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

3.
Title: An assessment of the knowledge, attitudes, and risk perceptions of pharmacy students regarding HIV/AIDS.
Author: Ahmed SI; Hassali MA; Aziz NA
Source: American Journal of Pharmaceutical Education. 2009 Feb 19;73(1):15.
Abstract: OBJECTIVE: To evaluate the level of knowledge, attitudes, and risk perceptions of University Sains Malaysia final-year pharmacy students regarding human immunodeficiency virus (HIV) and acquired immunity deficiency syndrome (AIDS). METHOD: A cross-sectional study among pharmacy students. Data were analyzed with Chi-square to find difference at p value < 0.05. RESULTS: The majority of students (83.07%) responded showing a difference in gender and race. Students showed low willingness (9.2%) to assist patients and low confidence (36.1%) in their education about HIV/AIDS patients. Students recommended HIV testing for health care professionals (69.4%) and patients (75.9%) before surgical procedures. Students knew little about Post Exposure Prophylaxis (18.5%) or about the time for HIV to develop into AIDS (57.4%). About 40% of students were unaware of the inability of antivirals to treat HIV/AIDS. Students had low awareness for opportunistic infections (18.5%), and low agreement on competency to treat and counsel HIV patients (12.9%). CONCLUSION: The study highlighted students' misconceptions, negative attitudes, and risk perceptions towards HIV/AIDS.
Language: English
Keywords:
MALAYSIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STUDENTS | PHARMACISTS | UNIVERSITIES | KNOWLEDGE | ATTITUDES | RISK FACTORS | PERCEPTION | HIV INFECTIONS | AIDS | TREATMENT | EXPOSURE | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Education | Health Personnel | Delivery of Health Care | Health | Schools | Sociocultural Factors | Psychological Factors | Behavior | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services
Document Number: 342691

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Title: Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR.
Author: Barennes H; Simmala C; Odermatt P; Thaybouavone T; Vallee J; Martinez-Aussel B; Newton PN; Strobel M
Source: European Journal of Clinical Nutrition. 2009 Mar;63(3):323-31.
Abstract: BACKGROUND/OBJECTIVE: To assess the traditional postpartum practices, mother and child nutritional status and associated factors. SUBJECTS/METHODS: A cross-sectional study in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR (Laos). 300 pairs of infants (< 6 months of age) and their mothers were enrolled. Information was collected about pregnancy, delivery and traditional practices through a standardized questionnaire. Dietary intake and food frequency were estimated using the 24 h recall method, calibrated bowls and FAO food composition tables. Mothers' and infants' anthropometry was assessed and multivariate analysis performed. RESULTS: Contrasting with a high antenatal care attendance (91%) and delivery under health professional supervision (72%), a high prevalence of traditional practices was found, including exposure to hot beds of embers (97%), use of traditional herb tea as the only beverage (95%) and restricted diets (90%). Twenty-five mothers (8.3%) were underweight. Mothers had insufficient intake of calories (55.6%), lipids (67.4%), iron (92.0%), vitamins A (99.3%) and C (45%), thiamin (96.6%) and calcium (96.6%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3-39.8 days) complementary food by 53.7% of mothers, and was associated with stunting in 10% children (OR=1.35, 95% CI:1.04-1.75). CONCLUSION: The high prevalence of traditional postpartum restricted diets and practices, and inadequate maternal nutritional intake in urban Laos, suggest that antenatal care may be an important opportunity to improve postpartum diets.
Language: English
Keywords:
LAOS | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | INFANT | CHILDREN | MOTHERS | FOOD AND BEVERAGE | DIET | CHILD NUTRITION | INFANT NUTRITION | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Nutrition | Health
Document Number: 341041

Peer Reviewed

Title: Second-trimester abortions and sex-selection of children in Hanoi, Vietnam.
Author: Belanger D; Oanh KT
Source: Population Studies. 2009 Jul;63(2):163-71.
Abstract: Because sex-selective abortions are generally conducted during the second term of the pregnancy, timing of abortion can be used as an indirect way of studying sex-selection by abortion. We examined the likelihood of having a first-trimester vs. second-trimester abortion among a group of 885 married women who had an abortion in an obstetric hospital in Hanoi in 2003. In the absence of sex-selection by abortion, the number and sex of living children should not affect the timing of abortion. Results indicate that women with more children, particularly those with more daughters or without a son, were more likely to undergo a second-term abortion than a first-term abortion. We estimate that, in 2003, 2 per cent of all abortions to women with at least one living child were intended to avoid the birth of a female.
Language: English
Keywords:
VIETNAM | URBAN AREAS | RESEARCH REPORT | ABORTION | CURRENTLY MARRIED | SONS | PREGNANCY, FIRST TRIMESTER | PREGNANCY, SECOND TRIMESTER | SEX PRESELECTION | SEX PREFERENCE | SEX RATIO | POPULATION POLICY | Asia, Southeastern | Asia | Developing Countries | Geographic Factors | Population | Fertility Control, Postconception | Family Planning | Marital Status | Nuptiality | Demographic Factors | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Pregnancy | Reproduction | Reproductive Technologies | Value Orientation | Psychological Factors | Behavior | Sex Distribution | Sex Factors | Population Characteristics | Social Policy | Policy | Political Factors
Document Number: 342945 Notification

Peer Reviewed

Title: Mother-to-child transmission of GB virus C in a cohort of women coinfected with GB virus C and HIV in Bangkok, Thailand.
Author: Bhanich Supapol W; Remis RS; Raboud J; Millson M; Tappero J; Kaul R; Kulkarni P; McConnell MS; Mock PA; McNicholl JM; Vanprapar N; Asavapiriyanont S; Shaffer N; Butera S
Source: Journal of Infectious Diseases. 2009 Jul 15;200(2):227-35.
Abstract: BACKGROUND: GB virus C (GBV-C) is an apathogenic virus that inhibits human immunodeficiency virus (HIV) replication in vitro. Mother-to-child transmission (MTCT) of GBV-C has been observed in multiple small studies. Our study examined the rate and correlates of MTCT of GBV-C in a large cohort of GBV-C-HIV-coinfected pregnant women in Thailand. METHODS: Maternal delivery plasma specimens from 245 GBV-C-HIV-infected women and specimens from their infants at 4 or 6 months of age were tested for GBV-C RNA. Associations with MTCT of GBV-C were examined using logistic regression. RESULTS: One hundred one (41%) of 245 infants acquired GBV-C infection. MTCT of GBV-C was independently associated with maternal antiretroviral therapy (adjusted odds ratio [AOR], 5.21 [95% confidence interval {CI}, 2.12-12.81]), infant HIV infection (AOR, 0.05 [95% CI, 0.01-0.26]), maternal GBV-C load (8.0 log(10) copies/mL: AOR, 86.77 [95% CI, 15.27-481.70]; 7.0-7.9 log(10) copies/mL: AOR, 45.62 [95% CI, 8.41-247.51]; 5.0-6.9 log(10) copies/mL: AOR, 9.07 [95% CI, 1.85-44.33]: reference, <5 log(10) viral copies/mL), and caesarean delivery (AOR, 0.26 [95% CI, 0.12-0.59]). CONCLUSIONS: Associations with maternal GBV-C load and mode of delivery suggest transmission during pregnancy and delivery. Despite mode of delivery being a common risk factor for virus transmission, GBV-C and HIV were rarely cotransmitted. The mechanisms by which maternal receipt of antiretroviral therapy might increase MTCT of GBV-C are unknown.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | COHORT ANALYSIS | MOTHERS | INFANT | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | HIV TESTING | PREGNANCY | RISK FACTORS | ANTIRETROVIRAL THERAPY | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Transmission | Infections | Diseases | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | HIV
Document Number: 342692

Peer Reviewed

Title: Independent association between rate of clearance of infection and clinical outcome of HIV-associated cryptococcal meningitis: analysis of a combined cohort of 262 patients.
Author: Bicanic T; Muzoora C; Brouwer AE; Meintjes G; Longley N; Taseera K; Rebe K; Loyse A; Jarvis J; Bekker LG; Wood R; Limmathurotsakul D; Chierakul W; Stepniewska K; White NJ; Jaffar S; Harrison TS
Source: Clinical Infectious Diseases. 2009 Sep 1;49(5):702-9.
Abstract: BACKGROUND: Progress in therapy for cryptococcal meningitis has been slow because of the lack of a suitable marker of treatment response. Previously, we demonstrated the statistical power of a novel endpoint, the rate of clearance of infection, based on serial quantitative cultures of cerebrospinal fluid, to differentiate the fungicidal activity of alternative antifungal drug regimens. We hypothesized that the rate of clearance of infection should also be a clinically meaningful endpoint. METHODS: We combined data from cohorts of patients with human immunodeficiency virus-associated cryptococcal meningitis from Thailand, South Africa, and Uganda, for whom the rate of clearance of infection was determined, and clinical and laboratory data prospectively collected, and explored the association between the rate of clearance of infection and mortality by Cox survival analyses. RESULTS: The combined cohort comprised 262 subjects. Altered mental status at presentation, a high baseline organism load, and a slow rate of clearance of infection were independently associated with increased mortality at 2 and 10 weeks. Rate of clearance of infection was associated with antifungal drug regimen and baseline cerebrospinal fluid interferon-gamma levels. CONCLUSIONS: The results support the use of the rate of clearance of infection or early fungicidal activity as a means to explore antifungal drug dosages and combinations in phase II studies. An increased understanding of how the factors determining outcome interrelate may help clarify opportunities for intervention.
Language: English
Keywords:
SOUTH AFRICA | THAILAND | UGANDA | RESEARCH REPORT | CLIENTS | MENINGITIS | HIV INFECTIONS | DRUGS | INTERVENTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Africa, Eastern | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342967

9.
Title: Causes of death in HIV-infected persons who have tuberculosis, Thailand.
Author: Cain KP; Anekthananon T; Burapat C; Akksilp S; Mankhatitham W; Srinak C; Nateniyom S; Sattayawuthipong W; Tasaneeyapan T; Varma JK
Source: Emerging Infectious Diseases. 2009 Feb;15(2):258-64.
Abstract: Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIV-infected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrug-resistant TB and 20 with disseminated TB; an HIV-associated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | CAUSES OF DEATH | AUTOPSY | ANTIRETROVIRAL THERAPY | DRUGS | PNEUMONIA | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Infections | Mortality | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Treatment | Pulmonary Effects | Physiology | Biology
Document Number: 341840

10.

Peer Reviewed

Title: AIDS and the stigma of sexual promiscuity: Thai nurses' risk perceptions ofoccupational exposure to HIV.
Author: Chan KY; Rungpueng A; Reidpath DD
Source: Culture, Health and Sexuality. 2009 May;11(4):353-368.
Abstract: This paper examines the culturally shaped meanings of AIDS and perceptions of accidental occupational exposure to HIV among a group of twenty nurses in Bangkok, Thailand. The findings are based on data collected as a part of a larger mixed-methods study that examined how perceptions of risk behaviours (including sexual promiscuity) shape health workers' perceptions of patients living with HIV/AIDS. Nurses' narratives revealed that despite acknowledgement of the low probability of occupational exposure to HIV, the fear of HIV infection remained and was largely driven by the enormity of the anticipated social (rather than the health) consequences of being HIV-positive. The perceived certainty of social ostracism was reinforced by participants' observations of the social rejection experienced by people living with HIV/AIDS both within and outside clinical settings. For female nurses, the dominant social perception that women living with HIV/AIDS were violators of gender norms, and thus 'guilty' victims, was an issue central to their self-identities. Ways of improving care for people living with HIV in the light of the nurses concerns and future research are discussed.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | KAP SURVEYS | MULTIPLE PARTNERS | NURSES AND NURSING | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | STIGMA | SEX BEHAVIOR | RISK BEHAVIOR | HIV TRANSMISSION | PERCEPTION | CULTURAL BACKGROUND | OCCUPATIONAL HEALTH | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Sexual Partners | Behavior | Health Personnel | Delivery of Health Care | Health | Economic Development | Economic Factors | HIV Infections | Viral Diseases | Diseases | Social Problems | Sociocultural Factors | Psychological Factors | Population Characteristics | Demographic Factors | Population
Document Number: 341088

11.

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

12.

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

13.
Title: HIV: time for the medical community to move forward [editorial]
Author: Chua AC
Source: Annals of the Academy of Medicine, Singapore. 2009 Feb;38(2):97-8.
Abstract: As we encourage more people to undergo HIV testing, it is important to understand the implications of an HIV diagnosis and to respect confidentiality and the voluntary consent process. Regarding HIV testing, 50% believe that it should be voluntary and 62.5% believe that mandatory HIV tests should be conducted on men who have sex with men (unpublished data -data available upon request from author). How do we begin to address these issues in our medical profession? We need sound policies and to challenge traditional medical education. (excerpt)
Language: English
Keywords:
SINGAPORE | SUMMARY REPORT | SCREENING | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HIV TESTING | HIV PREVENTION | TREATMENT | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH POLICY | INFORMED CONSENT | Asia, Southeastern | Asia | Developed Countries | Examinations and Diagnoses | Medical Procedures | Medicine | Health | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Policy | Political Factors | Sociocultural Factors
Document Number: 341548

15.

Peer Reviewed

Title: The epidemiology of human immunodeficiency virus infection, sexually transmitted infections, and associated risk behaviors among men who have sex with men in the Mekong Subregion and China: implications for policy and programming.
Author: de Lind van Wijngaarden JW; Brown T; Girault P; Sarkar S; van Griensven F
Source: Sexually Transmitted Diseases. 2009 May;36(5):319-24.
Abstract: BACKGROUND: Little systematic knowledge is available regarding risk behaviors and the prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) in populations of men having sex with men (MSM) in the Mekong Subregion and China. METHODS: Data on HIV/STI prevalence and risk behavior of MSM in the region were collected through Internet searches, were summarized and assessed for their policy and programming implications. RESULTS: Twenty-four articles, reports and abstracts of research studies were identified for review. High levels of HIV, STI and associated risk behavior were reported among MSM throughout the region. The HIV prevalence among MSM in urban areas varied between 5.5% and 28.3% in Thailand and Cambodia and between 0.0% and 9.4% in Vietnam and China. No HIV/STI prevalence data were available for Lao PDR and Myanmar. CONCLUSION: Levels of HIV/STI prevalence and risk behavior among MSM in the Mekong Subregion and China are high. Continued monitoring and surveillance and targeted preventive interventions are necessary to stop the spread of HIV in this vulnerable population.
Language: English
Keywords:
CHINA | VIETNAM | LAOS | CAMBODIA | MYANMAR | THAILAND | RESEARCH REPORT | DATA AGGREGATION | MEN HAVING SEX WITH MEN | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | SEX BEHAVIOR | EPIDEMIOLOGY | Asia, Eastern | Asia | Developing Countries | Asia, Southeastern | Research Methodology | Behavior | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Measurement | Public Health | Health
Document Number: 341442

16.

Peer Reviewed

Title: Utilization of skilled birth attendants in public and private sectors in Vietnam.
Author: Do M
Source: Journal of Biosocial Science. 2009 May;41(3):289-308.
Abstract: The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women's decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women's household wealth, education, antenatal care and community's wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | CHILDBIRTH | PRIVATE SECTOR | PUBLIC SECTOR | PROGRAM ACCESSIBILITY | SOCIOECONOMIC STATUS | Asia, Southeastern | Asia | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors
Document Number: 341399

17.
Title: Impact of a public antiretroviral program on TB/HIV mortality: Banteay Meanchey, Cambodia.
Author: Eng B; Cain KP; Nong K; Chhum V; Sin E; Roeun S; Kim S; Keo S; Heller TA; Varma JK
Source: Southeast Asian Journal of Tropical Medicine and Public Health. 2009 Jan;40(1):89-92.
Abstract: The WHO recommends antiretroviral therapy (ART) for most HIV-infected tuberculosis patients. To assess the impact of ART on tuberculosis case-fatality rates in Cambodia, we compared treatment outcomes of patients newly diagnosed with tuberculosis in 2004 (before implementation of ART clinics) with outcomes of patients diagnosed in 2005 (after these clinics opened). In 2004, 37% of HIV-infected tuberculosis patients died during TB treatment compared with 5% of HIV-uninfected tuberculosis patients. In 2005, 18% of HIV-infected tuberculosis patients died compared with 5% of HIV-uninfected tuberculosis patients. The case-fatality rate for HIV-associated tuberculosis decreased from 2004 to 2005, coincident with the introduction of ART.
Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | TESTING | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | Developing Countries | Asia, Southeastern | Asia | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Measurement | Research Methodology | Infections | HIV
Document Number: 341780

18.

Peer Reviewed

Title: Like parent, like child: Intergenerational transmission of partner violence in Cebu, the Philippines.
Author: Fehringer JA; Hindin MJ
Source: Journal of Adolescent Health. 2009 Apr;44(4):363-371.
Abstract: Purpose: This study investigates the prevalence of partner violence perpetration and receipt among a sample of young men and women in the Philippines, as well as the relationship between witnessing interparental violence during childhood and current violence in partnerships. Methods: We used 1994, 2002, and 2005 data from 472 married or cohabiting young adults from the Cebu Longitudinal Health and Nutrition Survey in Cebu, the Philippines. This is a longitudinal data set following more than 2000 Filipino women and their index children since the child's birth in 1983-1984. Results: Prevalence of partner violence perpetration was 55.8% for female and 25.1% for male respondents. Prevalence of victimization was 27.7% for females and 30.5% for males. In all, 45% of females and 50% of males reported having witnessed their parents/caretakers physically hurt one another during childhood. Multinomial logistic regression analysis showed that witnessing interparental violence significantly predicted report of violent act victimization and reciprocal violent acts. Greater parental joint decision making and being male were independently associated with a lower risk of report of both reciprocal violent acts and violent act victimization. Duration of marriage or cohabition was associated with report of violent act victimization and reciprocal violent acts. There were gender interaction effects for several factors, including mother's church attendance and household purchase of alcohol at age 11 years. Conclusions: Implications for further research and violence prevention programs include early intervention with adolescents and focus on gender differences in violence determinants.
Language: English
Keywords:
PHILIPPINES | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | LONGITUDINAL STUDIES | MULTIVARIATE ANALYSIS | SEXUAL PARTNERS | WOMEN IN DEVELOPMENT | CHILDREN | PARENTS | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | PREVALENCE | SEX FACTORS | RELIGION | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Sex Behavior | Behavior | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Crime | Social Problems | Measurement
Document Number: 341085

19.

Peer Reviewed

Title: Challenge and co-operation: civil society activism for access to HIV treatment in Thailand.
Author: Ford N; Wilson D; Cawthorne P; Kumphitak A; Kasi-Sedapan S; Kaetkaew S; Teemanka S; Donmon B; Preuanbuapan C
Source: Tropical Medicine and International Health. 2009 Mar;14(3):258-66.
Abstract: Civil society has been a driving force behind efforts to increase access to treatment in Thailand. A focus on HIV medicines brought civil society and non-governmental and government actors together to fight for a single cause, creating a platform for joint action on practical issues to improve care for people with HIV/AIDS (PHA) within the public health system. The Thai Network of People with HIV/AIDS, in partnership with other actors, has provided concrete support for patients and for the health system as a whole; its efforts have contributed significantly to the availability of affordable generic medicines, early treatment for opportunistic infections, and an informed and responsible approach towards antiretroviral treatment that is critical to good adherence and treatment success. This change in perception of PHA from 'passive receiver' to 'co-provider' of health care has led to improved acceptance and support within the healthcare system. Today, most PHA in Thailand can access treatment, and efforts have shifted to supporting care for excluded populations.
Language: English
Keywords:
THAILAND | PROGRESS REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | NONGOVERNMENTAL ORGANIZATIONS | ADVOCACY | PROGRAM ACCESSIBILITY | AIDS PREVENTION | TREATMENT | ANTIRETROVIRAL THERAPY | DELIVERY OF HEALTH CARE | USER COMPLIANCE | PERCEPTION | ACCEPTANCE PROCESS | Developing Countries | Asia, Southeastern | Asia | HIV Infections | Viral Diseases | Diseases | Organizations | Political Factors | Sociocultural Factors | Communication | Program Evaluation | Programs | Organization and Administration | AIDS | Medical Procedures | Medicine | Health Services | Health | HIV | Behavior | Psychological Factors | Decision Making
Document Number: 330957

20.

Peer Reviewed

Title: Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia.
Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W
Source: Studies in Family Planning. 2009 Mar;40(1):27-38.
Abstract: Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery-changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | COMMUNITY WORKERS | UTILIZATION OF HEALTH CARE | CHILDBIRTH | WOMEN'S HEALTH | PROGRAM ACCESSIBILITY | DECISION MAKING | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | TRADITIONAL BIRTH ATTENDANTS | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Program Evaluation | Programs | Organization and Administration | Behavior | Primary Health Care | Maternal Health Services | Maternal-Child Health Services
Document Number: 341081

21.
Peer Reviewed

Title: Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia.
Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W
Source: Studies In Family Planning. 2009 Mar;40(1):27-38.
Abstract: Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery--changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | FAMILY LIFE SURVEYS | WOMEN | MIDWIVES AND MIDWIFERY | ANTENATAL CARE | REPRODUCTIVE HEALTH | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southeastern | Asia | Family Research | Family and Household | Sociocultural Factors | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 341338

22.

23.

Peer Reviewed

Title: A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS.
Author: Genberg BL; Hlavka Z; Konda KA; Maman S; Chariyalertsak S; Chingono A; Mbwambo J; Modiba P; Van Rooyen H; Celentano DD
Source: Social Science and Medicine. 2009 Jun;68(12):2279-87.
Abstract: HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.
Language: English
Keywords:
THAILAND | TANZANIA | ZIMBABWE | SOUTH AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | STIGMA | SOCIAL DISCRIMINATION | ANTIRETROVIRAL THERAPY | KNOWLEDGE | HIV TESTING | Developing Countries | Asia, Southeastern | Asia | Africa, Eastern | Africa, Sub Saharan | Africa | Africa, Southern | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Social Problems | Sociocultural Factors | HIV | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342737

24.

Peer Reviewed

Title: Recent increase in sex ratio at birth in Viet Nam.
Author: Guilmoto CZ; Hoang X; Van TN
Source: PLoS One. 2009;4(2):e4624.
Abstract: INTRODUCTION: Since the 1980s, sex ratio at birth (male births per 100 female births) has increased in many Asian countries as a result of selective abortions, but to date there has been no such evidence for Viet Nam. Our aim in this paper is to ascertain the situation with respect to sex ratio at birth in Viet Nam over the past five years. MATERIALS AND METHODS: Original data were obtained from sample population surveys in Viet Nam recording annual birth rates since 2000 of about 450,000 women, as well as from two successive birth surveys conducted for the first time in 2007 (1.1 million births). The annual population surveys include specific information on birth history and mothers' characteristics to be used for the analysis of trends and differentials in sex ratio at birth. RESULTS AND DISCUSSION: Birth history statistics indicate that the SRB in Viet Nam has recorded a steady growth since 2001. Starting from a level probably close to the biological standard of 105, the SRB reached 108 in 2005 and 112 in 2006, a value significantly above the normal level. An independent confirmation of these results comes from the surveys of births in health facilities which yielded a SRB of 110 in 2006-07. High SRB is linked to various factors such as access to modern health care, number of prenatal visits, level of higher education and employment status, young age, province of residence and prenatal sex determination. These results suggest that prenatal sex determination followed by selective abortion has recently become more common in Viet Nam. This recent trend is a consequence of various factors such as preference for sons, declining fertility, easy access to abortion, economic development as well as the increased availability of ultrasonography facilities.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | DATA ANALYSIS | SONS | SEX RATIO | MATERNAL HEALTH SERVICES | EMPLOYMENT STATUS | SOCIOECONOMIC STATUS | ABORTION | EDUCATIONAL STATUS | ANTENATAL CARE | SEX PREFERENCE | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Sex Distribution | Sex Factors | Population Characteristics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors | Fertility Control, Postconception | Family Planning | Value Orientation | Psychological Factors | Behavior
Document Number: 331220 Notification

25.

Title: Posttest counseling and social support from health staff caring for HIV-infected pregnant women in Vietnam.
Author: Hanh NT; Rasch V; Chi BK; Gammeltoft T
Source: Journal of the Association of Nurses In AIDS Care. 2009 May-Jun;20(3):193-202.
Abstract: Women with HIV who want to have children face a range of challenges, quandaries, and hard decisions. This article examines the role of health staff in supporting HIV-infected pregnant women who desire to maintain their pregnancies. The article is derived from anthropological research conducted in Vietnam's Quang Ninh Province, an area that has a high HIV prevalence rate and is covered under the government's prevention of mother-to-child transmission program. The study included in-depth interviews with 23 HIV-infected women who had either recently given birth or were pregnant at the time of the research. Results showed that women were satisfied with the services they received from the program. The women believed that health care staff offered them not only medical care but also social and emotional support. The article concludes that the health care system is a vital point of support for pregnant women with HIV.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | PRE-POST TESTS | HEALTH PERSONNEL | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | CARE AND SUPPORT | SOCIAL NETWORKS | COUNSELING | Asia, Southeastern | Asia | Developing Countries | Program Evaluation | Programs | Organization and Administration | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Health Services | Friends and Relatives | Family and Household | Sociocultural Factors | Clinic Activities | Program Activities
Document Number: 342070

26.
Peer Reviewed

Title: Development of a framework for evaluating the sustainability of community-based dengue control projects.
Author: Hanh TT; Hill PS; Kay BH; Quy TM
Source: American Journal of Tropical Medicine and Hygiene. 2009 Feb;80(2):312-8.
Abstract: There are currently no frameworks developed specifically for assessing community-based dengue control project sustainability. We first review the literature for frameworks for assessing project sustainability and second validate the framework criteria against the oldest community-based intervention using Mesocyclops in Xuan Phong commune, Nam Dinh province, north Vietnam, the subject of an intervention in 1998-2000. The framework used 13 criteria, clustered into three categories: 1) maintenance of health benefits from the original project, 2) continued delivery of community activities, and 3) human resource development. To provide consistency between criteria and to allow comparison both over time and with non-intervention communes, a five-point scale for each criterion was used, with the overall sustainability score calculated as the mean of all criteria. The framework offers a practical tool for assessing sustainability, and is amenable to adaptation for specific interventions without compromising the framework as a whole.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | LITERATURE REVIEW | EVALUATION | DENGUE | COMMUNITY-BASED DISTRIBUTION | PROGRAM SUSTAINABILITY | PREVENTION AND CONTROL | Asia, Southeastern | Asia | Developing Countries | Viral Diseases | Diseases | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 330140

27.

Peer Reviewed

Title: Change in contraceptive methods following the Yogyakarta earthquake and its association with the prevalence of unplanned pregnancy.
Author: Hapsari ED; Widyawati; Nisman WA; Lusmilasari L; Siswishanto R; Matsuo H
Source: Contraception. 2009 Apr;79(4):316-22.
Abstract: BACKGROUND: This study was conducted to examine access to contraception and change in contraceptive methods before and after the disaster in Bantul area, and to evaluate the prevalence of unplanned pregnancy. STUDY DESIGN: In total, 450 married women participated. Questionnaires, which included participants' background, contraceptive methods, difficulties in accessing contraceptive method, and unplanned pregnancy, were completed. RESULTS: Within 1 year of the disaster, the percentage of participants who used injections and implants tended to decrease, while the percentage of participants who used pills tended to increase. Use of coitus interruptus significantly increased after the disaster. The prevalence of unplanned pregnancy was significantly higher in a group of participants who had difficulty accessing contraceptive methods compared to a group that did not. CONCLUSIONS: Health personnel should not only actively deliver contraceptive methods in a disaster situation but also educate couples to prevent unplanned pregnancy.
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | PREVALENCE | PREGNANCY, UNPLANNED | CONTRACEPTION FAILURE | NATURAL DISASTERS | CHANGES | Developing Countries | Asia, Southeastern | Asia | Measurement | Research Methodology | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Usage | Contraception | Family Planning | Environment | Social Change | Sociocultural Factors
Document Number: 330555

28.

Title: Application of evidence-based teaching in maternal and child health in remote Vietnam.
Author: Hirst JE; Jeffery HE; Morris J; Foster K; Elliott EJ
Source: International Journal of Gynaecology and Obstetrics. 2009 Feb;104(2):152-5.
Abstract: OBJECTIVE: To develop, implement, and evaluate an evidence-based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam. METHODS: Needs assessments identified prevention of infection, neonatal resuscitation, and prevention of postpartum hemorrhage as primary targets. A 3-day workshop based on the small group, interactive, skills-based SCORPIO method was developed. Participants underwent formative written and performance-based assessments. Qualitative and quantitative evaluation of course content and teaching method was conducted. RESULTS: Two annual workshops were conducted for 58 health professionals, all of whom demonstrated skills acquisition to an adequate standard on completion. The workshops were rated as good or excellent overall by 100% of the participants, who reported that the content would help with their clinical work and that the teaching method was acceptable and easy to understand. CONCLUSION: We demonstrated the SCORPIO method can be adapted to teach knowledge and clinical skills in remote Vietnam. Further work is needed to demonstrate an effect on health outcomes.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | NEEDS ASSESSMENT | POSTPARTUM WOMEN | BLEEDING | HEALTH EDUCATION | CHILD HEALTH | MATERNAL HEALTH | Asia, Southeastern | Asia | Developing Countries | Evaluation | Puerperium | Reproduction | Signs and Symptoms | Diseases | Education | Health
Document Number: 330824

29.

Title: Strong association between birth month and reproductive performance of Vietnamese women.
Author: Huber S; Fieder M
Source: American Journal of Human Biology. 2009 Jan-Feb;21(1):25-35.
Abstract: Epidemiological studies on premodern and modern Western societies indicate that birth season may influence female reproduction. Nothing is known, however, about this effect in developing economies. Many of the latter are characterised by tropical climates with a rainy season associated with lower food availability and a greater prevalence of infectious diseases. We therefore predict that an association between birth month and reproductive output, if it exists, should be related to the rainy season. To test this prediction, we analysed census data of Vietnam obtained from IPUMS-International (Vietnam 1999 Population and Housing Census). Based on 493,853 women born between 1950 and 1977 and thus aged 22 to 49 years, we found that the time series of mean offspring count per month of birth has a highly significant period of 12 months (power = 46.871, P < 0.00001). Our results further indicate that the 12-month periodic signal has a maximum in July and a minimum in January. Accordingly, the peak corresponds to birth during the rainy season, the low if the third pregnancy month concurs with the rainy season. The month of birth is therefore clearly associated with the later reproductive performance of Vietnamese women, strongly supporting the assumption that environmental and maternal conditions during early development exert long-term effects on reproductive functioning. Provided the rainy season adversely affects developmental processes due to inadequate food and/or high infection risk, the association reported here points to a critical period of reproductive development during early pregnancy.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | EPIDEMIOLOGY | CENSUS | WOMEN | REPRODUCTIVE BEHAVIOR | TIME FACTORS | SEASONAL VARIATION | CLIMATE | CHILDBIRTH | FOOD SECURITY | Asia, Southeastern | Asia | Developing Countries | Public Health | Health | Population Statistics | Research Methodology | Demographic Factors | Population | Fertility | Population Dynamics | Environment | Pregnancy Outcomes | Pregnancy | Reproduction | Food Supply | Natural Resources
Document Number: 330492

30.

Title: Confidential inquiries into maternal deaths: Modifications and adaptations in Ghana and Indonesia.
Author: Hussein J; D'Ambruoso L; Armar-Klemesu M; Achadi E; Arhinful D; Izati Y; Ansong-Tornui J
Source: International Journal of Gynaecology and Obstetrics. 2009 May 8;
Abstract: OBJECTIVE: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia. METHODS: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected. RESULTS: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours. CONCLUSION: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners.
Language: English
Keywords:
GHANA | INDONESIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | CONFIDENTIAL INFORMATION | MATERNAL MORTALITY | PERCEPTION | MOTIVATION | TIME FACTORS | PREGNANCY COMPLICATIONS | ECONOMIC FACTORS | AUTOPSY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Research Methodology | Economic Development | Population Characteristics | Demographic Factors | Population | Ethics | Sociocultural Factors | Mortality | Population Dynamics | Psychological Factors | Behavior | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341454


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