association of Malawi (CHAM) health facilities in Malawi. The assessment’s overall objective was to provide the MOH with information on the current status of laboratory services and the supporting supply chain that could be used to develop the Five-Year Strategic Laboratory Plan. During the assessment, a quantitative baseline was established on which to measure future improvements to laboratory services and the supporting supply chain. This report presents the methodology and findings of the assessment, as well as recommendations to improve the supply chain to support laboratory services in Malawi. Language: English Keywords: MALAWI | EVALUATION REPORT | GOVERNMENT AGENCIES | USAID | LABORATORY | LOGISTICS | EQUIPMENT AND SUPPLIES | INFORMATION RETRIEVAL SYSTEMS | QUALITY CONTROL | STORAGE AND WAREHOUSES | TRANSPORTATION | PERFORMANCE IMPROVEMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Organizations | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Organization and Administration | Data Storage and Retrieval | Information Processing | Information | Economic Factors Document Number: 331662 |
| 4. Title: Traffic-related air pollution and perinatal mortality: a case-control study. Author: de Medeiros AP; Gouveia N; Machado RP; de Souza MR; Alencar GP; Novaes HM; de Almeida MF Source: Environmental Health Perspectives. 2009 Jan;117(1):127-32. Abstract: BACKGROUND: Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways. OBJECTIVES: Our goal was to examine the association between traffic-related pollution and perinatal mortality. METHODS: We used the information collected for a case-control study conducted in 14 districts in the City of Sao Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes. RESULTS: Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67-3.19). Associations for fetal mortality were less consistent. CONCLUSIONS: These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality. Language: English Keywords: BRAZIL | RESEARCH REPORT | STATISTICAL REGRESSION | PERINATAL MORTALITY | ENVIRONMENTAL POLLUTION | TRANSPORTATION | RISK FACTORS | POPULATION PRESSURE | Developing Countries | South America, Eastern | South America | Latin America | Americas | Data Analysis | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Environmental Degradation | Environment | Economic Factors | Biology | Carrying Capacity | Natural Resources Document Number: 330469 |
| 5. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
| 6. Title: Guatemala: Using supply chain modeling and simulation to analyze the Ministry of Health supply chain. Author: Gibney J; Sanchez A; Lamadrid C Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Mar. 38 p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: This activity analyzed the characteristics of the integrated logistics system in three departments in Guatemala: Sololá, Totonicapán, and Jutiapa. This paper identifies some of the obstacles to achieving contraceptive availability for the underserved and vulnerable populations; it also offers options for improving equity in access for family planning commodities. The study identifies elements in the Ministry of Public Health and Social Welfare’s (MSPAS) logistics system that could impede the availability and accessibility of contraceptives. By using supply chain simulation and optimization modeling software, with geographic information system tools, the authors propose system-related solutions that could improve the performance of the overall MSPAS. Language: English Keywords: GUATEMALA | RECOMMENDATIONS | GOVERNMENT AGENCIES | LOGISTICS | HEALTH SERVICES EVALUATION | CONTRACEPTIVE AVAILABILITY | OBSTACLES | NEEDS | CONTRACEPTIVE DISTRIBUTION | PERFORMANCE IMPROVEMENT | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | TRANSPORTATION | Central America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Evaluation | Programs | Contraception | Family Planning | Economic Factors | Distributional Activities | Program Activities | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information Document Number: 331663 |
| 7. Peer Reviewed Title: Maternal health in Gujarat, India: a case study. Author: Mavalankar DV; Vora KS; Ramani KV; Raman P; Sharma B; Upadhyaya M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):235-48. Abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | OBSTETRICS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | BLOOD SUPPLY | HUMAN RESOURCES | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Management | Organization and Administration | Medicine | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Medical Procedures | Education Document Number: 341932 |
| 8. Title: Perinatal audit using the 3-delays model in western Tanzania. Author: Mbaruku G; van Roosmalen J; Kimondo I; Bilango F; Bergstrom S Source: International Journal of Gynaecology and Obstetrics. 2009 May 11; Abstract: OBJECTIVE: To audit intrapartum fetal and early neonatal deaths of infants weighing >/=2000 g in a regional hospital in western Tanzania. METHODS: The 3-delays methodology was applied to a cohort of perinatal deaths from July 2002 to July 2004. RESULTS: The overall perinatal mortality rate in the hospital was 38 per 1000 live births, and in just over half of these cases the birth weight was >/=2000 g. The leading clinicopathologic causes of death were birth asphyxia (19.0%), prolonged or obstructed labor (18.5%), antepartum hemorrhage (11.5%), and uterine rupture (9.0%). First delays occurred in 19.0% of the cases, second delays occurred in 21.5%, and third delays occurred in 72.5%. CONCLUSION: For women who delivered in this hospital, most of the substandard care occurred after admission to the health facility. The improvement of institutional health care may have a significant impact on the decision to attend health institutions and, thereby, reduce first delays. Language: English Keywords: TANZANIA | RESEARCH REPORT | COHORT ANALYSIS | PERINATAL MORTALITY | BIRTH WEIGHT | HOSPITALS | QUALITY OF HEALTH CARE | CAUSES OF DEATH | TRANSPORTATION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology | Health Facilities | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Economic Factors Document Number: 341453 |
| 9. Peer Reviewed Title: MALE PARTICIPATION IN PREGNANCY AND DELIVERY IN NIGERIA: A SURVEY OF ANTENATAL ATTENDEES. Author: Olayemi O; Bello FA; Aimakhu CO; Obajimi GO; Adekunle AO Source: Journal of Biosocial Science. 2009 Mar 23;41:493-503. Abstract: Summary.This was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic - paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompanytheir wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable. Language: English Keywords: NIGERIA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | MEN | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MEN'S INVOLVEMENT | ANTENATAL CARE | CHILDBIRTH | ATTITUDES | TRANSPORTATION | FEES | EDUCATIONAL STATUS | CULTURE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Economic Development | Economic Factors | Population Characteristics | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Psychological Factors | Behavior | Financial Activities | Socioeconomic Status | Socioeconomic Factors | Sociocultural Factors Document Number: 341481 |
| 10. Peer Reviewed Title: Access to health care and mortality of children under 5 years of age in the Gambia: a case-control study. Author: Rutherford ME; Dockerty JD; Jasseh M; Howie SR; Herbison P; Jeffries DJ; Leach M; Stevens W; Mulholland K; Adegbola RA; Hill PC Source: Bulletin of the World Health Organization. 2009 Mar;87(3):216-24. Abstract: OBJECTIVE: To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. METHODS: We conducted a case-control study in a population under demographic surveillance. Cases (n = 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. FINDINGS: Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, CI: 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% CI: 1.2-4.1), had no one to relax with (OR: 1.8; 95% CI: 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% CI: 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% CI: 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% CI: 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% CI: 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% CI: 0.1-0.5). CONCLUSION: Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers' support networks and their access to the financial resources they need. Language: English Keywords: GAMBIA | RESEARCH REPORT | CONTROL GROUPS | STATISTICAL REGRESSION | CHILDREN | HEALTH SERVICES | PROGRAM ACCESSIBILITY | CHILD MORTALITY | CAUSES OF DEATH | DISTANCE | TRANSPORTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Geographic Factors | Economic Factors Document Number: 342351 |
| 11. Peer Reviewed Title: Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambarene, Gabon. Author: Schwarz NG; Gysels M; Pell C; Gabor J; Schlie M; Issifou S; Lell B; Kremsner PG; Grobusch MP; Pool R Source: Vaccine. 2009 Jul 16; Abstract: The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem at odds with the region's observed low vaccination coverage. Important reasons for MCC non-attendance included distance to the MCC, transport costs, negative experiences at MCCs (such as interactions with unfriendly staff) and mothers' feeling of shame provoked by different, often poverty-associated reasons such as attending the clinic with a dirty or poorly clothed child. Language: English Keywords: GABON | RESEARCH REPORT | MOTHERS | MATERNAL-CHILD HEALTH SERVICES | VACCINATION | USER COMPLIANCE | ATTITUDES | QUESTIONNAIRES | INTERVIEWS | CLINIC VISITS | DISTANCE | TRANSPORTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Immunization | Behavior | Psychological Factors | Data Collection | Research Methodology | Service Statistics | Program Activities | Programs | Organization and Administration | Geographic Factors | Population | Economic Factors Document Number: 342280 |
| 12. Peer Reviewed Title: Traditional birth attendants in rural Nepal: Knowledge, attitudes and practices about maternal and newborn health. Author: Thatte N; Mullany LC; Khatry SK; Katz J; Tielsch JM; Darmstadt GL Source: Global Public Health. 2009 May 8;:1-17. Abstract: Efforts to formalise the role of traditional birth attendants (TBAs) in maternal and neonatal health programmes have had limited success. TBAs' continued attendance at home deliveries suggests the potential to influence maternal and neonatal outcomes. The objective of this qualitative study was to identify and understand the knowledge, attitudes and practices of TBAs in rural Nepal. Twenty-one trained and untrained TBAs participated in focus groups and in-depth interviews about antenatal care, delivery practices, maternal complications and newborn care. Antenatal care included advice about nutrition and tetanus toxoid (TT) immunisation, but did not include planning ahead for transport in cases of complications. Clean delivery practices were observed by most TBAs, though hand-washing practices differed by training status. There was no standard practice to identify maternal complications, such as excessive bleeding, prolonged labour, or retained placenta, and most referred outside in the event of such complications. Newborn care practices included breastfeeding with supplemental feeds, thermal care after bathing, and mustard seed oil massage. TBAs reported high job satisfaction and desire to improve their skills. Despite uncertainty regarding the role of TBAs to manage maternal complications, TBAs may be strategically placed to make potential contributions to newborn survival. Language: English Keywords: NEPAL | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | RURAL POPULATION | TRADITIONAL BIRTH ATTENDANTS | ATTITUDES | MATERNAL-CHILD HEALTH SERVICES | ANTENATAL CARE | PREGNANCY COMPLICATIONS | TRANSPORTATION | IMMUNIZATION | MATERNAL NUTRITION | HYGIENE | EDUCATIONAL STATUS | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Psychological Factors | Behavior | Primary Health Care | Health Services | Maternal Health Services | Diseases | Economic Factors | Nutrition | Public Health | Socioeconomic Status | Socioeconomic Factors Document Number: 341473 |
| 13. Title: Transporting, storing, and handling malaria rapid diagnostic tests in health clinics. Author: World Health Organization [WHO]. Regional Office for the Western Pacific; John Snow [JSI]. DELIVER; Foundation for Innovative New Diagnostics [FIND]; Roll Back Malaria Partnership; United States. President's Malaria Initiative Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Jul. [35] p. (USAID Contract No. GPO-I-03-06-00007-00) Abstract: The publication is intended for staff at health clinics that use malaria rapid diagnostic tests (RDTs). It describes the basic principles for management and storage of RDT stock, and it outlines practical solutions for protecting RDTs against high temperatures during storage and transport. It also describes how to manage waste generated from RDT use. Language: English Keywords: DEVELOPING COUNTRIES | MANUAL | TECHNICAL ASSISTANCE | HEALTH PERSONNEL | HEALTH FACILITIES | CLINIC ACTIVITIES | MALARIA PREVENTION | TESTING | STORAGE AND WAREHOUSES | LOGISTICS | WASTE MANAGEMENT | PHARMACY DISTRIBUTION | TRANSPORTATION | Programs | Organization and Administration | Delivery of Health Care | Health | Program Activities | Malaria | Parasitic Diseases | Diseases | Measurement | Research Methodology | Management | Environment | Nonclinical Distribution | Distributional Activities | Economic Factors Document Number: 331477 |
| 14. Title: Human population growth and temperature increase along with the increase in urbanisation, motor vehicle numbers and green area amount in the sample of Erzurum city, Turkey. Author: Yilmaz S; Toy S; Demircioglu Yildiz N; Yilmaz H Source: Environmental Monitoring and Assessment. 2009 Jan;148(1-4):205-13. Abstract: In the study, main purpose was to determine the effect of population growth along with the increase in urbanisation, motor vehicle use and green area amount on the temperature values using a 55-year data set in Erzurum, which is hardly industrialised, and one of the coldest cities with highest elevation in Turkey. Although the semi-decadal increases, means of which are 0.1 degrees C for mean, minimum and maximum temperatures, are not clear enough to make a strong comment even in the lights of figures or tables, it was found as the result of the statistical analysis that population growth and increases in the number of vehicles, the number of buildings and the green area amount in the city have no significant effect on mean temperatures. However, the relationships between population growth and maximum temperature; and the number of vehicles and minimum temperature were found to be statistically significant. Language: English Keywords: TURKEY | RESEARCH REPORT | STATISTICAL STUDIES | URBANIZATION | POPULATION GROWTH | TRANSPORTATION | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Dynamics | Demographic Factors | Economic Factors Document Number: 330493 |
| 15. Title: Risk factors for perinatal mortality in Arua regional referral hospital, West Nile, Uganda. Author: Akello B; Nabiwemba E; Zirabamuzaale C; Orach CG Source: East African Journal of Public Health. 2008 Dec;5(3):180-5. Abstract: BACKGROUND: In low-income countries, the majority of neonatal deaths occur during the perinatal period. The fourth millennium development goal of reducing child mortality cannot therefore be met without substantial reduction in perinatal deaths. OBJECTIVE: To investigate the risk factors for perinatal mortality in Arua regional referral hospital, West Nile region. METHODS: We conducted a facility based unmatched case-control study at Arua Regional Referral hospital during January- March 2006. A total of 60 new cases of perinatal deaths and 120 controls were selected over a 3 months period. A case was defined as any baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression analysis was used to determine the risk factors for perinatal mortality. RESULTS: The mean age of case mothers was similar to that of controls 24.1 years, range 15-38 years versus 24.9 years range 16-40 years (p - value = 0.52). Babies who died during the perinatal period were more likely not to have been resuscitated (OR = 24.85, 95% CI 8.77-74.17). Mothers whose babies died were more likely to have travelled more than 5 kilometres to Arua hospital (OR = 3.89 CI 1.96-7.74), having had transport problem (OR= 3.35, CI 1.00-12.00), first sought help from other health facilities or TBA (OR = 8.03, CI 3.38-19.46), have been referred due to obstetric complications (OR = 11.45, CI 4.75-27.59), and had obstetric interventions i.e. C/S or vacuum extraction (OR= 3.79, CI 1.64-8.83). After controlling for confounding, significant risk factors for perinatal deaths included living more than 5 kilometres from the hospital (Adjusted OR = 0.91, CI 0.83-0.95), transport problem (Adjusted OR = 4.37, CI 1.14-39.75), baby not being resuscitated (Adjusted OR=4.87, CI 4.371-7.11) and baby being born with low Apgar score (Adjusted OR= 6.76, CI 2.75-187.38). CONCLUSION AND RECOMMENDATIONS: Our study has identified several risk factors for perinatal deaths related to poor accessibility to and low quality of health care services in the setting. The study underscores the importance of improved accessibility to and quality of basic and comprehensive emergency obstetrical care. The findings suggest the need to improve the capacity of local health system at first, second and tertiary levels, accessibility to and quality health care services in the settings. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CASE CONTROL STUDIES | STATISTICAL REGRESSION | INFANT | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | RISK FACTORS | PERINATAL MORTALITY | HOSPITALS | DISTANCE | TRANSPORTATION | PREGNANCY COMPLICATIONS | ABORTION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Health | Mortality | Population Dynamics | Health Facilities | Delivery of Health Care | Geographic Factors | Diseases | Fertility Control, Postconception | Family Planning Document Number: 331264 Notification |
| 16. Peer Reviewed Title: Traditional medicine, delays and hospital mortality of children under five years of age in the rural district of Kigoma, western Tanzania: an observational hospital-based study. Author: Blanke CH; Naisabha GB; Lange CR Source: Tropical Doctor. 2008 Jul;38(3):150-2. Abstract: The use of traditional medicine in the treatment of 596 children aged 0-60 months before admission was common (41.4 %). Children were more likely to die if they had first been treated with traditional medicine (50/244; 20.5% vs 29/342; 8.5%) or were younger (median 9 vs 12 months old.) Children who had received traditional medicine were younger (median 11 vs. 13 months), came later for hospital treatment (median three vs. five days), had a longer journey on foot to reach the health centre (3.4 vs. 2.9 h), and died from common diseases and not from an obvious toxic syndrome. Language: English Keywords: TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RURAL POPULATION | CHILDREN | TRADITIONAL HEALTH PRACTICES | WAITING AREAS AND QUEUES | TIME FACTORS | CHILD MORTALITY | RISK FACTORS | HOSPITALS | HARMFUL TRADITIONAL PRACTICES | AGE FACTORS | DISTANCE | TRANSPORTATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Culture | Sociocultural Factors | Workplace | Employment | Macroeconomic Factors | Economic Factors | Population Dynamics | Mortality | Biology | Health Facilities | Delivery of Health Care | Health | Geographic Factors Document Number: 328430 |
| 17. Peer Reviewed Title: Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost? Averting maternal death and disability. Author: Hofman JJ; Dzimadzi C; Lungu K; Ratsma EY; Hussein J Source: International Journal of Gynecology and Obstetrics. 2008 Aug;102(2):191-197. Abstract: The objectives of this study were to assess whether motorcycle ambulances placed at rural health centers are a more effective method of reducing referral delay for obstetric emergencies than a car ambulance at the district hospital, and to compare investment and operating costs with those of a 4 wheel drive car ambulance at the district hospital. Motorcycle ambulances were placed at 3 remote rural health centers in Malawi. Data were collected over a 1-year period, from October 2001 to September 2002, using logbooks, cashbooks, referral forms, and maternity registers. Depending on the site, median referral delay was reduced by 2-4.5 hours (35%-76%). Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were US $508, which was almost 24 times cheaper than for a car ambulance. In resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for thehealth sector. (author's) Language: English Keywords: RESEARCH REPORT | OPERATIONS RESEARCH | RURAL HEALTH CENTERS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | SAFE MOTHERHOOD | COST EFFECTIVENESS | COST BENEFIT ANALYSIS | QUANTITATIVE RESEARCH | Program Evaluation | Programs | Organization and Administration | Research Methodology | Health Facilities | Delivery of Health Care | Health | Health Services | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Maternal Health | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 327687 |
| 18. Peer Reviewed Title: User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania. Author: Kruk ME; Mbaruku G; Rockers PC; Galea S Source: Tropical Medicine and International Health. 2008 Dec;13(12):1442-51. Abstract: OBJECTIVE: To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions. METHODS: We selected a representative sample of households in a rural district in western Tanzania. Women who given birth within 5 years were asked about payments for doctor's/nurse's fees, drugs, non-medical supplies, medical tests, maternity waiting home, transport and other expenses. Wealth was assessed using a household asset index. We estimated the proportion of women who cut down on spending or borrowed money/sold household items to pay for delivery in each wealth group. RESULTS: In all, 73.3% of women with facility delivery reported having made out-of-pocket payments for delivery-related costs. The average cost was 6272 Tanzanian shillings (TZS), [95% Confidence Interval (CI): 4916, 7628] or 5.0 United States dollars. Transport costs (53.6%) and provider fees (26.6%) were the largest cost components in government facilities. Deliveries in mission facilities were twice as expensive as those in government facilities. Nearly half (48.3%) of women reported cutting down on spending or borrowing money/selling household assets to pay for delivery, with the poor reporting this most frequently. CONCLUSION: Out-of-pocket payments for facility delivery were substantial and were driven by high transport costs, unofficial provider payments, and preference for mission facilities, which levy user charges. Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery. Language: English Keywords: TANZANIA | RESEARCH REPORT | STATISTICAL STUDIES | RURAL POPULATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | FEES | EXAMINATIONS AND DIAGNOSES | DRUGS | MATERNAL HEALTH SERVICES | TRANSPORTATION | HOME ECONOMICS | EXPENDITURES | CHILDBIRTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Financial Activities | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Maternal-Child Health Services | Primary Health Care | Microeconomic Factors | Pregnancy Outcomes | Pregnancy | Reproduction Document Number: 330043 |
| 19. Title: Solid-waste management in Jalandhar city and its impact on community health. Author: Puri A; Kumar M; Johal E Source: Indian Journal of Occupational and Environmental Medicine. 2008 Aug;12(2):76-81. Abstract: In this study, solid-waste management practices were evaluated in order to find out its link with occurrence of vector-borne disease. Strategies for solid-waste management were employed as practical model to solve the problems regarding pollution which is originated by solid-waste. Language: English Keywords: INDIA | RESEARCH REPORT | HEALTH SURVEYS | URBAN POPULATION | WASTE MANAGEMENT | VECTOR CONTROL | ENVIRONMENTAL POLLUTION | URBAN AREAS | STORAGE AND WAREHOUSES | TRANSPORTATION | RECYCLING | RISK FACTORS | Developing Countries | Asia, Southern | Asia | Health | Population Characteristics | Demographic Factors | Population | Environment | Disease Transmission Control | Prevention and Control | Diseases | Environmental Degradation | Geographic Factors | Organization and Administration | Economic Factors | Biology Document Number: 322520 |
| 20. Title: Healthy aging in cities. Author: Quinn A Source: Journal of Urban Health. 2008 Mar;85(2):151-153. Abstract: In the coming decades, the global population will urbanize and age at high rates. Today, half of the world's populations lives in cities.1 By 2030, that proportion will rise to 60%, and urbanization will occur most greatly in developing countries. At the same time, the world's population aged 60 and over will double from 11% to 22% by 2050, and that growth will be concentrated in urban areas in less developed countries. All of these trends challenge public health workers, doctors, researchers, and urban planners to ensure healthy livable cities for older people. (excerpt) Language: English Keywords: URBAN AREAS | CRITIQUE | COMMUNITY | SOCIAL NETWORKS | DEMOGRAPHIC AGING | RETIREMENT | QUALITY OF LIFE | TRANSPORTATION | HOUSING | WHO | HEALTH SERVICES | Geographic Factors | Population | Residence Characteristics | Population Distribution | Friends and Relatives | Family and Household | Sociocultural Factors | Population Dynamics | Demographic Factors | Employment Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Social Welfare | UN | International Agencies | Organizations | Political Factors | Delivery of Health Care | Health Document Number: 325554 |
| 21. Peer Reviewed Title: Prevalence of tuberculosis suspects and their healthcare-seeking behavior in urban and rural Jordan. Author: Rumman KA; Sabra NA; Bakri F; Seita A; Bassili A Source: American Journal of Tropical Medicine and Hygiene. 2008 Oct;79(4):545-51. Abstract: To determine the prevalence and healthcare-seeking behavior of tuberculosis (TB) suspects in Middle and South Jordan. A community-based survey was carried out between June-September 2005, whereby 61,730 adult household members were inquired about the presence of persistent cough for more than three weeks to identify TB suspects. These adults were then interviewed and referred to the nearest health center for clinical and sputum smear examination. Of the 61,730 surveyed household members, 1,544 (2.51%) were identified as TB suspects, of these two were sputum smear positive pulmonary TB. The first action with the onset of symptoms was to visit the health centers. Reasons for timely seeking care were accessibility of the facilities and confidence in obtaining a cure, and obstacles were belief that symptoms would resolve and economic constraints in rural residents. Females, rural residents, expatriates, and using private means of transportation were predictors of delay in seeking care for more than three weeks. This study has set the baseline information about the prevalence of TB suspects in Jordan and their healthcare-seeking behavior that shows community preference to seek care at health centers. These should be upgraded and the health workers trained on suspect management to enhance the TB elimination efforts. Language: English Keywords: JORDAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | KAP SURVEYS | URBAN POPULATION | COMMUNITY | HOUSEHOLDS | PREVALENCE | UTILIZATION OF HEALTH CARE | TUBERCULOSIS | SIGNS AND SYMPTOMS | TIME FACTORS | BELIEFS | SEX FACTORS | TRANSPORTATION | Developing Countries | Middle East | Research Methodology | Surveys | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Family and Household | Sociocultural Factors | Measurement | Health Services | Delivery of Health Care | Health | Infections | Diseases | Population Dynamics | Culture | Economic Factors Document Number: 329085 |
| 22. Title: Delay in tuberculosis diagnosis and treatment in four provinces of Argentina. Author: Zerbini E; Chirico MC; Salvadores B; Amigot B; Estrada S Source: International Journal of Tuberculosis and Lung Disease. 2008 Jan;12(1):63-68. Abstract: SETTING: Public health care services in the provinces of Buenos Aires, Santa Fe, Jujuy and Santa Cruz, Argentina. OBJECTIVE: To evaluate delays in tuberculosis (TB) diagnosis and treatment and associated risk factors in departments and administrative areas of four Argentine provinces. DESIGN: Cross-sectional survey including retrospective medical record review and patient interviews. RESULTS: A total of 243 patients with smear-positive pulmonary TB and a mean age of 40 years were included in the study. The mean diagnostic delays were as follows: total delay 92.1 days (median 62.0); patient delay 58.8 days (median 31); health service delay 32.6 days (median 12.5). The mean treatment delay was 0.9 days (median 0). Associations were observed between patient delays of >30 days and residence in Jujuy, age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough. The >60-day total diagnosis delay was associated with age >50 years and need for transport to the nearest public health service. CONCLUSION: Diagnostic delay is an important problem in the areas studied, with patient delay being of most concern. Patient delay was associated with age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough. Language: English Keywords: ARGENTINA | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | RETROSPECTIVE STUDIES | KAP SURVEYS | TARGET POPULATION | LABORATORY EXAMINATIONS AND DIAGNOSES | TUBERCULOSIS | TIME FACTORS | UTILIZATION OF HEALTH CARE | AGE FACTORS | TRANSPORTATION | DISTANCE | RISK FACTORS | South America, Southern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Surveys | Sampling Studies | Program Design | Programs | Organization and Administration | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Population Dynamics | Demographic Factors | Population | Population Characteristics | Economic Factors | Geographic Factors | Biology Document Number: 325809 |
| 24. Title: Health without borders: Improving health and reducing HIV / AIDS vulnerability among long-distance road transport workers through a multisectoral approach. Author: United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP] Source: [Bangkok, Thailand], ESCAP, 2007. [94] p. (ST/ESCAP/2442) Abstract: By 2012, all GMS (Greater Mekong Subregion) countries are expected to be connected to each other, by a series of all-weather roads or "corridors." Together with improvements in power and telecommunications, these roads will play a key role in promoting closer economic cooperation. However, enhanced subregional integration, also poses corresponding challenges to existing lifestyles and cultures, and serious health and environmental threats. The market-oriented vision for economic development of the GMS has not always been balanced by social and human development. As a general trend, development in the subregion is creating an unprecedented flow of people, capital and goods across borders, including trafficking in labour, prostitution, arms, drugs and other contraband. These multiple flows are inevitably linked to the spread of serious infectious diseases, such as dengue fever and malaria as well as SARS, and more currently avian influenza. The combination of high mobility, intravenous drug use, andunsafe sex practices has further caused many parts of the subregion - Cambodia, Thailand and Yunnan - to become flash points of the HIV/AIDS pandemic. (excerpt) Language: English Keywords: THAILAND | VIETNAM | LAOS | SUMMARY REPORT | PILOT PROJECTS | LABOR FORCE | MIGRANT WORKERS | TRUCK DRIVERS | TRANSPORTATION | CAPACITY BUILDING | ALCOHOL USE AND ABUSE | RISK FACTORS | SEX BEHAVIOR | RISK BEHAVIOR | DISEASE PREVENTION | Asia, Southeastern | Asia | Developing Countries | Studies | Research Methodology | Human Resources | Economic Factors | Program Sustainability | Programs | Organization and Administration | Behavior | Biology | Prevention and Control | Diseases Document Number: 319345 |
| 25. Title: Knowledge and attitudes of mariners about AIDS in Turkey. Author: Acaroglu R Source: Journal of the Association of Nurses in AIDS Care. 2007 Jan-Feb;18(1):48-55. Abstract: Given the significant high risks of both being exposed to the virus and spreading it, mariners traveling across countries on a regular basis fall into one of the top-priority populations of those to whom education on HIV/AIDS should be given. However, there have been no reports regarding HIV/AIDS knowledge and attitudes on the part of mariners in Turkey. Therefore, this study was carried out with the aim of defining the knowledge and attitudes of 660 Turkish mariners. Data were determined using a self-completed questionnaire. Percentage and mean scores were used in data analysis. Results show that the mariners' knowledge was inadequate (mean score was 52.31 ± 20.46 over a total of 100 points). The lowest knowledge pertained to HIV/AIDS prevention (mean score was 44.62 ± 19.97). About half of the mariners considered themselves to be in the risk group. Very few of them (10%) have had an AIDS test. Most (68%) were informed about HIV/ AIDS by the media. These results show that the mariners need to increase HIV/AIDS knowledge about prevention, transmission, treatment information, motivation, and behavioral skills to decrease HIV/AIDS risky behaviors. The mariners had the least knowledge about HIV/AIDS protection. Having a critical role in preventing the transmission and spreading of diseases, nurses should conduct more extensive and advanced research into HIV/AIDS and assume educational and counseling responsibilities in illuminating society. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | QUESTIONNAIRES | WORKERS | MIGRANT WORKERS | BOATS | TRANSPORTATION | AIDS | HIV INFECTIONS | HIV TRANSMISSION | KNOWLEDGE | ATTITUDES | Developing Countries | Europe, Southeastern | Europe | Labor Force | Human Resources | Economic Factors | Viral Diseases | Diseases | Sociocultural Factors | Psychological Factors | Behavior Document Number: 308410 |
| 26. Peer Reviewed Title: Sexually transmitted infections and risk factors among truck stand workers in Dhaka, Bangladesh. Author: Alam N; Rahman M; Gausia K; Yunus MD; Islam N Source: Sexually Transmitted Diseases. 2007 Feb;34(2):99-103. Abstract: This study was conducted to determine the prevalence of selected sexually transmitted infections (STIs) and their risk factors among workers in and near a truck stand in Dhaka, Bangladesh. A random sample of 696 men and 206 women were recruited into a cross--sectional study using a census that enumerated transport agents, motor mechanics, laborers, and vendors in Tejgaon truck stand. The prevalence rates of syphilis (rapid plasma reagin and Treponema pallidum hemagglutination), gonorrhea (polymerase chain reaction [PCR]), and chlamydial infections (PCR) among men were 4.1%, 7.7%, and 2.3%, respectively, and among women were 2.9%, 8.3%, and 5.2%. Multivariable analysis revealed that having = 2 sex partners in the last month, never using a condom with sex workers, and ever injecting narcotics were significant predictors of STI among men. Being never married, working as a laborer, older age, and living within the truck stand were significant predictors of practicing high-risk behaviors among men, but none predicted infection with STIs. Both behavioral and STI data suggest that truck stand workers should be included in the STI/HIV intervention programs. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CENSUS | PREVALENCE | LABOR FORCE | TRANSPORTATION | TRUCK DRIVERS | SEXUALLY TRANSMITTED DISEASES | SYPHILIS | CHLAMYDIA | RISK BEHAVIOR | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASE PREVENTION | Developing Countries | Asia, Southern | Asia | Research Methodology | Population Statistics | Measurement | Human Resources | Economic Factors | Reproductive Tract Infections | Infections | Diseases | Behavior Document Number: 312773 |
| 27. Title: Determinants of female labor force particpation in Pakistan: An empirical analysis of PSLM (2004-05) micro data. Author: Ejaz M Source: The Lahore Journal of Economics. 2007 Sep;Spec No:203-235. Abstract: This paper seeks to identify the major determinants of female labor force participation (FLFP) in Pakistan, specifically with reference to rural and urban areas. Limited dependent variable techniques (Logit and Probit) are utilized to determine the factors affecting female labor force participation. This analysis uses data taken from the PSLW (Pakistan Social and Living Standards Measurement Survey, 2004-05) which measure individual and household characteristics of females between the ages of 15-49. Empirical results suggest that age, educational attainment and marital status have significant and positive effects on female labor force participation. When women belong to the nuclear family and have access to vehicles, they are more likely to participate in economic activities, whereas a large number of children and the availability of home appliances reduces the probability of FLFP. The results imply that reducing the child care burden on females and facilitating educational attainment would lead to a higher labor force participation rate for females in Pakistan. Language: English Keywords: PAKISTAN | RESEARCH REPORT | SURVEYS | WOMEN IN DEVELOPMENT | LABOR FORCE | PARTICIPATION | AGE FACTORS | EDUCATIONAL STATUS | MARITAL STATUS | TRANSPORTATION | AUTOMOBILES | FAMILY SIZE | HOUSEWORK | CHILD CARE | EMPLOYMENT | Developing Countries | Asia, Southern | Asia | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Human Resources | Social Behavior | Behavior | Population Characteristics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Nuptiality | Family Characteristics | Family and Household | Sociocultural Factors | Microeconomic Factors | Child Rearing | Macroeconomic Factors Document Number: 327831 |
| 28. Peer Reviewed Title: Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa. Author: Hardon AP; Akurut D; Comoro C; Ekezie C; Irunde HF Source: AIDS Care. 2007 May;19(5):658-665. Abstract: Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ART users and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care. (author's) Language: English Keywords: BOTSWANA | TANZANIA | UGANDA | RESEARCH REPORT | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | TRANSPORTATION | TIME FACTORS | STIGMA | COUNSELING | SIDE EFFECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Eastern | HIV | HIV Infections | Viral Diseases | Diseases | Behavior | Economic Factors | Population Dynamics | Demographic Factors | Population | Social Problems | Sociocultural Factors | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 317065 |
| 29. Title: [Barriers to accessing health care services for the indigenous population in Rabinal, Guatemala] Las barreras de acceso a los servicios de salud en la población indígena de Rabinal en Guatemala. Author: Hautecoeur M; Zunzunegui MV; Vissandjee B Source: Salud Pública de México. 2007 Mar-Apr;49(2):86-93. Abstract: The objective was to identify and document access barriers to health care services for the indigenous population in Rabinal, Guatemala. A qualitative analysis was used. Over a period of two months, 20 semidirectional interviews were conducted in Rabinal, Guatemala: 15 with Achis indigenous people and five with health professionals. A focus group was done to verify the information collected during the individual interviews. The qualitative analysis was based on the transcription of interviews and the compilation of the data. Barriers to access are inter-relational. Geographic barriers include distance and a significant lack of means of transportation. Economic barriers are the cost of office visits and medicine. Among the cultural barriers, the Spanish language is an obstacle. Indigenous people have other concepts of medicine and treatments and they complain on occasion of abuse by health professionals. At the same time, health professionals recognize that the trauma of the civil war is still present and criticize the poor living conditions and the lack of resources. Health care services in Rabinal are inadequate and insufficient for responding to the needs of the local population. (author's) Spanish Abstract: Identificar y documentar las barreras de acceso a los servicios de salud en la población indígena de Rabinal en Guatemala. Se privilegió el análisis cualitativo y la recopilación de datos se realizó en Rabinal durante dos meses (Guatemala). Se realizaron quince entrevistas semi dirigidas a indígenas achís y cinco entrevistas a profesionales de la salud. Un grupo de discusión fue formado para validar la información recogida durante las entrevistas individuales; la retranscripción de éstas y la compilación de los datos permitieron hacer el análisis de contenido. Las barreras de acceso están interrelacionadas y las barreras geográficas están relacionadas con la distancia y con la escasez de transporte; las barreras económicas son los precios de las consultas y de los medicamentos, además, entre las barreras culturales, la lengua española es un obstáculo. Los indígenas tienen otra concepción de la medicina y de los tratamientos y se quejan en ocasiones de trato abusivo por parte de los profesionales sanitarios. A su vez, los profesionales de la salud reconocen que el trauma de la guerra está presente y critican las malas condiciones de vida y la falta de recursos. Los servicios de salud no son adecuados ni suficientes para responder a las necesidades de la población local. (del autor) Language: Spanish Keywords: GUATEMALA | RESEARCH REPORT | QUALITATIVE RESEARCH | INTERVIEWS | INDIGENOUS POPULATION | TRANSPORTATION | FEES | SOCIOECONOMIC FACTORS | HEALTH SERVICES | NEEDS | Central America | Latin America | Americas | Developing Countries | Research Methodology | Data Collection | Population Characteristics | Demographic Factors | Population | Economic Factors | Financial Activities | Delivery of Health Care | Health Document Number: 321574 |
| 30. Title: Community perspective of maternal mortality: Experience from Konduga local government area, Borno State, Nigeria. Author: Kawuwa MB; Mairiga AG; Usman HA Source: Annals of African Medicine. 2007;6(3):109-114. Abstract: High maternal mortality in Nigeria in particular and Sub-Saharan Africa in general has remained one of the key indicators of our poor health care services, infrastructural facilities and negative socio-cultural attitudes to healthy living. The objective is to identify barriers to prompt and effective treatment of obstetric complications leading to maternal mortality in order to develop appropriate strategies to address them at the community level. The study took place between 10th October and 10th December 2003. An in-depth interview guide developed by the network for the prevention of maternal mortality (NPMM), which contains mainly open ended questions, modified to suit our socio-cultural setting was used. There was a good understanding among the people of the area that women are dying during pregnancy, labour and puerperium. 28 (93.3%) of the respondents recognized some obstetric complications. The main obstacles to accessing the hospital for emergency obstetric care were lack of money and transportation difficulties. Equipping the health facilities, employment of qualified staff, community supported emergency funds for obstetric emergency and the provision of reliable, effective and affordable transport are identified as necessary measures to prevent maternal mortality. The Local Government Areas and community leaders are to champion the cause for the provision of these facilities in their localities. There is a good understanding of obstetric complications in the community leading to maternal death. The main reasons for delay in seeking care are ignorance, poverty, lack of transportation and distance. Community enlightenment, health education, training of TBAs, poverty reduction and effective, affordable and reliable transportation are means of obviating delays in the decision and transportation leading to maternal mortality. Upgrading and re-equipping of health facilities to provide emergency obstetric care services are mandatory. Community participation in the safe motherhood drive can be ensured using the traditional rulers, religious leaders and the Local Government Authority. (author's) Language: English Keywords: NIGERIA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | COMMUNITY | MATERNAL MORTALITY | OBSTETRICS | EMERGENCY SERVICES | UTILIZATION OF HEALTH CARE | OBSTACLES | TRANSPORTATION | DECISION MAKING | SAFE MOTHERHOOD | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Geographic Factors | Population | Residence Characteristics | Population Distribution | Mortality | Population Dynamics | Demographic Factors | Medicine | Health Services | Delivery of Health Care | Health | Organization and Administration | Economic Factors | Behavior | Maternal Health Document Number: 320302 |
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