1.  Title: Kangaroo mother care for low birth weight babies: a prospective observational study. Source: Journal of Nepal Paediatric Society. 2009 Jan-Jun;29(1):6-9. Abstract: Introduction: Kangaroo Mother Care is the low cost, humane technique for caring low birth weight babies by direct skin to contact with the mother. Objective: The Prospective observational study was done to see the effect of KMC especially on weight gain on low birth weight babies weighing 2000 grams or less at Special Care Baby Unit of Paropakar Maternity and Women's hospital, Kathmandu. Method: The study was conducted in Special Care Baby Unit (SCBU) of Paropakar Maternity and Women's Hospital over 7 months period May 2007 to Nov. 2008 (from Baishakh 2064 to Kartik 2065). The method of care consisted of skin to skin contact between the mother and the infant. Result: It was observed that babies had good weight gain of average 30gms/day and had short duration of hospital stay of average 9 days. Babies had less morbidities like hypothermia, apnea, skin infections and oral thrush.100% babies had exclusive breast feeding and KMC was acceptable to mothers. Conclusion: Kangaroo Mother Care shows early and good weight gain in low birth weight babies. It is simple, low cost technique and well acceptable by mother and family and can be continued at home. Language: English Keywords: NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | INFANT | LOW BIRTH WEIGHT | TREATMENT | INFANT HEALTH | GESTATIONAL AGE | BREASTFEEDING, EXCLUSIVE | COST EFFECTIVENESS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Birth Weight | Body Weight | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Child Health | Fetus | Pregnancy | Reproduction | Breastfeeding | Infant Nutrition | Nutrition | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 341512 |
| 2. Title: Assessment of family planning services in Kenya: Evidence from the 2004 Kenya Service Provision Assessment Survey. Author: Agwanda A; Khasakhala A; Kimani M Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [51] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 4) Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Abstract: This study focused on factors associated with the readiness of Kenyan health facilities to provide quality and appropriate care to family planning clientele; the degree to which health care providers foster informed selection of an appropriate contraceptive method; and the extent to which clients perceive services to be of high quality. Data was obtained from the 2004 Kenya Service Provision Assessment. The composite indicators scores for facility readiness were generally low and many facilities lacked simple items like visual aids, guidelines, towels, speculum, etc. There were marked differences in facility readiness by region, facility type, and managing authority. Provider service provision scores were generally high but the only important difference was by region. Client satisfaction was dependent on the facility type, managing authority, sex of the provider, and the waiting time to receive services. Clients were more likely to be satisfied with female rather than male providers. Clients were less satisfied in Nyanza, although the facilities were more ready with high-performing providers. In contrast, North Eastern Province had less ready facilities, but high client satisfaction and high provider performance. Health centre, clinics, and dispensaries need to be revamped to appropriate standards so as to include all basic elements of family planning service provision. North Eastern Province, with motivated workers, highly satisfied clients but poor facilities, deserves proper attention. Facilities in Nairobi need improvements in staff supervision and retraining. There is need to educate the clientele on the availability of appropriate services within the government facilities. Language: English Keywords: KENYA | RESEARCH REPORT | RECOMMENDATIONS | HEALTH SURVEYS | KAP SURVEYS | EVALUATION INDEXES | FAMILY PLANNING PERSONNEL CHARACTERISTICS | FAMILY PLANNING PERSONNEL EVALUATION | FAMILY PLANNING PROGRAM EVALUATION | PERCEPTION | HUMAN GEOGRAPHY | SATISFACTION | SEX FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Family Planning Personnel | Family Planning Programs | Family Planning | Psychological Factors | Behavior | Geography | Social Sciences | Science | Sociocultural Factors | Population Characteristics | Demographic Factors | Population Document Number: 329890 |
3.  Peer Reviewed Title: Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. Author: Allen RH; Fitzmaurice G; Lifford KL; Lasic M; Goldberg AB Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):276-83. Abstract: OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I. Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | EVALUATION INDEXES | KAP SURVEYS | PREGNANT WOMEN | ANESTHESIA | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ADMINISTRATION AND DOSAGE | PAIN | SIDE EFFECTS | SATISFACTION | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Drugs | Signs and Symptoms | Diseases | Psychological Factors | Behavior Document Number: 330360 Notification |
| 4. Peer Reviewed Title: Impact of the Family Health Project on infant mortality in Brazilian municipalities. Author: Aquino R; de Oliveira NF; Barreto ML Source: American Journal of Public Health. 2009 Jan;99(1):87-93. Abstract: The authors evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level. They collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. They performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables. The authors observed a statistically significant negative association between FHP coverage and infant mortality rate. After controlling for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period. The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | INFANT | URBAN POPULATION | INFANT MORTALITY | AGE SPECIFIC DEATH RATE | PRIMARY HEALTH CARE | HEALTH STATUS INDEXES | INEQUALITIES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Death Rate | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors Document Number: 328585 |
| 5. Peer Reviewed Title: Universal voluntary HIV testing and immediate antiretroviral therapy [letter] Author: Assefa Y; Lera M Source: Lancet. 2009 Mar 28;373(9669):1080; author reply 1080-1. Abstract: Reuben Granich and colleagues use mathematical models to show that annual screening of most adults for HIV, with immediate commencement of antiretroviral therapy for all infected, would strikingly reduce HIV incidence. The findings are very interesting. We would like to share our lessons from Ethiopia. Ethiopia had a millennium AIDS campaign with the objective of increasing the number of people tested for HIV through universal voluntary counselling and testing and providing antiretroviral treatment for eligible patients. We were able to increase the number of people tested in 1 year from 560 000 in 2005/06 to 4.6 million in 2007/08. The number of patients started on antiretroviral therapy per month increased from 3500 to more than 5700. Even though we accomplished a lot in terms of HIV testing and antiretroviral therapy provision, we had challenges during the rapid scale-up of these services. We learnt that mass testing is very resource-intensive and needs a strong health system, including adequate human resources and a continuous supply of commodities. As a result, our current guiding principle is "high yield" and "high impact" through targeted testing of most-at-risk populations: patients with tuberculosis or sexually transmitted diseases, and pregnant women. Universal voluntary HIV testing and antiretroviral therapy provision might be effective in reducing HIV transmission, but with the current health system constraints in many sub-Saharan African countries such as Ethiopia, it is really not feasible to practise it. We recommend "high yield" and "high impact" HIV testing with early initiation of antiretroviral therapy, and improved adherence and retention of patients in care and treatment. (full-text) Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | RESEARCH PROPOSAL | THEORETICAL MODELS | COST BENEFIT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | BEST PRACTICES | HIV PREVENTION | PUBLIC HEALTH | TIME FACTORS | COST EFFECTIVENESS | ETHICS | NOTIFICATION | Studies | Research Methodology | Quantitative Evaluation | Evaluation | HIV Infections | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Health | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Sociocultural Factors | Political Factors Document Number: 330977 |
| 6. Peer Reviewed Title: "Conditional scholarships" for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa. Author: Barnighausen T; Bloom DE Source: Social Science and Medicine. 2009 Feb;68(3):544-51. Abstract: Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | MARKOV CHAIN | LABOR FORCE | HEALTH PERSONNEL | HUMAN RESOURCES | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | AIDS | COST BENEFIT ANALYSIS | MANAGEMENT | Africa | Developing Countries | Probability | Statistical Studies | Studies | Research Methodology | Economic Factors | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Organization and Administration Document Number: 330870 |
| 7. Title: On what diseases and health conditions should new economic research on health and development focus? Author: Behrman JR; Behrman JA; Perez NM Source: Health Economics. 2009 Apr;18 Suppl 1:S109-28. Abstract: Given the public goods nature of research, economic research on health in developing countries is likely to have the highest returns by focusing, inter alia, on diseases and health conditions that are relatively widespread and costly and that are relatively rapidly growing. This article first summarizes the time patterns in economic research on diseases and health in developing countries for 1990-2005. It then compares those time patterns with the distribution of disability-adjusted life years (DALYs) for diseases and health conditions in developing countries estimated for 2005 and for 2030. These comparisons suggest relatively overemphasis on HIV/AIDS and underemphasis on noncommunicable diseases (NCDs). This opens the possibility for individuals or organizations initiating, re-evaluating, or increasing their economic research on health and development to make a significant contribution by focusing particularly on the analysis of behaviour and policy choices related to NCDs. Careful consideration must, of course, be given to other demands, but on the basis of these two criteria, potential contributions are likely to be greatest from research with such a focus. Language: English Keywords: GLOBAL | CRITIQUE | LITERATURE REVIEW | RESEARCH ACTIVITIES | ECONOMICS | ECONOMIC DEVELOPMENT | HEALTH | HIV INFECTIONS | DISEASES | INTERVENTIONS | COST BENEFIT ANALYSIS | LENGTH OF LIFE | Research Methodology | Social Sciences | Science | Sociocultural Factors | Economic Factors | Viral Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 341823 |
| 8. Peer Reviewed Title: Expanding antiretroviral options in resource-limited settings--a cost-effectiveness analysis. Author: Bendavid E; Wood R; Katzenstein DA; Bayoumi AM; Owens DK Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):106-13. Abstract: BACKGROUND: Current World Health Organization (WHO) guidelines for treatment of HIV in resource-limited settings call for 2 antiretroviral regimens. The effectiveness and cost-effectiveness of increasing the number of antiretroviral regimens is unknown. METHODS: Using a simulation model, we compared the survival and costs of current WHO regimens with two 3-regimen strategies: an initial regimen of 3 nucleoside reverse transcriptase inhibitors followed by the WHO regimens and the WHO regimens followed by a regimen with a second-generation boosted protease inhibitor (2bPI). We evaluated monitoring with CD4 counts only and with both CD4 counts and viral load. We used cost and effectiveness data from Cape Town and tested all assumptions in sensitivity analyses. RESULTS: Over the lifetime of the cohort, 25.6% of individuals failed both WHO regimens by virologic criteria. However, when patients were monitored using CD4 counts alone, only 6.5% were prescribed additional highly active antiretroviral therapy due to missed and delayed detection of failure. The life expectancy gain for individuals who took a 2bPI was 6.7-8.9 months, depending on the monitoring strategy. When CD4 alone was available, adding a regimen with a 2bPI was associated with an incremental cost-effectiveness ratio of $2581 per year of life gained, and when viral load was available, the ratio was $6519 per year of life gained. Strategies with triple-nucleoside reverse transcriptase inhibitor regimens in initial therapy were dominated. Results were sensitive to the price of 2bPIs. CONCLUSIONS: About 1 in 4 individuals who start highly active antiretroviral therapy in sub-Saharan Africa will fail currently recommended regimens. At current prices, adding a regimen with a 2bPI is cost effective for South Africa and other middle-income countries by WHO standards. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | COST EFFECTIVENESS | MONITORING | WHO | IMMUNOLOGICAL EFFECTS | LIFE EXPECTANCY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Evaluation Indexes | Quantitative Evaluation | Evaluation | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342908 |
| 9. Title: Targeted screening and treatment for latent tuberculosis infection using QuantiFERON-TB Gold is cost-effective in Mexico. Author: Burgos JL; Kahn JG; Strathdee SA; Valencia-Mendoza A; Bautista-Arredondo S; Laniado-Laborin R; Castaneda R; Deiss R; Garfein RS Source: International Journal of Tuberculosis and Lung Disease. 2009 Aug;13(8):962-8. Abstract: OBJECTIVE: To assess the cost-effectiveness of screening for latent tuberculosis infection (LTBI) using a commercially available detection test and treating individuals at high risk for human immunodeficiency virus (HIV) infection in a middle-income country. DESIGN: We developed a Markov model to evaluate the cost per LTBI case detected, TB case averted and quality-adjusted life year (QALY) gained for a cohort of 1000 individuals at high risk for HIV infection over 20 years. Baseline model inputs for LTBI prevalence were obtained from published literature and cross-sectional data from tuberculosis (TB) screening using QuantiFERON-TB Gold In-Tube (QFT-GIT) testing among sex workers and illicit drug users at high risk for HIV recruited through street outreach in Tijuana, Mexico. Costs are reported in 2007 US dollars. Future costs and QALYs were discounted at 3% per year. Sensitivity analyses were performed to evaluate model robustness. RESULTS: Over 20 years, we estimate the program would prevent 78 cases of active TB and 55 TB-related deaths. The incremental cost per case of LTBI detected was US$730, cost per active TB averted was US$529 and cost per QALY gained was US$108. CONCLUSIONS: In settings of endemic TB and escalating HIV incidence, targeting LTBI screening and treatment among high-risk groups may be highly cost-effective. Language: English Keywords: MEXICO | RESEARCH REPORT | SCREENING | TUBERCULOSIS | COST EFFECTIVENESS | TREATMENT | North America | Americas | Developing Countries | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 342957 |
| 10. Title: Correlates of in-law conflict and intimate partner violence against Chinese pregnant women in Hong Kong Author: Chan KL; Tiwari A; Fong DY; Leung WC; Brownridge DA; Ho PC Source: Journal of Interpersonal Violence. 2009 Jan;24(1):97-110. Abstract: This study examines correlates of in-law conflict with intimate partner violence (IPV) against pregnant women in a cohort of Chinese pregnant women who visited antenatal clinics in Hong Kong. This was a territory-wide, cross-sectional study of 3,245 pregnant women recruited from seven hospitals in Hong Kong. Participants were invited to complete the Chinese Abuse Assessment Screen and a demographic questionnaire. About 9% of the pregnant women reported having been abused by their partners in the preceding year. In-law conflict was the characteristic most significantly associated with preceding-year abuse against pregnant women, after controlling for covariates. Findings underscore the need to obtain information on in-law conflict as a risk factor for IPV. In-law conflict should be included in the assessment of risk for IPV. For the prevention of IPV, family-based intervention is needed to work with victims as well as in-laws. Language: English Keywords: HONG KONG | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | EVALUATION INDEXES | DEMOGRAPHIC SURVEYS | EPIDEMIOLOGIC METHODS | PREGNANT WOMEN | SEXUAL PARTNERS | WOMEN IN DEVELOPMENT | EXTENDED FAMILY | VIOLENCE AGAINST WOMEN | DOMESTIC VIOLENCE | FAMILY RELATIONSHIPS | PREVALENCE | RISK FACTORS | Asia, Eastern | Asia | Developed Countries | Research Methodology | Quantitative Evaluation | Evaluation | Population Dynamics | Demographic Factors | Population | Population Characteristics | Sex Behavior | Behavior | Economic Development | Economic Factors | Family Characteristics | Family and Household | Sociocultural Factors | Crime | Social Problems | Measurement | Biology Document Number: 328410 |
| 11. Title: Affordability--the forgotten criterion in health-care priority setting [editorial] Author: Cleary SM; McIntyre D Source: Health Economics. 2009 Apr;18(4):373-5. Abstract: The authors argue both for the importance of mathematical programming as a technique for the economic evaluation of alternative HIV-treatment strategies in South Africa and affordability as a criterion in priority setting. The consequences of not considering affordability, efficiency and equity issues are likely to be a very heavy burden on the health budget and a large opportunity cost in terms of other interventions. Language: English Keywords: SOUTH AFRICA | CRITIQUE | HEALTH POLICY | GOALS | ANTIRETROVIRAL THERAPY | COST EFFECTIVENESS | PROGRAM EFFICIENCY | ECONOMICS | RESOURCE ALLOCATION | ETHICS | PROGRAM APPROPRIATENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Policy | Political Factors | Sociocultural Factors | Planning | Organization and Administration | HIV | HIV Infections | Viral Diseases | Diseases | Evaluation Indexes | Quantitative Evaluation | Evaluation | Program Evaluation | Programs | Social Sciences | Science | Financial Activities | Economic Factors Document Number: 341832 |
| 12. Peer Reviewed Title: Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger. Author: Dale NM; Grais RF; Minetti A; Miettola J; Barengo NC Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):126-30. Abstract: OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs. Language: English Keywords: NIGER | UNITED STATES OF AMERICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CLASSIFICATION | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | EVALUATION INDEXES | CHILDREN | GROWTH | MALNUTRITION | STANDARDS | HEALTH STATUS INDEXES | WHO | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Development | Biology | Nutrition Disorders | Diseases | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors Document Number: 330228 |
| 13. Peer Reviewed Title: Economic analysis of HIV prevention interventions in Andhra Pradesh state of India to inform resource allocation. Author: Dandona L; Kumar SG; Kumar GA; Dandona R Source: AIDS. 2009 Jan 14;23(2):233-42. Abstract: OBJECTIVE: To conduct composite economic analysis of HIV prevention interventions to inform efficient utilization of resources in India. METHODS: We obtained output and economic cost data for the 2005-2006 fiscal year from a representative sample of 128 public-funded HIV prevention programmes of 14 types in Andhra Pradesh state of India. Using data from various sources, we developed a model to estimate the number of HIV infections averted. We estimated the additional HIV infections that could be averted if each intervention reached optimal coverage and the associated cost. RESULTS: In a year, 9688 HIV infections were averted by public-funded HIV prevention interventions in Andhra Pradesh. Scaling-up interventions to the optimal level would require US$38.8 million annually, 2.8 times the US$13.8 million economic cost in 2005-2006. This could increase the number of HIV infections averted by 2.4-fold, if with higher resources there were many-fold increases in the proportional allocation for programmes for migrant labourers, men who have sex with men and voluntary counselling and testing, and reduction of the high proportion for mass media campaigns to one-third of the 2005-2006 proportion of resource utilization. If the proportions of resource allocation for interventions remained similar to 2005-2006, the higher resources would avert 54% of the additional avertable HIV infections. CONCLUSION: The recent four-fold increase in public funding for HIV/AIDS control in India should be adequate to scale-up HIV prevention interventions to an optimal level in Andhra Pradesh, but the prevention would be suboptimal if additional investments were not preferentially directed to some particular interventions. Language: English Keywords: INDIA | RESEARCH REPORT | INTERVENTIONS | HIV INFECTIONS | COST BENEFIT ANALYSIS | ECONOMIC FACTORS | RESOURCE ALLOCATION | FUNDS | FINANCIAL ACTIVITIES | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation Document Number: 330502 |
| 14. Title: Women, contraception, and consent to research participation [editorial] Author: Ding EL; Nagda SR Source: Journal of Women's Health. 2009 Apr;18(4):439-41. Abstract: This editorial piece explores women's Willingness To Participate (WTP) in clinical research. The sufficient inclusion of women in clinical research remains a challenge due to research participation conflicting with women's contraceptive behaviors and is further complicated by the potential risk of harm to a fetus. Language: English Keywords: UNITED STATES OF AMERICA | METHODOLOGICAL STUDIES | CRITIQUE | RECOMMENDATIONS | STUDY DESIGN | PILOT PROJECTS | WOMEN | INFORMED CONSENT | SEX FACTORS | GENDER ISSUES | CONTRACEPTION RESEARCH | PARTICIPATION | CONTRACEPTIVE METHODS CHOSEN | PERCEPTION | COST EFFECTIVENESS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Population Characteristics | Sociocultural Factors | Contraception | Family Planning | Social Behavior | Behavior | Contraceptive Usage | Psychological Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 330976 |
| 15. Peer Reviewed Title: Estimation of the predictive role of plasma viral load on CD4 decline in HIV-1 subtype C-infected subjects in India. Author: Ding M; Tarwater P; Rodriguez M; Chatterjee R; Ratner D; Yamamura Y; Roy P; Mellors J; Neogi D; Chen Y; Gupta P Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):119-25. Abstract: BACKGROUND: Plasma viral load has been shown to be a meaningful prognostic marker for disease progression in untreated, HIV-1 subtype B-infected subjects in United States and Western Europe and therefore used as a prognostic marker for disease progression. Because of high expenses of commercially available viral load assays, the role of viral load in disease progression has not been evaluated in HIV-1 subtype C-infected patients in India. METHODS: We developed an inexpensive real-time reverse transcriptase-polymerase chain reaction assay to quantify viral load in plasma of HIV-1 subtype C-infected subjects from India and used it in a longitudinal analysis of viral load and CD4 cell number in HIV-infected subjects from Calcutta, India. RESULTS: The real-time reverse transcriptase-polymerase chain reaction assay can quantify plasma viral load with a linear range of detection from 10 to 10 HIV-1 RNA copies per input. Longitudinal analysis of viral load in a cohort of 39 subjects over an average period of approximately 3 years indicates that 1-log increase in HIV-1 RNA level was associated with a decline of 67 CD4 cell count. Furthermore, HIV-1 RNA level between 500 and 50,000 copies per milliliter would predict a 12.9% decrease in CD4 cell count per year, whereas HIV-1 RNA levels above 50,000 copies HIV-1 RNA per milliliter would predict a 25.3% decrease in CD4 cells per year. In addition, we estimated that the mean incubation period of disease development, as defined by the loss of CD4 below 200, is 8.2 years. CONCLUSION: Our report on the level of viral load on predicting CD4 decline in Indian subjects with HIV-1 provides an additional important tool to the physicians for treating and planning a therapeutic strategy to control HIV-1 infection in India. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | ESTIMATION TECHNIQUES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | HIV INFECTIONS | COST EFFECTIVENESS | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNITY, CELLULAR | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology Document Number: 330366 |
| 16. Peer Reviewed Title: Cost savings from the provision of specific methods of contraception in a publicly funded program. Author: Foster DG; Rostovtseva DP; Brindis CD; Biggs MA; Hulett D; Darney PD Source: American Journal of Public Health. 2009 Mar;99(3):446-51. Abstract: OBJECTIVES: We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955,000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. METHODS: We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. RESULTS: More than half of the 178,000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. CONCLUSIONS: All contraceptive methods were cost-effective-they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | COST EFFECTIVENESS | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | INJECTABLES | BARRIER METHODS | IUD | CONTRACEPTIVE IMPLANTS | Developed Countries | North America | Americas | Evaluation Indexes | Quantitative Evaluation | Evaluation | Contraception | Family Planning Document Number: 330488 |
| 17. Peer Reviewed Title: Tubal sterilization by laparoscopy or hysteroscopy: which is the most cost-effective procedure? Author: Franchini M; Cianferoni L; Lippi G; Calonaci F; Calzolari S; Mazzini M; Florio P Source: Fertility and Sterility. 2009 Apr;91(4 Suppl):1499-502. Abstract: By using the activity-based cost/management (ABC/M) system we computed and compared costs needed for laparoscopic tubal sterilization (LTS) and Essure hysteroscopic tubal occlusion (EHTO). We found that total health costs related to consultation and presurgery did not differ between LTS and EHTO; EHTO has low recovery unit costs but is more costly for the operating theater, mainly due to Essure microinserts. Language: English Keywords: UNITED STATES OF AMERICA | ITALY | RESEARCH REPORT | WOMEN | TUBAL LIGATION | FEMALE STERILIZATION | SURGERY | COST BENEFIT ANALYSIS | TREATMENT | DELIVERY OF HEALTH CARE | MANAGEMENT | LOGISTICS | SCREENING | PROGRAM EFFICIENCY | Developed Countries | North America | Americas | Europe, Southern | Europe | Demographic Factors | Population | Sterilization, Sexual | Family Planning | Medical Procedures | Medicine | Health Services | Health | Quantitative Evaluation | Evaluation | Organization and Administration | Examinations and Diagnoses | Program Evaluation | Programs Document Number: 341007 |
| 18. Title: A prospective study evaluating clinical outcomes and costs of three NNRTI-based HAART regimens in Kerala, India. Author: George C; Yesoda A; Jayakumar B; Lal L Source: Journal of Clinical Pharmacy and therapeutics. 2009 Feb;34(1):33-40. Abstract: OBJECTIVE: This prospective, observational, study evaluates the clinical outcomes, drug utilization patterns, and adherence to treatment of patients on highly active anti retroviral therapy (HAART) at a government institution in Kerala, India. METHODS: Patients who met criteria for treatment of HIV/AIDS were enrolled into the study, given free NNRTI-based combination therapy, and were followed for a period of 6 months. Data regarding demographics, clinical outcome, laboratory results, drug utilization, adherence and adverse effects were collected. Analysis was conducted utilizing descriptive statistics, anova, Fisher-exact, andt-test. RESULTS: One hundred and forty-two patients with HIV-1 were enrolled in the study into three treatment groups. The mean age was 37.88 years, 64% of the patients were male, and 92% were married. Group 1 was given zidovudine, lamivudine, and nevirapine [n = 52 (37%)], group 2 was given lamivudine, stavudine, and nevirapine [n = 51 (36%)], and group 3 was given lamivudine, stavudine, and efavirenz [n = 39 (27%)]. The increase in CD4 was 107.46 (SD: 106.25). Mean medication adherence for the 104 patients who completed the study, was 90.7%; for group 1: 92.06%, group 2: 93.37%1, and group 3: 85.71% (P > 0.05). Forty (38%) patients have at least one adverse event to HARRT, with headache being the most common side effect (11.5%). Mortality rate was 3.5% during the course of the study. CONCLUSION: Provision of free NNRTI-based combination therapy to patients in Kerala, India, resulted in greater than 90% adherence leading to better clinical outcomes in terms of increasing CD4 counts and low mortality, for patients consistently attending a treatment clinic. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | COST BENEFIT ANALYSIS | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | COST EFFECTIVENESS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | HEADACHE | SIDE EFFECTS | DEATH RATE | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Evaluation Indexes | HIV | Behavior | Signs and Symptoms | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 330372 |
| 19. Title: Monitoring HIV epidemics: declines in prevalence do not always mean good news [editorial] Author: Hallett T Source: AIDS. 2009 Jan 2;23(1):131-2. Abstract: The future of HIV epidemic monitoring is likely to rely on HIV prevalence for many years to come. After years of intensive research, direct measurements of incidence in local cohort studies are becoming less and less representative of whole countries, and assays that discriminate recent infections in cross-sectional serosurveys have been shown to be unreliable in African countries without calibration. Antiretroviral therapy will add a further layer of complexity, as longer survival times will tend to increase HIV prevalence; so that upturns in epidemics may not indicate increased risk behaviour, and stable prevalence rates could mask substantial reductions in incidence. It will, therefore, be essential to make maximum use of mathematical modelling in the interpretation of trends in HIV prevalence. To be conservative and defensible, these modelsmust reasonably account for all other potential sources of natural changes in epidemics, so that the contribution of actual reductions in risk-if any-can be resolved. And only from that starting point, can the important investigations into the proximal and distal causes and reasons for the behaviour changes begin. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MONITORING | HIV INFECTIONS | EPIDEMIOLOGY | EPIDEMICS | RELIABILITY | VALIDITY | ERROR SOURCES | Africa | Developing Countries | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Public Health | Health Document Number: 330256 |
| 20. Title: Household ownership and use of insecticide treated nets among target groups after implementation of a national voucher programme in the United Republic of Tanzania: plausibility study using three annual cross sectional household surveys. Author: Hanson K; Marchant T; Nathan R; Mponda H; Jones C; Bruce J; Mshinda H; Schellenberg JA Source: BMJ. 2009;339:b2434. Abstract: OBJECTIVES: To evaluate the impact of the Tanzania National Voucher Scheme on the coverage and equitable distribution of insecticide treated nets, used to prevent malaria, to pregnant women and their infants. DESIGN: Plausibility study using three nationally representative cross sectional household and health facility surveys, timed to take place early, mid-way, and at the end of the roll out of the national programme. SETTING: The Tanzania National Voucher Scheme was implemented in antenatal services, and phased in on a district by district basis from October 2004 covering all of mainland Tanzania in May 2006. PARTICIPANTS: 6115, 6260, and 6198 households (in 2005, 2006, and 2007, respectively) in a representative sample of 21 districts (out of a total of 113). INTERVENTIONS: A voucher worth $2.45 ( pound1.47, euro1.74) to be used as part payment for the purchase of a net from a local shop was given to every pregnant woman attending antenatal services. MAIN OUTCOME MEASURES: Insecticide treated net coverage was measured as household ownership of at least one net and use of a net the night before the survey. Socioeconomic distribution of nets was examined using an asset based index. RESULTS: Steady increases in net coverage indicators were observed over the three year study period. Between 2005 and 2007, household ownership of at least one net (untreated or insecticide treated) increased from 44% (2686/6115) to 65% (4006/6198; P<0.001), and ownership of at least one insecticide treated net doubled from 18% (1062/5961) to 36% (2229/6198) in the same period (P<0.001). Among infants under 1 year of age, use of any net increased from 33% (388/1180) to 56% (707/1272; P<0.001) and use of an insecticide treated net increased from 16% (188/1180) to 34% (436/1272; P<0.001). After adjusting for potential confounders, household ownership was positively associated with time since programme launch, although this association did not reach statistical significance (P=0.09). Each extra year of programme operation was associated with a 9 percentage point increase in household insecticide treated net ownership (95% confidence interval -1.6 to 20). In 2005, only 7% (78/1115) of nets in households with a child under 1 year of age had been purchased with a voucher; this value increased to 50% (608/1211) in 2007 (P<0.001). In 2007, infants under 1 year in the least poor quintile were more than three times more likely to have used an insecticide treated net than infants in the poorest quintile (54% v 16%; P<0.001). CONCLUSIONS: The Tanzania National Voucher Scheme was associated with impressive increases in the coverage of insecticide treated nets over a two year period. Gaps in coverage remain, however, especially in the poorest groups. A voucher system that facilitates routine delivery of insecticide treated nets is a feasible option to "keep up" coverage. Language: English Keywords: TANZANIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HOUSEHOLDS | PREGNANT WOMEN | INFANT | MALARIA PREVENTION | BED NETS | COST EFFECTIVENESS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Malaria | Parasitic Diseases | Diseases | Parasite Control | Public Health | Health | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 342233 |
| 21. Title: Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City. Author: Hu D; Grossman D; Levin C; Blanchard K; Goldie SJ Source: BJOG. 2009 May;116(6):768-79. Abstract: OBJECTIVE: To assess the comparative health and economic outcomes associated with three alternative first-trimester abortion techniques in Mexico City and to examine the policy implications of increasing access to safe abortion modalities within a restrictive setting. DESIGN: Cost-effectiveness analysis. SETTING: Mexico City. POPULATION: Reproductive-aged women with unintended pregnancy seeking first-trimester abortion. METHODS: Synthesising the best available data, a computer-based model simulates induced abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for first-trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical abortion using vaginal misoprostol. MAIN OUTCOME MEASURES: Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy. RESULTS: In comparison to the magnitude of health gains associated with all safe abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe abortion was always more influential than shifting between safe abortion modalities. CONCLUSIONS: This study demonstrates that the provision of safe abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical abortion will have the best chance to minimise abortion-related morbidity and mortality. Language: English Keywords: MEXICO | RESEARCH REPORT | COST EFFECTIVENESS | ABORTION | PREGNANCY, FIRST TRIMESTER | HEALTH | ECONOMIC FACTORS | SAFETY | North America | Americas | Developing Countries | Evaluation Indexes | Quantitative Evaluation | Evaluation | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health Document Number: 342068 Notification |
| 22. Title: Dried blood spots versus plasma for the quantification of HIV-1 RNA using the manual (PCR-ELISA) amplicor monitor HIV-1 version 1.5 assay in Yaounde, Cameroon. Author: Ikomey GM; Atashili J; Okomo-Assoumou MC; Mesembe M; Ndumbe PM Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):181-4. Abstract: OBJECTIVES: Considering the recent accrued need for viral load quantification in resource-limited settings, this study evaluated the use of dried blood spots (DBS) compared to plasma as a means of sample collection and storage for HIV-1 RNA quantification using a non-automated assay. METHODS: Venous blood was collected from 60 consenting HIV-1-positive patients, plasma separated within 4 hours, and stored at -20 degrees C. Venous blood, 50 microL, was blotted on 4 designated areas of Whatman filter paper and air-dried at room temperature for 2 hours. RESULTS: There was a strong statistically significant correlation between HIV-1 RNA viral load using plasma and DBS (r = .955, P < .001). On average plasma viral loads were only slightly higher than DBS viral loads (mean difference: 0.06 log(10) copies/mL). CONCLUSION: Even when using an entirely manual HIV-quantification assay, DBS may provide a reliable, cost-effective method for sample collection and storage for HIV-1 RNA quantification in resource-limited settings. Language: English Keywords: CAMEROON | RESEARCH REPORT | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HEMATOLOGIC TESTS | MONITORING | LABORATORY PROCEDURES | COST EFFECTIVENESS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Evaluation Indexes | Quantitative Evaluation Document Number: 342457 |
| 23. Title: Audit for maternal and newborn health services in resource-poor countries. Author: Kongnyuy EJ; van den Broek N Source: BJOG. 2009 Jan;116(1):7-10. Abstract: Each year more than 536 000 women worldwide die from complications of pregnancy and childbirth. Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neonatal deaths occur each year, accounting for almost 40% of all deaths in children younger than 5 years. The key strategies that have been identified to reduce this global burden are the presence of skilled birth attendants, the availability of essential (or emergency) obstetric care4 and newborn care. To have major effects on maternal outcomes, it is crucial that these elements are not just available but also of high quality. And assessment of quality requires effective clinical audit. However, anyone who has undertaken a clinical audit will realise that the practice is not as simple as the theory, and 'closing the loop' (to achieve the desired endpoint of improvements in clinical care) is often difficult. So the process of clinical audit itself must be critically evaluated. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | INFANT | INFANT HEALTH | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | NEEDS ASSESSMENT | PERFORMANCE IMPROVEMENT | COST EFFECTIVENESS | MEASUREMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Evaluation | Management | Evaluation Indexes | Quantitative Evaluation | Research Methodology Document Number: 330471 |
| 24. Peer Reviewed Title: Directing diarrhoeal disease research towards disease-burden reduction. Author: Kosek M; Lanata CF; Black RE; Walker DG; Snyder JD; Salam MA; Mahalanabis D; Fontaine O; Bhutta ZA; Bhatnagar S; Rudan I Source: Journal of Health, Population, and Nutrition. 2009 Jun;27(3):319-31. Abstract: Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015. Language: English Keywords: DEVELOPING COUNTRIES | EVALUATION REPORT | RESEARCH ACTIVITIES | DIARRHEA | PREVENTION AND CONTROL | INTERVENTIONS | PROGRAM EFFECTIVENESS | PROGRAM SUSTAINABILITY | CHILD HEALTH | GOALS | DELIVERY OF HEALTH CARE | COST EFFECTIVENESS | Evaluation | Research Methodology | Diseases | Programs | Organization and Administration | Program Evaluation | Health | Planning | Evaluation Indexes | Quantitative Evaluation Document Number: 341924 |
| 25. Peer Reviewed Title: The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers. Author: Kumar D; Aggarwal AK; Kumar R Source: Health Policy and Planning. 2009 Mar;24(2):94-100. Abstract: The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective. Language: English Keywords: INDIA | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | COST BENEFIT ANALYSIS | HEALTH PERSONNEL | TRAINING PROGRAMS | NEONATAL DISEASES AND ABNORMALITIES | CHILD HEALTH | INTEGRATED PROGRAMS | TIME FACTORS | PRIMARY HEALTH CARE | KNOWLEDGE | EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Delivery of Health Care | Health | Education | Diseases | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Health Services | Sociocultural Factors | Medical Procedures | Medicine | Evaluation Indexes Document Number: 331230 |
| 26. Peer Reviewed Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation. Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG Source: Reproductive Health Matters. 2009 May;17(33):120-132. Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation. Spanish Abstract: En 2005, antes de la legalización del aborto en el Distrito Federal de México, se realizó una evaluación del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos públicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los cálculos de costos directos incluían personal, medicamentos, suministros desechables, y equipo médico para inducir el aborto o tratar abortos incompletos y otras complicaciones. También se calcularon los costos indirectos de las pacientes en viajes, cuido de niños y sueldos perdidos. El costo promedio por cada aborto con dilatación y curetaje fue de US $143. Para la aspiración manual endouterina (AMEU), fue de US $111 en tres hospitales públicos y US $53 en una clínica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales públicos varió de US $601 a más de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podrían disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al año. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en ámbitos ambulatorios, disminuirían también los costos de la atención del aborto, lo cual sería un gran beneficio tanto para el sistema de salud de México como para las mujeres que buscan servicios de aborto. Aún se necesitan más investigaciones para explorar si se han logrado ahorros en costos post-legalización. French Abstract: En 2005, avant la légalisation de l'avortement, on a évalué les résultats et le coût de l'avortement sur le système sanitaire à Mexico, dans des établissements publics et privés. Les données ont été obtenues auprès du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des coûts incluaient le personnel, les médicaments, les consommables et l'équipement médical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de déplacement, de garde d'enfants et de perte de gain des patientes ont aussi été calculés. Le coût moyen par avortement avec dilatation et curetage était de $US143. Par aspiration manuelle, il était de $US 111 dans trois hôpitaux publics et $US 53 dans une clinique privée. Le coût moyen de l'avortement médicamenteux avec du misoprostol seul était de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les hôpitaux publics allait de $US 601 à plus de $US 2100. Un accès élargi à l'aspiration manuelle et à l'avortement précoce au misoprostol permettrait de réduire de 62% les coûts gouvernementaux, avec des économies potentielles se chiffrant à $US 1,6 million par an. En réduisant les complications par l'amélioration de l'accès à des services ambulatoires sûrs, on diminuerait encore le coût des soins de l'avortement, avec de nets avantages pour le système de santé mexicain et les femmes souhaitant avorter. Il faut mener des recherches supplémentaires pour déterminer si des économies ont été réalisées après l'adoption de la légalisation. Language: English Keywords: MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation Document Number: 342021 Notification |
| 27. Peer Reviewed Title: Actual cost of providing long-acting reversible contraception: a study of Implanon((R)) cost. Author: Lipetz C; Phillips C; Fleming C Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):75-9. Abstract: BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) has judged Implanon((R)) to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. METHODS: The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. RESULTS: The annual cost for the method (using Implanon) was pound77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. CONCLUSION: The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | COST BENEFIT ANALYSIS | COHORT ANALYSIS | WOMEN | CONTRACEPTIVE IMPLANTS | COST EFFECTIVENESS | COMMUNITY HEALTH SERVICES | FAMILY PLANNING PROGRAM EVALUATION | TIME FACTORS | Developed Countries | Europe, Western | Europe | Research Methodology | Quantitative Evaluation | Evaluation | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Evaluation Indexes | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning Programs | Population Dynamics Document Number: 330950 |
| 28. Peer Reviewed Title: The cost-effectiveness of a long-acting reversible contraceptive (Implanon) relative to oral contraception in a community setting. Author: Lipetz C; Phillips CJ; Fleming CF Source: Contraception. 2009 Apr;79(4):304-9. Abstract: BACKGROUND: Within the setting of a UK community sexual health service, the cost-effectiveness of Implanon and oral contraception provision over a 36-month period was compared. STUDY DESIGN: A case-controlled retrospective cost-effectiveness study was done on a cohort of 493 Implanon users and 493 oral contraceptive users. The actual cost of provision of both methods was calculated. Cost-effectiveness was calculated based on provision of method and pregnancy costs of each cohort. RESULTS: Implanon provision is more cost-effective than oral contraception at all time points. After 12 months of use, Implanon is half the cost of oral contraception. Oral contraception reached similar annual cost to Implanon at 36 months of use. CONCLUSIONS: Long-acting reversible contraception is perceived to be expensive. It is reassuring to contraception providers that Implanon is, in fact, highly cost-effective when compared to oral contraception with typical use. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | COST EFFECTIVENESS | ORAL CONTRACEPTIVES | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Evaluation Indexes | Quantitative Evaluation | Evaluation | Contraceptive Methods | Contraception | Family Planning Document Number: 330557 |
| 29. Peer Reviewed Title: Assessment of the Chinese version of HIV and homosexuality related stigma scales. Author: Liu H; Feng T; Rhodes AG; Liu H Source: Sexually Transmitted Infections. 2009 Feb;85(1):65-69. Abstract: Objectives: To design and assess HIV and homosexuality related stigma scales in a developing world context. Methods: A respondent-driven sampling survey was conducted among 351 men who have sex with men (MSM) in Shenzhen, China. Exploratory and confirmatory factor analyses were used to examine and determine the latent factors of stigma subscales. Results: Factor analyses identified three subscales associated with homosexuality and HIV stigma: public homosexual stigma (10 items), self homosexual stigma (8 items) and public HIV stigma (7 items). There were no items with cross-loadings onto multiple factors, supporting the distinctness of the constructs that these scales were meant to measure. The fit indices in confirmatory factor analysis provide evidence for the hypothesised three-factor structure of associations (the x2/degree ratio=1.84, CFI=0.91, RMSEA=0.05 and SRMR=0.05). Reliability of the three scales was excellent (Cronbach's alpha: 0.78-0.85) and stable across split samples and for the data as a whole. Conclusions: The selection of three latent factors was supported by both psychometric properties and theories of stigmatisation. The scales are brief and suitable for use in developing countries where less time-consuming measurement is preferable. Language: English Keywords: CHINA | RESEARCH REPORT | METHODOLOGICAL STUDIES | KAP SURVEYS | QUESTIONNAIRE DESIGN | EVALUATION INDEXES | FACTOR ANALYSIS | HOMOSEXUALS | MEN HAVING SEX WITH MEN | PERSONS LIVING WITH HIV/AIDS | STIGMA | HIV INFECTIONS | PUBLIC OPINION | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Survey Methodology | Quantitative Evaluation | Evaluation | Data Analysis | Sex Behavior | Behavior | Viral Diseases | Diseases | Social Problems | Sociocultural Factors | Attitudes | Psychological Factors Document Number: 340113 |
| 30. Peer Reviewed Title: Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women. Author: Lizarelli PM; Martins WP; Vieira CS; Soares GM; Franceschini SA; Ferriani RA; Patta MC Source: Contraception. 2009 Jan;79(1):35-40. Abstract: BACKGROUND: The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function. STUDY DESIGN: The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile. RESULTS: A significant difference in FMD was observed between the COC and control groups (6.4+/-2.2% vs. 8.7+/-3.4%, p<.01) and between the DMPA and control groups (6.2+/-2.1% vs. 8.7+/-3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-densitylipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9+/-21.5 mg/dL vs. controls=167.1+/-29.2 mg/dL vs. COC=168.2+/-37.5, p=.001; LDL-C: DMPA=85.3+/-20.1 mg/dL vs. controls=102+/-24.5 mg/dL vs. COC=106.7+/-33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4+/-14.1 mg/dL vs. DMPA=42.2+/-7.2 mg/dL vs. COC=45.4+/-9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables. CONCLUSIONS: FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | EVALUATION INDEXES | WOMEN IN DEVELOPMENT | ORAL CONTRACEPTIVES, COMBINED | DEPO-PROVERA | SIDE EFFECTS | HEALTH STATUS INDEXES | CHOLESTEROL | ADMINISTRATION AND DOSAGE | BLOOD PRESSURE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Economic Development | Economic Factors | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Lipids | Physiology | Biology | Drugs | Hemic System Document Number: 330537 |
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