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2.
Title: Contraceptive use among postpartum women - 12 states and New York City, 2004-2006.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Aug 7;58(30):821-6.
Abstract: Postpartum use of highly effective contraceptive methods can prevent unintended pregnancies and ensure adequate birth spacing. Unintended pregnancies and short interpregnancy intervals are associated with adverse maternal and infant outcomes. In 2001, the year for which the most recent data are available, 49% of all pregnancies were unintended, and 21% of women gave birth within 24 months of a previous birth. Two Healthy People 2010 goals are to increase the percentage of intended pregnancies to 70% (objective 9-1) and to reduce the percentage of births occurring within 24 months of a previous birth to 6% (objective 9-2). To estimate the prevalence and types of contraception being used by women 2-9 months postpartum, CDC analyzed data from the 2004-2006 Pregnancy Risk Assessment Monitoring System (PRAMS) from 12 states and New York City. This report summarizes those results, which indicated that 88.0% of postpartum women reported current use of at least one contraceptive method; 61.7% reported using a method defined as highly effective, 20.0% used a method defined as moderately effective, and 6.4% used less effective methods. Rates of using highly effective contraceptive methods postpartum were lowest among Asian/Pacific Islanders (35.3%), women who had wanted to get pregnant sooner (49.9%), women aged >or=35 years (53.0%), and women who had no prenatal care (54.5%). State policy makers and health-care providers can use these results to promote use of highly effective contraception among postpartum women and target interventions for those with particularly low rates of usage, including women with no prenatal care.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | DATA ANALYSIS | POSTPARTUM WOMEN | ETHNIC GROUPS | CDC | CONTRACEPTIVE USAGE | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE EFFECTIVENESS | PREGNANCY, UNPLANNED | AGE FACTORS | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Research Methodology | Puerperium | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Public Assistance | Grants | Financial Activities | Economic Factors
Document Number: 342395

Title: The U.S. commitment to global health: Recommendations for the public and private sectors.
Author: Institute of Medicine. Committee on the U.S. Commitment to Global Health
Source: Washington, D.C., Institute of Medicine, 2009 May. 4 p. (Report Brief)
Abstract: In 2008, the Institute of Medicine convened the expert Committee on the U.S. Commitment to Global Health to investigate the U.S. commitment to global health and to articulate a vision for future U.S. investments in this arena. The committee concludes that the U.S. government and U.S.-based commercial entities, foundations, universities, and other nonprofit organizations have an opportunity to improve global health. The committee initially issued an interim report with recommendations aimed specifically at the U.S. government, such as prioritizing global health as a pillar of foreign policy. This subsequent report addresses other sectors as well as government. The committee identifies five areas for action by the interdisciplinary team: 1. Scale-up existing interventions to achieve significant health gains; 2. Generate and share knowledge to address problems prevalent in poor countries; 3. Invest in people, institutions, and capacity building with global partners; 4. Increase U.S. financial commitments to global health; 5. Set the example of engaging in respectful partnerships. (Excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | RECOMMENDATIONS | GOVERNMENT | ORGANIZATIONS | PRIVATE SECTOR | HEALTH | FOREIGN AID | CAPACITY BUILDING | KNOWLEDGE | LEADERSHIP | INTERNATIONAL COOPERATION | Developed Countries | North America | Americas | Political Factors | Sociocultural Factors | Macroeconomic Factors | Economic Factors | Financial Activities | Program Sustainability | Programs | Organization and Administration
Document Number: 331419

Title: Global action for health system strengthening: Policy recommendations to the G8 Task Force on Global Action for Health System Strengthening.
Author: Japan Center for International Exchange. Task Force on Global Action for Health System Strengthening
Source: Tokyo, Japan, Japan Center for International Exchange, 2009. 131 p.
Abstract: On January 16, 2009, a high-level working group on global health convened by the Japan Center for International Exchange (JCIE) released a report to the Japanese government outlining measures that the G8 countries should take to set them on a path toward fulfilling their existing commitments to contributing to an overall improvement in the health of individuals and communities around the world. The Working Group on Challenges in Global Health and Japan's Contributions (the "Takemi Working Group") is chaired by Japan's former Senior Vice Minister for Health, Labour and Welfare Keizo Takemi and directed by JCIE President Tadashi Yamamoto. The Japanese government will pass the report to the Italian government, encouraging them to put these recommendations on the agenda of the 2009 G8 Summit in Italy. The report includes chapters by an international team of researchers and advisors on three specific building blocks of health systems-health financing, health information, and the health workforce-that are generally acknowledged to be critical components of any strong health system. While each paper offers specific recommendations for improvements that can be made in each individual building block, they also come to several common conclusions: 1.) While there is still a dire need for more resources-financial, human, and knowledge resources-in the global health field, there is also a critical need to use existing resources more efficiently and more effectively. Recognizing that the current global financial environment will make it even more difficult to secure the resources needed to make health systems work better for everyone, the paper writers recommend complementing the quest for more resources with creative thinking on ways to achieve better health outcomes with the resources we already have. 2.) The human security concept, which has become a pillar of Japan's foreign policy, is identified as a promising approach that can be adopted globally for strengthening health systems. Human security's emphasis on the wellbeing of individuals and communities is very much in line with the ultimate goal of health system strengthening: improving people's health and making health services available to all so that they can be healthy, productive members of society. Human security also responds to the complexity of health system strengthening with its focus on integrating community empowerment with protection strategies and its recognition of the dynamic way in which health is interconnected with many other human security challenges. 3.) In all areas of health system strengthening, donor countries tend to tell their partners in developing countries how they should behave and make decisions. This can lead to confusion, with contradicting instructions often coming from multiple donors and even from single donors, and loss of motivation for stakeholders in partner countries to take ownership of processes to improve their own health sectors. Contributing to this challenge, capacity for making informed decisions on health is often weak, further discouraging domestic decision making in planning and management of health systems. The paper writers all recommend that donor countries invest in capacity building for health sector decision making at the national and local levels and, at the same time, encourage stakeholders in partner countries to drive their own planning and implementation processes. 4.) Finally, the paper writers all recommend that the G8 follow through on its commitment to accountability by establishing an annual review of its activities and accomplishments within each of these three building blocks. (excerpt)
Language: English
Keywords:
GLOBAL | DEVELOPING COUNTRIES | CONFERENCES AND CONGRESSES | RECOMMENDATIONS | SYSTEMS ANALYSIS | HEALTH PERSONNEL | LABOR FORCE | HEALTH POLICY | FOREIGN AID | CAPACITY BUILDING | GOVERNMENT FINANCING | INFORMATION SERVICES | PRIMARY HEALTH CARE | INTERNATIONAL COOPERATION | COORDINATION | Research Methodology | Delivery of Health Care | Health | Human Resources | Economic Factors | Policy | Political Factors | Sociocultural Factors | Financial Activities | Program Sustainability | Programs | Organization and Administration | Information | Health Services
Document Number: 328416

Title: Voluntary population planning activities -- supplemental requirements (January 2009) [letter]
Author: United States. Agency for International Development [USAID]. Bureau for Management. Office of Acquisition and Assistance
Source: Washington, D.C., USAID, Bureau for Management, Office of Acquisition and Assistance, 2009 Jan 26. [5] p.
Abstract: The purpose of this letter is to amend the Standard provisions of all grants and cooperative agreements involving any aspect of voluntary population planning activities and which contain the provision VOLUNTARY POPULATION PLANNING ACTIVITIES - SUPPLEMENTAL REQUIREMENTS (May 2006). This provision is deleted and replaced by the new provision VOLUNTARY POPULATION PLANNING ACTIVITIES - SUPPLEMENTAL REQUIREMENTS (January 2009) which removes the conditions relating to the Mexico City Policy that were set forth in the May 2006 version of the provision. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | GOVERNMENT PUBLICATION | RECOMMENDATIONS | EVALUATION | POLICYMAKERS | USAID | STANDARDIZATION | GRANTS | POPULATION POLICY | FAMILY PLANNING PROGRAM EVALUATION | INCENTIVES | FAMILY PLANNING POLICY | CONTRACEPTIVE AGENTS | ABORTION LAW | STERILIZATION, SEXUAL | Administrative Personnel | Organization and Administration | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Data Adjustment | Research Methodology | Financial Activities | Economic Factors | Social Policy | Policy | Family Planning Programs | Family Planning | Contraception | Fertility Control, Postconception
Document Number: 331346 Notification

Title: Celebrating life: The U.S. President's Emergency Plan for AIDS Relief. 2009 Annual Report to Congress.
Author: United States. Office of the United States Global AIDS Coordinator
Source: Washington, D.C., Office of the United States Global AIDS Coordinator, 2009. 64 p.
Abstract: The fifth Annual Report celebrates life. In countless communities around the world, through partnerships with the American people, courageous individuals in nations devastated by HIV/AIDS are choosing life, saving the lives of their fellow countrymen and women, and creating hope for a future free of HIV/AIDS. Through the power of these partnerships, the American people and the dedicated men and women in nations devastated by HIV/ AIDS have proven that the seemingly impossible is possible.
Language: English
Keywords:
DEVELOPING COUNTRIES | ANNUAL REPORT | EVALUATION | POLICYMAKERS | PROGRAM EVALUATION | AIDS PREVENTION | HIV PREVENTION | ANTIRETROVIRAL THERAPY | FOREIGN AID | INTERNATIONAL COOPERATION | TREATMENT | GOVERNMENT FINANCING | INTERVENTIONS | Administrative Personnel | Organization and Administration | Programs | AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Financial Activities | Economic Factors | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328418

Title: Sexual and reproductive health and HIV linkages: evidence review and recommendations.
Author: World Health Organization [WHO]; United Nations Population Fund [UNFPA]; International Planned Parenthood Federation [IPPF]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; University of California, San Francisco. Global Health Sciences
Source: Geneva, Switzerland, WHO, 2009 Apr. [8] p.
Abstract: The importance of linking sexual and reproductive health (SRH) and HIV is widely recognized. The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to SRH and HIV prevention, treatment, care and support. In order to gain a clearer understanding of the effectiveness, optimal circumstances, and best practices for strengthening SRH and HIV linkages, a systematic review of the literature was conducted. The findings corroborate the many benefits gained from linking SRH and HIV policies, systems and services. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CLIENTS | HIV TESTING | COUNSELING | HIV PREVENTION | FAMILY PLANNING | MATERNAL HEALTH | SEXUALLY TRANSMITTED DISEASE PREVENTION | CHILD HEALTH | MANAGEMENT | KNOWLEDGE | ATTITUDES | STIGMA | BEHAVIOR | FEES | HIV/FP INTEGRATION | INTERVENTIONS | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Sociocultural Factors | Psychological Factors | Social Problems | Financial Activities | Economic Factors
Document Number: 331466

Title: The economic burden of HIV and AIDS on households in Nigeria.
Author: Adedigba MA; Naidoo S; Abegunde A; Olagundoye O; Adejuyigbe E; Fakande I
Source: African Journal of AIDS Research. 2009 Apr;8(1):107-114.
Abstract: The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness ( 2 = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | SAMPLING STUDIES | HOUSEHOLDS | AIDS | HIV INFECTIONS | ECONOMIC FACTORS | EXPENDITURES | INCOME | POVERTY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Financial Activities | Socioeconomic Factors
Document Number: 341292

10.
Title: Counsellors are human [letter]
Author: Anand V
Source: Indian Journal of Medical Ethics. 2009 Jul-Sep;6(3):169-70.
Abstract: This letter touches on the subject of the medical knowledge of physicians in India. It first discusses male circumcision and then moves on to India not having an established system for sharing medical information and updates. It asks that better systems of regularly updating the medical knowledge of Indian physicians be developed.
Language: English
Keywords:
INDIA | CRITIQUE | PROVIDERS WITH CLIENTS | MALE CIRCUMCISION | KNOWLEDGE | INFORMED CONSENT | FEES | INFORMATION DISTRIBUTION | Asia, Southern | Asia | Developing Countries | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Sociocultural Factors | Financial Activities | Economic Factors | Communication
Document Number: 342876

11.

12.

Peer Reviewed

Title: Incidence and correlates of 'catastrophic' maternal health care expenditure in India.
Author: Bonu S; Bhushan I; Rani M; Anderson I
Source: Health Policy and Planning. 2009 Aug 17;
Abstract: Using data from the 60(th) round of the National Sample Survey of India (2004), the study investigates the incidence and correlates of 'catastrophic' maternal expenditure (ME) in India. Data on ME come from 6879 births that took place during 365 days prior to the survey. The study adapts earlier definitions and methods for catastrophic total health care expenditure to measure 'catastrophic' ME as: (i) maternal health care expenditure more than 10% of the annual normative household consumption expenditure (ME-1), and (ii) maternal health care expenditure more than 40% of the annual 'capacity to pay' (ME-2). The 'capacity to pay' was derived by subtracting state-wise poverty-line household expenditure from household consumption expenditure. The average maternal expenditure varied by place of delivery: US$9.5, US$24.7 and US$104.3 for birth at home, in a public facility and in a private facility, respectively. Sixteen per cent of households incurred ME of more than 10% of total household consumption expenditure (ME-1), while 51% households incurred ME of more than 40% of household 'capacity to pay' (ME-2). While incidence of ME-1 increased with income decile, the reverse was observed for ME-2, reflecting higher non-utilization of institutional maternal care and its non-affordability among poorer households. All the households from the poorest decile and 99% from the second poorest decile paid more than 40% of their capacity to pay. Multivariate regression results indicate that antenatal care and delivery care in private facilities increased the chances of ME-1 and ME-2 (P < 0.001). Measuring maternal expenditure against 'capacity to pay' (ME-2) may be better than measuring it as a proportion of overall household expenditure when assessing financial constraints in the use of maternal services. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase utilization of maternal services and reduce the financial distress associated with ME.
Language: English
Keywords:
INDIA | RESEARCH REPORT | EXPENDITURES | INCIDENCE | MATERNAL HEALTH | UTILIZATION OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | FEES | Asia, Southern | Asia | Developing Countries | Financial Activities | Economic Factors | Measurement | Research Methodology | Health | Health Services | Delivery of Health Care | Primary Health Care
Document Number: 342553

13.
Peer Reviewed

Title: Financial barriers to HIV treatment in Yaounde, Cameroon: first results of a national cross-sectional survey.
Author: Boyer S; Marcellin F; Ongolo-Zogo P; Abega SC; Nantchouang R; Spire B; Moatti JP
Source: Bulletin of the World Health Organization. 2009 Apr;87(4):279-87.
Abstract: OBJECTIVE: To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaounde, Cameroon. METHODS: Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaounde) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months. FINDINGS: Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/microl; P = 0.04). CONCLUSION: Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection.
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | FEES | ANTIRETROVIRAL THERAPY | OBSTACLES | TREATMENT | ANTIRETROVIRAL DRUGS | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Financial Activities | Economic Factors | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation
Document Number: 342978

14.

Title: Zambia: National long term forecasting and quantification for family planning commodities, 2009-2015.
Author: Bwembya M; Mbewe RK
Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009. 23 p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: In December 2008, the Ministry of Health (MOH) and the Society for Family Health (SFH), with technical assistance from the USAID | DELIVER PROJECT, conducted a national long term quantification of contraceptive needs from 2009 -2015. The quantification's overall objective was to calculate the contraceptive requirements for each year of the forecast period and to use those requirements to mobilize resources for the country to support contraceptive commodity security. This report presents the findings of the quantification as well as the methodology used and assumptions made to arrive at these findings.
Language: English
Keywords:
ZAMBIA | SUMMARY REPORT | RESEARCH METHODOLOGY | TECHNICAL ASSISTANCE | USAID | NEEDS ASSESSMENT | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE SECURITY | COLD CHAIN | LOGISTICS | FUNDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Programs | Organization and Administration | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Evaluation | Contraceptive Usage | Contraception | Family Planning | Contraceptive Availability | Management | Financial Activities | Economic Factors
Document Number: 331474

15.

Peer Reviewed

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

16.

17.

Peer Reviewed

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

18.

Peer Reviewed

Title: A global fund for the health MDGs?
Author: Cometto G; Ooms G; Starrs A; Zeitz P
Source: Lancet. 2009 May 2;373(9674):1500-2.
Abstract: The world is off track to achieve the health-related targets of the Millennium Development Goals (MDGs) by 2015. Maternal mortality has stagnated for two decades, child mortality is not declining fast enough, HIV/AIDS still infects people faster than the pace of antiretroviral treatment roll-out, and inequalities are widening within and across countries. Addressing these crises will require increased funding and more efficient spending. The next Board meetings of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance, scheduled for May and June, respectively, present an opportunity to tackle these issues. We propose that the exceptional approach created for the fight against AIDS should be expanded: the entire global health agenda must adopt a rights-based approach, which in some countries requires challenging the model of national financial autonomy. We therefore recommend that the Global Fund and the GAVI Alliance gradually move towards becoming a global fund for all the health MDGs, which will require substantially greater resources to address the broader mandate. As a first step the next Global Fund and GAVI Alliance board meetings should expand the review of their architecture to provide greater support to national health plans, including co-financing non-disease-specific human resources for health. A global fund for the health MDGs would eventually allow the delivery of prevention and treatment services for specific diseases through revamped general health services, reducing transaction costs and streamlining the global health architecture. Such radical, yet rational, action is our best chance of meeting-or at least making significant progress toward-the health-related MDG targets by 2015.
Language: English
Keywords:
DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | POLICYMAKERS | GOALS | DEVELOPMENT POLICY | HEALTH POLICY | FUNDS | FOREIGN AID | INTERNATIONAL COOPERATION | COORDINATION | WHO | Administrative Personnel | Organization and Administration | Planning | Policy | Political Factors | Sociocultural Factors | Financial Activities | Economic Factors | UN | International Agencies | Organizations
Document Number: 341099

19.

Title: Global health and the Bill & Melinda Gates Foundation [letter]
Author: Dabade G; Puliyel J
Source: Lancet. 2009 Jun 27;373(9682):2195-6.
Abstract: David McCoy and colleagues note that half of all Gates Foundation funding goes towards vaccination. US$1.5 billion provided by the Gates Foundation and some donor countries go to fund the GAVI Alliance's "advance marketing commitments" to purchase vaccines and provide them at subsidised costs in developing countries. The advance marketing commitments for pneumococcal vaccine illustrate the problem with this policy quite lucidly. Madhi and colleagues have calculated that 1000 children have to be vaccinated to prevent approximately four cases of pneumonia. Given that the vaccine costs $250 per child, $250 000 will be spent to prevent these four cases of pneumonia. Treatment of four children with pneumonia with oral cotrimoxazole, in accordance with the WHO protocol, will cost $1 in India. The hope that GAVI's funding of vaccines would push down their prices has been belied. One review found that prices actually went up after GAVI funding, meaning that the higher costs are borne by poor nations when GAVI funding is withdrawn. Entering into advance commitments to market this vaccine in developing countries allows GAVI to divert Gates Foundation money to vaccine manufacturers, without providing commensurate benefits to the children it is supposed to help. We agree with McCoy and colleagues that, given the substantial public subsidies that the foundation receives in the form of tax exemptions, its programmes must be subjected to public scrutiny. (full-text)
Language: English
Keywords:
GLOBAL | CRITIQUE | FUNDS | DECISION MAKING | HEALTH POLICY | DISEASE PREVENTION | VACCINES | PROGRAM ACTIVITIES | RESEARCH AND DEVELOPMENT | INTERNATIONAL COOPERATION | Financial Activities | Economic Factors | Behavior | Policy | Political Factors | Sociocultural Factors | Prevention and Control | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Technology
Document Number: 342052

21.

Title: Funding cuts threaten women's access to contraception. UN warns that global economic crisis may hit reproductive health services around the world.
Author: Ford L
Source: Guardian. 2009 Apr 8;:[2] p. Posting to Katine Chronicles blog.
Abstract: The article highlights the fears that the current financial crisis will lead to a shortfall in development financing available for family planning and in turn adversely affect the ability of developing nations to meet their Millenium Development Goals to improve women's wealth.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | NEEDS ASSESSMENT | REPRODUCTIVE HEALTH | FAMILY PLANNING | FUNDS | PROGRAM ACTIVITIES | Evaluation | Health | Financial Activities | Economic Factors | Programs | Organization and Administration
Document Number: 331361

22.
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

23.
Title: [A fixed dose anti-HIV combination for the poor? Triomune] Triom une: la tritherapie du pauvre ?
Author: Garcia MV; Mukeba-Tshialala D; Vaira D; Moutschen M
Source: Revue Medicale De Liege. 2009 Jan;64(1):32-6.
Abstract: Despite a relative global stabilization of its incidence, HIV infection remains a major threat for public health, principally in Africa where it concerns more than 22 million people and constitutes the first cause of death on the continent. To face the emergency of the HIV/AIDS epidemics on the African continent, the primary goal is to make available to all patients free and efficient antiretroviral medications. Such a goal cannot be dissociated from large scale prevention campaigns. In 2000, Triomune, one of the first fixed dose combinations of three antiretrovirals (stavudine, lamivudine & nevirapine) was launched by the Indian drug company Cipla, specialized in the production of low cost medications. Its convenient pill burden (one pill twice a day) and its very low cost (around 30 US $ per month) make Triomune an appealing solution for the treatment of HIV/AIDS in Africa. Unfortunately, Triomune presents several drawbacks (low genetic barrier, frequent side effects) and one of its constituents is not used in Europe anymore. Other first line treatments are urgently needed.
Language: French
Keywords:
AFRICA | RESEARCH REPORT | INCIDENCE | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | HIV INFECTIONS | FEES | NEEDS ASSESSMENT | PREVENTION AND CONTROL | TREATMENT | PROGRAM ACCESSIBILITY | Developing Countries | Measurement | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341155

24.

Title: The social context of childcare practices and child malnutrition in Niger's recent food crisis.
Author: Hampshire K; Casiday R; Kilpatrick K; Panter-Brick C
Source: Disasters. 2009 Mar;33(1):132-51.
Abstract: In 2004-05, Niger suffered a food crisis during which global attention focused on high levels of acute malnutrition among children. In response, decentralised emergency nutrition programmes were introduced into much of southern Niger. Child malnutrition, however, is a chronic problem and its links with food production and household food security are complex. This qualitative, anthropological study investigates pathways by which children are rendered vulnerable in the context of a nutritional 'emergency'. It focuses on household-level decisions that determine resource allocation and childcare practices in order to explain why practices apparently detrimental to children's health persist. Risk aversion, the need to maintain self-identity and status, and constrained decision making result in a failure to invest extra necessary resources ingrowth-faltering children. Understanding and responding to the social context of child malnutrition will help humanitarian workers to integrate their efforts more effectively with longer-term development programmes aimed at improving livelihood security.
Language: English
Keywords:
NIGER | RESEARCH REPORT | CLINICAL RESEARCH | CHILDREN | HOUSEHOLDS | CHILD NUTRITION | MALNUTRITION | FAMINE | DECENTRALIZATION | NUTRITION PROGRAMS | ANTHROPOLOGY, CULTURAL | DECISION MAKING | RESOURCE ALLOCATION | HOME ECONOMICS | CHILD CARE | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Nutrition | Health | Nutrition Disorders | Diseases | Food Supply | Natural Resources | Environment | Political Factors | Primary Health Care | Health Services | Delivery of Health Care | Anthropology | Social Sciences | Science | Behavior | Financial Activities | Economic Factors | Microeconomic Factors | Child Rearing
Document Number: 331289

25.

Peer Reviewed

Title: Enhancing HIV prevention requires addressing the complex relationship between prevention and treatment.
Author: Henderson K; Worth H; Aggleton P; Kippax S
Source: Global Public Health. 2009;4(2):117-30.
Abstract: Globally each year, HIV continues to infect millions of people, and the number of people living with HIV and AIDS grows. While there has been an increase in funding for HIV and AIDS, there is a growing gap between the funds available and the funds needed for both prevention and treatment. Yet, one of the means of closing that gap - preventing new infections - has slipped down the agenda. In arguing for a significant intensification of the HIV prevention response, and the relevance of a strong social stance within this response, this paper addresses the need to manage finding a balance between prevention and treatment and care. Not only is there not enough being spent on HIV prevention, but also in some instances, the prevention agenda has been hijacked by those who favour morally conservative, but ineffective, HIV prevention strategies. We argue that effective prevention needs to be firmly located within the everyday realities affecting communities and societies, and needs to focus on what is known to work. In particular, we need to move beyond a public health underpinned by neo-liberal notions of agency and individual responsibility to a public health that recognises the collective nature of epidemics, and works with communities and networks to transform social relations. This latter, more 'social' public health, is concerned with the social, political and economic factors that produce HIV risk and responses to it. Contrary to what some might suggest, HIV prevention has not failed, rather, governments and donors have failed HIV prevention.
Language: English
Keywords:
GLOBAL | CRITIQUE | AIDS PREVENTION | HIV PREVENTION | EPIDEMICS | FUNDS | PROGRAM EFFECTIVENESS | PUBLIC HEALTH | ANTIRETROVIRAL THERAPY | AIDS | HIV Infections | Viral Diseases | Diseases | Financial Activities | Economic Factors | Program Evaluation | Programs | Organization and Administration | Health | HIV
Document Number: 341398

26.

27.

Peer Reviewed

Title: Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study.
Author: Huy R; Wichmann O; Beatty M; Ngan C; Duong S; Margolis HS; Vong S
Source: BMC Public Health. 2009;9:155.
Abstract: BACKGROUND: The average annual reported dengue incidence in Cambodia is 3.3/1,000 among children < 15 years of age (2002-2007). To estimate the economic burden of dengue, accurate cost-of-illness data are essential. We conducted a prospective, community-based, matched case-control study to assess the cost and impact of an episode of dengue fever and other febrile illness on households in rural Cambodia. METHODS: In 2006, active fever surveillance was conducted among a cohort of 6,694 children aged < or = 15 years in 16 villages in Kampong Cham province, Cambodia. Subsequently, a case-control study was performed by individually assigning one non-dengue febrile control from the cohort to each laboratory-confirmed dengue case. Parents of cases and controls were interviewed using a standardized questionnaire to determine household-level, illness-related expenditures for medical and non-medical costs, and estimated income loss (see Additional file 1). The household socio-economic status was determined and its possible association with health seeking behaviour and the ability to pay for the costs of a febrile illness. RESULTS: Between September and November 2006, a total of 60 household heads were interviewed: 30 with dengue-positive and 30 with dengue-negative febrile children. Mean total dengue-related costs did not differ from those of other febrile illnesses (31.5 vs. 27.2 US dollars, p = 0.44). Hospitalization almost tripled the costs of dengue (from 14.3 to 40.1 US dollars) and doubled the costs of other febrile illnesses (from 17.0 to 36.2 US dollars). To finance the cost of a febrile illness, 67% of households incurred an average debt of 23.5 US dollars and higher debt was associated with hospitalization compared to outpatient treatment (23.1 US dollars vs. 4.5 US dollars, p < 0.001). These costs compared to an average one-week expenditure on food of 9.5 US dollars per household (range 2.5-21.3). In multivariate analysis, higher socio-economic status (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4-13.2), duration of fever (OR 2.1; 95%CI 1.3-3.5), and age (OR 0.8; 95%CI 0.7-0.9) were independently associated with hospitalization. CONCLUSION: In Cambodia, dengue and other febrile illnesses pose a financial burden to households. A possible reason for a lower rate of hospitalization among children from poor households could be the burden of higher illness-related costs and debts.
Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | PROSPECTIVE STUDIES | RURAL POPULATION | DENGUE | FEVER | FEES | HOUSEHOLDS | MICROECONOMIC FACTORS | MORBIDITY | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Body Temperature | Physiology | Biology | Financial Activities | Economic Factors | Family and Household | Sociocultural Factors
Document Number: 342904

28.
Peer Reviewed

Title: Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India.
Author: Iyengar SD; Iyengar K; Suhalka V; Agarwal K
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):303-12.
Abstract: A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.
Language: English
Keywords:
INDIA | RURAL AREAS | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | WOMEN | CHILDBIRTH | FEES | TRADITIONAL HEALTH PRACTICES | OBSTETRICS | OXYTOCIN | INTERVIEWS | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Demographic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Financial Activities | Economic Factors | Culture | Sociocultural Factors | Medicine | Health Services | Delivery of Health Care | Health | Pituitary Hormones | Hormones | Endocrine System | Physiology | Biology | Data Collection
Document Number: 341927

29.

Peer Reviewed

Title: Fragile, threatened, and still urgently needed: family planning programs in Sub-Saharan Africa.
Author: Jacobstein R; Bakamjian L; Pile JM; Wickstrom J
Source: Studies in Family Planning. 2009 Jun;40(2):147-154.
Abstract: Many family planning (FP) programs in sub-Saharan Africa are fragile; recent performance has fallen off and future performance is challenged. Yet robust and wellfunctioning FP programs are still urgently needed if countries are to meet their health, equity, poverty-alleviation, and economic development goals. In support of these observations, we present data on FP parameters in sub- Saharan Africa overall and in eight of its countries, including Nigeria, the most populous African country; Kenya, a long-time leader in FP in the region; and Uganda, with fertility among the highest in Africa and a population projected to more than triple in the next 40 years to become sub-Saharan Africa's fourth-most-populous country. We also draw upon findings of individual case studies of the contraceptive programs of Ghana (Solo et al. 2005c), Malawi (Solo et al. 2005a), Senegal (Wickstrom et al. 2006), Tanzania (Pile and Simbakalia 2006), and Zambia (Solo et al. 2005b), as well as a synthesis of some of these case studies (ACQUIRE Project 2005). All eight of these countries, which together comprise 40 percent of the population of sub-Saharan Africa, are facing the same difficult dynamics in terms of threat and need.
Language: English
Keywords:
AFRICA, SUB SAHARAN | CRITIQUE | DEMOGRAPHIC AND HEALTH SURVEYS | FAMILY PLANNING PROGRAMS | NEEDS | CONTRACEPTIVE USAGE | TOTAL FERTILITY RATE | FERTILITY PREFERENCES | DECENTRALIZATION | FUNDS | URBANIZATION | POVERTY | FOOD SECURITY | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Family Planning | Economic Factors | Contraception | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Political Factors | Sociocultural Factors | Financial Activities | Urban Population Distribution | Population Distribution | Geographic Factors | Socioeconomic Factors | Food Supply | Natural Resources | Environment
Document Number: 341898

30.
Title: Baseline survey on functioning of abortion services in government approved CAC centers in three pilot districts of Nepal.
Author: Karki C; Ojha M; Rayamajhi RT
Source: Kathmandu University Medical Journal. 2009 Jan- Mar;7(25):31-9.
Abstract: BACKGROUND: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. OBJECTIVE: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. MATERIALS AND METHODS: Direct observation of the functioning of these centers, assessment of physical facilities and service provider's skill was done. At the same time service provider's attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. RESULT: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. CONCLUSION: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | ABORTION | PILOT PROJECTS | HEALTH PERSONNEL | HEALTH SERVICES EVALUATION | FEES | ATTITUDES | KNOWLEDGE | EQUIPMENT AND SUPPLIES | Developing Countries | Asia, Southern | Asia | Fertility Control, Postconception | Family Planning | Studies | Research Methodology | Delivery of Health Care | Health | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Psychological Factors | Behavior | Sociocultural Factors | Medical Procedures | Medicine | Health Services
Document Number: 342477 Notification


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