6320 research outputs found
Sort by
[How can earlier entry of patients into antiretroviral programs in low-income countries be promoted?] [reply]
No full textTuberculosis pulmonar con baciloscopia negativa, peculiaridades de su frecuencia en Cuba 1992-2002
No full textReviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda
No full textThe definitive version is available at www3.interscience.wiley.comIn many low-income countries, performance of pyramidal health systems with a public purpose is not meeting the expectations and needs of the populations they serve. A question that has not been studied and tested sufficiently is, 'What is the right package of institutional mechanisms required for organisations and individuals working in these health systems?' This paper presents the experience of the Performance Initiative, an innovative contractual approach that has reshaped the incentive structure in place in two rural districts of Rwanda. It describes the general background, the initial analysis, the institutional arrangement and the results after 3 years of operations. At this stage of the experience, it shows that 'output-based payment + greater autonomy' is a feasible and effective strategy for improving the performance of public health centres. As part of a more global package of strategies, contracting-in approaches could be an interesting option for governments, donors and non-governmental organisations in their effort to achieve some of the Millennium Development Goals
Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India
No full textThe definitive version is available at www3.interscience.wiley.comOBJECTIVES: To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. METHODS: Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. RESULTS: The total cost of care per episode of VL from the societal perspective was estimated at US217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. CONCLUSIONS: The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL
The economic burden of visceral leishmaniasis for households in Nepal
No full textVisceral leishmaniasis (VL) affects persons from the lowest socioeconomic strata of the community, but its economic impact is not precisely known. An exploratory survey to document the economic costs of VL to households was conducted in an endemic focus in eastern Nepal. Data were collected from the 20 households in this cluster. Cases of VL over the last 3 years were elicited and information on direct and indirect costs incurred due to the disease as well as income of the households over the last year was estimated. It was reported that 15.0% (16/107) of the residents had suffered from VL and that almost all of the patients had preferred, in the first instance, to visit the private services or local faith healers instead of visiting the local public health facility. Average total costs incurred per episode of VL were above the median annual per capita income, and six of the seven affected households either had to sell part of their livestock or to take a loan to cover the costs. Direct costs consisted of 53% of the total cost, with 75% of this cost incurred before the patients actually received any treatment for VL. This study demonstrates how VL can lead to catastrophic expenditure for affected households
Audit de la qualité de prise en charge des "échappées belle" (near miss) dans les maternités de référence du Sud Bénin
No full textOBJECTIVES: Maternal mortality is highly associated with the provision of obstetric care. The provision of safe and timely emergency obstetric care (EOC) for women with severe obstetric complications is one of the main components of safe motherhood programs. In this research the objective was to determine the quality of EOC by examining its availability and its provision in a timely fashion. DESIGN: prospective observational study in qualified facilities providing EOC. SETTING: two teaching, two regional and three district hospitals in the southern part of Benin, West Africa. METHOD: The study was conducted from July to October 2003. Data collection tools used were based on the World Health organisation Guidelines for monitoring EOC. The midwives in charge of the survey started observation from the admission room and followed the provision of the care offered to the women admitted with near miss complications until they were discharged from hospital. The information about EOC, its availability, timeliness and patients' follow-up were recorded. RESULTS: The study sample included 557 women; immediate emergency care was given within 30 minutes for 61% of the patients. Surgical care (caesarean section and ectopic pregnancies surgery) was started within 60 minutes for 42% and 45 % of the women. In the near miss cases suffering anaemia, blood was not available for 12% of patients and blood transfusions were started within 60 minutes in 10% of cases. In the case of uterine rupture or pre-rupture, the time for starting caesarean section was 60 minutes for 58% of women. As to haemorrhagic near-miss cases, blood was not available in 44% of cases and if caesarean section was indicated, it was done within 60 minutes in 47% of the cases. Half of the patients with hypertension received treatment within 60 minutes after the decision to do so was taken. In infection cases, 53% of the patients received antibiotics treatment within 60 minutes. Generally, the quality of providing EOC in the facilities of the study was good in only 16.4% of cases. The quality of care was good in 31.4% of the cases with dystocia, 19% of the cases with hypertension, in 18% of the cases with haemorrhage, in 13.4% of the cases with infection, and in 6.4% of the cases with anaemia. CONCLUSION: Our study has shown that, often, EOC was not provided in a timely fashion. A reflection with all the health providers involved should lead to a better understanding of better ways to improve the quality of EOC
Discrepanties en inconsistentie tussen de Europese richtlijnen voor primaire cardiovasculaire preventie; resultaten van een vergelijkend onderzoek
No full textKala-azar in Nepal: from clinical evidence to control
No full textMonografieën van de Vakgroep Maatschappelijke Gezondheidskund
Efficacy of chloroquine, sulfadoxine-pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria among children under five in Bongor and Koumra, Chad
No full textWe report two 28-day in-vivo antimalarial efficacy studies carried out in the urban centres of Bongor and Koumra, southern Chad. We assess chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) to treat Plasmodium falciparum uncomplicated malaria. Methods and outcome classification complied with latest WHO guidelines. Out of the 301 and 318 children aged 6-59 months included in Bongor and Koumra, respectively, 246 (81.7%) and 257 (80.8%) were eligible for analysis. In Bongor and Koumra, the 28-day PCR-adjusted failure rates for CQ were 23.7% (95% CI 14.7-34.8%) and 32.9% (95% CI 22.1-45.1%), respectively, and those for SP were 16.3% (95% CI 9.4-25.5%) and 4.3% (95% CI 1.2-10.5%). AQ failure rates were 6.4% (95% CI 2.1-14.3%) and 2.2% (95% CI 0.3-7.6%). The current use of CQ in Bongor and Koumra is questionable, and a more efficacious treatment is needed. Considering the reduced efficacy of SP in Bongor, AQ seems to be the best option for the time being. Following WHO recommendations that prioritize the use of artemisinin-based combinations, artesunate plus amodiaquine could be a potential first-line treatment. Nevertheless, the efficacy of this combination should be evaluated and the change carefully prepared, implemented and monitored
Evaluation of three strategic parasite control programs in captive wild ruminants
No full textParasite control in wild ruminants is based mainly on anthelmintics. The objective of the present study was to evaluate three parasite control programs in seven herds of captive wild ruminants in 3 consecutive years. In the first year, a biannual spring-summer treatment regime with fenbendazole at 7.5 mg/kg body weight p.o. for 3 days was applied. The next year, an early-season treatment program with three administrations of fenbendazole at the same dosage at 3-wk intervals was used. In the third year, an early-season treatment program with ivermectin (0.2 mg/kg p.o. for 3 days), applied three times at 5-wk intervals, was evaluated. Effectiveness of these control programs was assessed by fecal egg counts and by scores of body condition and fecal consistency at weekly intervals. Involved animal species were Arabian oryx (Oryx leucoryx), scimitar-horned oryx (Oryx dammah), slender-horned gazelle (Gazella leptoceros), Soay sheep (Ovis aries soay), ibex (Capra ibex), red deer (Cervus elaphus hippelaphus), and Nelson's elk (Cervus elaphus nelsoni). With the spring-summer regime, fecal egg counts remained low during the first 5 mo, but from September onward, they slowly increased to significant levels in all seven herds. The early-season program with fenbendazole resulted in fecal egg counts near zero during the entire year in four herds but a significant egg shedding from August onward was noted in Arabian oryx, scimitar-horned oryx, and Soay sheep. The early-season program with ivermectin resulted in very low to zero egg shedding in gazelle, adult Soay sheep, ibex, red deer, and Nelson's elk during the entire grazing season, but failed to prevent high shedding in October in Arabian oryx and scimitar-horned oryx. High contamination of grassy pastures with infective larvae/eggs in the previous year or before the first treatment may explain failure of the treatment regimes in some herds