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Sommersguter-Reichmann M, Reichmann G. Untangling the corruption maze: exploring the complexity of corruption in the health sector. HEALTH ECONOMICS REVIEW 2024; 14:50. [PMID: 38995456 PMCID: PMC11241952 DOI: 10.1186/s13561-024-00530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels. OBJECTIVE The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures. METHOD We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility. FINDINGS Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services. CONCLUSIONS The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.
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Affiliation(s)
| | - Gerhard Reichmann
- Department of Operations and Information Systems, University of Graz, Graz, Austria
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2
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Patterson AC. Civil service organization as a political determinant of health: Analyzing relationships between merit-based hiring, corruption, and population health. Soc Sci Med 2024; 348:116813. [PMID: 38581811 DOI: 10.1016/j.socscimed.2024.116813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Abstract
A growing literature finds that the way governments are organized can impact the societies they serve in important ways. The same is apparent with respect to civil service organizations. Numerous studies show that the recruitment of civil servants based on their credentials rather than on nepotism or patronage reduces corruption in government. Political corruption in turn appears to harm population health. Up to this time, however, civil service organization is not a recognized determinant of health and is little discussed outside of political science disciplines. To provoke a broader conversation on this subject, the following study proposes that meritocratic recruitment of civil servants improves population health. To test this proposition, a series of regression models examines comparative data for 118 countries. Consistent with study hypotheses, meritocratic recruitment of civil servants corresponds longitudinally with both lower rates of corruption and lower rates of infant mortality. Results are similar after robustness checks. Findings with regard to life expectancy are more mixed. However, additional tests suggest meritocratic recruitment contributes to life expectancy over a longer span of time. Findings also offer more support for a direct pathway from meritocratic recruitment to population health rather than via changes in corruption levels per se, although this may depend on a country's level of economic development. Overall, this study offers first evidence that civil service organization, particularly the recruitment of civil servants based on the merits of their applications rather than on whom they happen to know in government, is a positive determinant of health. More research in this area is needed.
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Affiliation(s)
- Andrew C Patterson
- Department of Sociology, MacEwan University, Edmonton, AB, T5J4S2, Canada.
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Toffolutti V, Paglino E, Kentikelenis A, Mencarini L, Aassve A. Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000847. [PMID: 38048332 PMCID: PMC10695367 DOI: 10.1371/journal.pgph.0000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002-2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10-73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.
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Affiliation(s)
- Veronica Toffolutti
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
| | - Eugenio Paglino
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania (PA), United States of America
| | - Alexandros Kentikelenis
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Letizia Mencarini
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Arnstein Aassve
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
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Hadipour A, Delavari S, Bayati M. What is the role of institutional quality in health outcomes? A panel data analysis on 158 countries from 2001-2020. Heliyon 2023; 9:e20251. [PMID: 37809989 PMCID: PMC10560016 DOI: 10.1016/j.heliyon.2023.e20251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Our study investigated the impact of institutional quality on health system outcomes, utilizing worldwide governance indicators and analyzing data from 158 countries between 2001 and 2020. We employed Principal Component Analysis (PCA) to create a composite index of institutional quality and conducted various tests to select the appropriate econometric model. The role of institutional quality, along with other variables, in health outcomes was estimated using fixed effects and generalized method of moments (GMM) models. High-income and low-income countries were analyzed separately. The results of our study revealed that institutional quality, as measured by Control of Corruption, Voice and Accountability, Political Stability, Rule of Law, Regulatory Quality, and Government Effectiveness, had a negative impact on infant mortality rates and a positive impact on life expectancy. Similarly, variables such as GDP, mean years of schooling, total health expenditure, and urbanization rate showed a negative association with infant mortality rates and a positive association with life expectancy. Conversely, the logarithm of CO2 emissions exhibited a positive effect on infant mortality rates and a negative effect on life expectancy. These findings highlight the crucial role of institutional quality in determining health outcomes. Improving institutional quality contributes to the development of democratic and meritocratic systems, infrastructure enhancement, efficient tax and subsidy systems, optimal budget allocation, improved public education, and enhanced access to primary healthcare services. The influence of institutional quality is particularly significant in high-income countries compared to low-income countries. In conclusion, our study emphasizes the importance of institutional quality in shaping health system outcomes. Enhancing institutional quality is essential for the overall advancement of healthcare systems, encompassing governance, infrastructure, education, and access to healthcare services. It is crucial to prioritize efforts to improve institutional quality, especially in high-income countries, to achieve better health outcomes for populations worldwide.
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Affiliation(s)
- Alireza Hadipour
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Mhazo AT, Maponga CC. Retracing loss of momentum for primary health care: can renewed political interest in the context of COVID-19 be a turning point? BMJ Glob Health 2023; 8:e012668. [PMID: 37474277 PMCID: PMC10360423 DOI: 10.1136/bmjgh-2023-012668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
The COVID-19 pandemic has revealed major weaknesses in primary health care (PHC), and how such weaknesses pose a catastrophic threat to humanity. As a result, strengthening PHC has re-emerged as a global health priority and will take centre stage at the 2023 United Nations High Level Meeting (UNHLM) on Universal Health Coverage (UHC). In this analysis, we examine why, despite its fundamental importance and incredible promise, the momentum for PHC has been lost over the years. The portrayal of PHC itself (policy image) and the dominance of global interests has undermined the attractiveness of intended PHC reforms, leading to legacy historical policy choices (critical junctures) that have become extremely difficult to dismantle, even when it is clear that such choices were a mistake. PHC has been a subject of several political declarations, but post-declarative action has been weak. The COVID-19 provides a momentous opportunity under which the image of PHC has been reconstructed in the context of health security, breaking away from the dominant social justice paradigms. However, we posit that effective PHC investments are those that are done under calm conditions, particularly through political choices that prioritise the needs of the poor who continue to face a crisis even in non-pandemic situations. In the aftermath of the 2023 UNHLM on UHC, country commitment should be evaluated based on the technical and financial resources allocated to PHC and tangible deliverables as opposed to the formulation of documents or convening of a gathering that simply (re) endorses the concept.
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Affiliation(s)
- Alison T Mhazo
- Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
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Bressan T, Valdivia-Gago A, Silvera-Ccallo RM, Llanos-Cuentas A, Condor DF, Padilla-Huamantinco PG, Vilcarromero S, Miranda JJ, Zavaleta-Cortijo C. Challenges of design, implementation, acceptability, and potential for, biomedical technologies in the Peruvian Amazon. Int J Equity Health 2022; 21:183. [PMID: 36536404 PMCID: PMC9762865 DOI: 10.1186/s12939-022-01773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Biomedical technologies have the potential to be advantageous in remote communities. However, information about barriers faced by users of technology in general and in remote Indigenous communities is scarce. The purpose of this study was to characterize the leading challenges faced by researchers who have used biomedical technologies in the Peruvian Amazon. METHODS This exploratory, qualitative study with a phenomenological approach depicts the lived experience of participants who were researchers with experience working with biomedical technologies in the Peruvian Amazon in the past five years. Analysis was based on three core themes: design, implementation, and acceptability. Sub-themes included environment, community, and culture. Of the 24 potential participants identified and contacted, 14 agreed to participate, and 13 met inclusion criteria and completed semi-structured interviews. Results were sent to each participant with the opportunity to provide feedback and partake in a 30-minute validation meeting. Five participants consented to a follow-up meeting to validate the results and provide further understanding. RESULTS Participants recognized significant challenges, including technologies designed out-of-context, difficulty transporting the technologies through the Amazon, the impact of the physical environment (e.g., humidity, flooding), and limited existing infrastructure, such as electricity and appropriately trained health personnel. Participants also identified cultural factors, including the need to address past experiences with technology and health interventions, understand and appropriately communicate community benefits, and understand the effect of demographics (e.g., age, education) on the acceptance and uptake of technology. Complementary challenges, such as corruption in authority and waste disposal, and recommendations for technological and health interventions such as co-design were also identified. CONCLUSIONS This study proposes that technological and health interventions without efforts to respect local cultures and health priorities, or understand and anticipate contextual challenges, will not meet its goal of improving access to healthcare in remote Amazon communities. Furthermore, the implications of corruption on health services, and improper waste disposal on the environment may lead to more detrimental health inequities.
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Affiliation(s)
- Tiana Bressan
- grid.34429.380000 0004 1936 8198School of Engineering, University of Guelph, 50 Stone Rd E, Guelph, ON N1G 2W1 Canada
| | - Andrea Valdivia-Gago
- grid.11100.310000 0001 0673 9488Escuela de Nutrición, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Rosa M. Silvera-Ccallo
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Alejandro Llanos-Cuentas
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Daniel F. Condor
- grid.11100.310000 0001 0673 9488School of Nursing, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Biomedical Informatics in Global Health Unit, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488 CuidART-e Research Group, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Pierre G. Padilla-Huamantinco
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102 ,Health Innovation Lab, Institute of Tropical Medicine Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.7870.80000 0001 2157 0406Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile Av Vicuña Mackenna 4860,
| | - Stalin Vilcarromero
- grid.420173.30000 0000 9677 5193Hospital Nacional Edgardo Rebagliati Martins (HNERM), EsSalud, Lima, Peru Av. Edgardo Rebagliati 490, 15072
| | - J. Jaime Miranda
- grid.11100.310000 0001 0673 9488CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.1005.40000 0004 4902 0432The George Institute for Global Health, UNSW, Sydney, Australia
| | - Carol Zavaleta-Cortijo
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
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Botero-Rodríguez F, Pantoja-Ruiz C, Rosselli D. Corruption and its relation to prevalence and death due to noncommunicable diseases and risk factors: a global perspective. Rev Panam Salud Publica 2022; 46:e10. [PMID: 35355691 PMCID: PMC8959101 DOI: 10.26633/rpsp.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
Objective. To describe the relation between corruption indicators and statistics on noncommunicable diseases and their risk factors by continent. Methods. An ecological study was conducted to examine the relation of the GINI coefficient, the Country Policy and Institutional Assessment (CPIA), and the Corruption Perception Index (CPI) with noncommunicable diseases, using the Spearman’s rank correlation test. Results. There is a moderate and positive correlation between Corruption Perception Index and cause of death due to noncommunicable diseases and risk factors for these diseases (r = 0.532), prevalence of schizophrenia (r = 0.526), bipolar disorder (r = 0.520), and eating disorders (r = 0.677). There is a moderate negative association between the GINI index and cause of death due to noncommunicable diseases (r = –0.571) and smoking prevalence (r = –0.502), and between the Corruption Perception Index and mortality caused by cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases between the exact ages of 30 and 70 years (r = –0.577) and malnutrition prevalence (r = –0.602). Conclusions. This study indicates a correlation between corruption and noncommunicable diseases and their risk factors. This suggests that the high prevalence of noncommunicable diseases and risk factors could be related with political practices that negatively impact the population. Further research should study the weight of these associations, to take action on the way corruption is impacting on the health of societies.
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Affiliation(s)
- Felipe Botero-Rodríguez
- Pontificia Universidad Javeriana Bogotá Colombia Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camila Pantoja-Ruiz
- Pontificia Universidad Javeriana Bogotá Colombia Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego Rosselli
- Pontificia Universidad Javeriana Bogotá Colombia Pontificia Universidad Javeriana, Bogotá, Colombia
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Handayani K, Susilawati D, Sutaryo, Mulatsih S, Kaspers GJL, Mostert S, Sitaresmi M. Health-care providers’ perception and communication about traditional and complementary medicine in childhood cancer in Indonesia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Suchman L, Owino E, Montagu D. Recognizing and mediating bureaucratic barriers: increasing access to care through small and medium-sized private providers in Kenya. Gates Open Res 2021; 5:95. [PMID: 34934905 PMCID: PMC8649627 DOI: 10.12688/gatesopenres.13313.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Equitable access to health services can be constrained in countries where private practitioners make up a large portion of primary care providers. Expanding purchasing arrangements has helped many countries integrate private providers into government-supported payment schemes, reducing financial barriers to care. However, private providers often must go through an onerous accreditation process to enroll in these schemes. The difficulties of this process are exacerbated where health policy is changed often and low-level bureaucrats must navigate these shifts at their own discretion. This paper analyzes one initiative to increase private provider accreditation with social health insurance (SHI) in Kenya by creating an intermediary between providers and “street-level” SHI bureaucrats. Methods: This paper draws on 126 semi-structured interviews about SHI accreditation experience with private providers who were members of a franchise network in Kenya. It also draws on four focus group discussions conducted with franchise representatives who provided accreditation support to the providers and served as liaisons between the franchised providers and local SHI offices. There was a total of 20 participants across all four focus groups. Results: In a governance environment where regulations are weak and impermanent, street-level bureaucrats often created an accreditation process that was inconsistent and opaque. Support from the implementing organizations increased communication between SHI officials and providers, which clarified rules and increased providers’ confidence in the system. The intermediaries also reduced bureaucrats’ ability to apply regulations at will and helped to standardize the accreditation process for both providers and bureaucrats. Conclusions: We conclude that intermediary organizations can mitigate institutional weaknesses and facilitate process efficiency. However, intermediaries only have a temporary role to play where there is potential to: 1) directly increase private providers’ power in a complex regulatory system; 2) reform the system itself to be more responsive to the limitations of on-the-ground implementation.
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Affiliation(s)
- Lauren Suchman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Dominic Montagu
- University of California San Francisco, San Francisco, CA, USA
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10
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Olbara G, van der Wijk T, Njuguna F, Langat S, Mwangi H, Skiles J, Vik TA, Kaspers GJL, Mostert S. Childhood acute lymphoblastic leukemia treatment in an academic hospital in Kenya: Treatment outcomes and health-care providers' perspectives. Pediatr Blood Cancer 2021; 68:e29366. [PMID: 34569156 DOI: 10.1002/pbc.29366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early deaths and treatment nonadherence are major reasons for low childhood acute lymphoblastic leukemia (ALL) survival in low- and middle-income countries. This study assessed treatment outcomes of children presenting with ALL and evaluated perspectives of health-care providers (HCP) on ALL treatment at a Kenyan academic hospital. METHODS This was a combined retrospective medical records and cross-sectional questionnaire study. Treatment outcomes of 136 children diagnosed with ALL between 2010 and 2016 were collected. Questionnaires were completed by 245 HCP (response rate, 86%) between September and October 2016. RESULTS Childhood ALL treatment outcomes were death (30%), progressive or relapsed disease (26%), abandonment (24%), and event-free survival (20%). Of all deaths, 80% were early deaths (prior or during induction), whereas 20% occurred in remission. Probability of event-free survival at three years was 18%. Only 57% of HCP believed childhood ALL can be cured, with more doctors (96%) than other HCP (45%) believing in curability of ALL (P < 0.001). The majority of HCP (96%) thought that experienced doctors should put more time and effort into making parents understand the diagnosis and necessity to complete treatment. According to HCP, reasons for protocol nonadherence included parental financial difficulties (94%) and use of alternative treatment (79%). CONCLUSIONS Event-free survival for ALL in Kenya is low. The primary reason for treatment failure is early death from treatment-related complications. More efforts should be directed toward improving supportive care strategies. In the opinion of HCPs, improved communication with parents and supervision of junior staff will improve ALL treatment outcomes.
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Affiliation(s)
- Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Thyra van der Wijk
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Henry Mwangi
- Department of Health Information Management, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terrry A Vik
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya.,Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gertjan J L Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Association of Urban Liveability with Cancer Incidence in Iran: A Nationwide Ecological Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Urban liveability is a multidimensional concept associated with many domains of human health. Objectives: This study aimed at investigating the association between urban liveability and cancer incidence in Iran. Methods: The data of provincial-level urban liveability were obtained from reliable sources. The data of cancer incidence were inquired from the population-based cancer registry of the Iranian Ministry of Health and Medical Education in 2016. Urban liveability scores were determined in all provinces of Iran by utilizing the Global Liveable City Index (GLCI) method. Negative binomial Poisson regression was used to examine the relationship between urban liveability and cancer incidence. Results: Provinces with a higher urban liveability had a higher likelihood of cancer incidence. Higher economic score was significantly associated with higher incidence in colorectal (IRR = 1.49, P = 0.005), liver (IRR = 1.48, P = 0.002), leukemia (IRR = 1.39, P = 0.005), lung (IRR = 1.39, P = 0.039), breast (IRR = 1.38, P = 0.011), and prostate cancers (IRR = 2.11, P < 0.001). Also, provinces with higher environmental friendliness and sustainability had significantly more stomach (IRR = 1.53, P = 0.004), colorectal (1.79, P < 0.001), lung (IRR = 1.43, P = 0.014), and prostate (IRR = 1.50, P = 0.032) cancer incidence. Provinces with higher political governance had significantly more breast cancer (IRR = 1.34, P = 0.002) and leukemia (IRR = 1.30, P = 0.016) incidence rates. Conclusions: Along with the development of urban liveability, the incidence of cancers is increasing in Iran. Cancer control strategies should be implemented especially in settings with higher urbanization.
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Suchman L, Owino E, Montagu D. Recognizing and mediating bureaucratic barriers: increasing access to care through small and medium-sized private providers in Kenya. Gates Open Res 2021; 5:95. [DOI: 10.12688/gatesopenres.13313.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Equitable access to health services can be constrained in countries where private practitioners make up a large portion of primary care providers. Expanding purchasing arrangements has helped many countries integrate private providers into government-supported payment schemes, reducing financial barriers to care. However, private providers often must go through an onerous accreditation process to enroll in these schemes. The difficulties of this process are exacerbated where health policy is changed often and low-level bureaucrats must navigate these shifts at their own discretion. This paper analyzes one initiative to increase private provider accreditation with social health insurance (SHI) in Kenya by creating an intermediary between providers and “street-level” SHI bureaucrats. Methods: This paper draws on 126 semi-structured interviews about SHI accreditation experience with private providers who were members of a franchise network in Kenya. It also draws on four focus group discussions conducted with franchise representatives who provided accreditation support to the providers and served as liaisons between the franchised providers and local SHI offices. There was a total of 20 participants across all four focus groups. Results: In a governance environment where regulations are weak and impermanent, street-level bureaucrats often created an accreditation process that was inconsistent and opaque. Support from the implementing organizations increased communication between SHI officials and providers, which clarified rules and increased providers’ confidence in the system. The intermediaries also reduced bureaucrats’ ability to apply regulations at will and helped to standardize the accreditation process for both providers and bureaucrats. Conclusions: We conclude that intermediary organizations can mitigate institutional weaknesses and facilitate process efficiency. However, intermediaries only have a temporary role to play where there is potential to: 1) directly increase private providers’ power in a complex regulatory system; 2) reform the system itself to be more responsive to the limitations of on-the-ground implementation.
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Indraswari BW, Kelling E, Vassileva SM, Sitaresmi MN, Danardono D, Mulatsih S, Supriyadi E, Widjajanto PH, Sutaryo S, Kaspers GL, Mostert S. Impact of universal health coverage on childhood cancer outcomes in Indonesia. Pediatr Blood Cancer 2021; 68:e29186. [PMID: 34114307 DOI: 10.1002/pbc.29186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low- and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital. METHODS Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained. FINDINGS After introduction of UHC, the number of insured patients increased from 38% to 82% (P < 0.001). Among low SES population, insurance coverage increased from 40% to 85% (P < 0.001), and among high SES population from 33% to 77% (P < 0.001). In the overall population, treatment abandonment decreased from 36% to 22% (P < 0.001). Event-free survival estimates at four years after diagnosis of overall population improved from 16% to 22% (P < 0.001). Hazard ratio for treatment failure was 1.26 (CI: 1.07-1.48, P = 0.006) for uninsured versus insured patients. In the low SES population, treatment abandonment decreased from 36% to 19% (P < 0.001). Event-free survival estimates at four years after diagnosis of low SES population improved from 14% to 22% (P < 0.001). INTERPRETATION Introduction of UHC in Indonesia contributed significantly to better treatment outcome and event-free survival of children with cancer from low SES families.
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Affiliation(s)
- Braghmandita Widya Indraswari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Emil Kelling
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sofi M Vassileva
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Danardono Danardono
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sutaryo Sutaryo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan L Kaspers
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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14
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Smith SI, Ajayi A, Jolaiya T, Onyekwere C, Setshedi M, Schulz C, Otegbayo JA, Ndip R, Dieye Y, Alboraie M, Ally R, Gunturu R, Hyasinta J, Ugiagbe R, Ndububa D, Arigbabu A. Helicobacter pylori Infection in Africa: Update of the Current Situation and Challenges. Dig Dis 2021; 40:535-544. [PMID: 34380131 DOI: 10.1159/000518959] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of Helicobacter pylori infection (HPI) in Africa remains high with varying levels of prevalence among children and adults reported in different regions of the continent. Persistent and uneradicated HPI could result in gastric cancer, although less severe pathological outcomes have been reported among Africans - the so-called "African enigma." SUMMARY Analysis of endoscopic findings of the upper gastrointestinal tract demonstrates similarities with that of patients from the West. Thus, it could be asserted that the true picture of HPI in Africa is yet to be unveiled due to several challenges including inadequate health-care system, lack of treatment guidelines and standardized protocol for diagnosis, and lack of data. This review explores the prevalence, diagnosis, treatment, and health-care system in Africa as it relates to HPI, thus providing an update and highlighting the need for an African HPI guideline. KEY MESSAGES There is high prevalence of Helicobacter pylori infection (HPI) in Africa with an increasing burden of antibiotic resistance. Various methods including invasive and noninvasive methods are deployed in the diagnosis of HPI in Africa. There is a need for consensus on diagnosis and treatment of HPI in Africa.
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Affiliation(s)
- Stella Ifeanyi Smith
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria.,Department of Microbiology, Mountain Top University, Ogun, Nigeria
| | - Abraham Ajayi
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Charles Onyekwere
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Mashiko Setshedi
- Division of Gastroenterology, Departments of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christian Schulz
- Department of Medicine 2, LMU Hospital, Ludwig-Maximillians-University, Munich, Germany
| | | | - Roland Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Yakhya Dieye
- Department of Microbiology, Institut Pasteur, Dakar, Senegal
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Reidwaan Ally
- Department of Gastroenterology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Revathi Gunturu
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Jaka Hyasinta
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Ugiagbe
- Department of Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Dennis Ndububa
- Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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15
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Sharma A, Alatise OI, O'Connell K, Ogunleye SG, Aderounmu AA, Samson ML, Wuraola F, Olasehinde O, Kingham TP, Du M. Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria: a cross-sectional study. BMJ Open 2021; 11:e040352. [PMID: 34312189 PMCID: PMC8314695 DOI: 10.1136/bmjopen-2020-040352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND/AIMS Cancer burden is predicted to double by 2030 in sub-Saharan Africa; access to healthcare services for cancer management is a priority in the region. In Nigeria, National Cancer Control Plan aims to ensure >50% cancer screening of eligible populations by 2022 for all Nigerians. We describe healthcare utilisation, cancer screening activities and potential barriers to accessing cancer care within an understudied rural community-based adult population in South West Nigeria. METHODS In April 2018, we conducted a cross-sectional study of community-based adults (>18 years) ~130 km east of Ibadan, 250 km from Lagos in Osun State, South West Nigeria. Participants completed a face-to-face survey in local dialect. We used a questionnaire to assess demographics, health status, income, medical expenditures, doctor visits and cancer screening history. RESULTS We enrolled 346 individuals: with median age of 52 years and 75% women. Of the entire cohort, 4% had medical insurance. 46% reported a major medical cost in the last year. Cancer screening activities were infrequent in eligible participants: 1.5% reported having had cervical cancer screening, 3.3% mammogram and 5% colonoscopy screening. Cancer screening assessment was less frequent in those with less income and lower education levels. Using a multivariable logistic regression model including personal income, insurance status and education, higher personal income was associated with more cancer screening activity (OR 2.7, 95% CI 1.3 to 5.7, p<0.01). Despite this, most individuals had contact with a primary healthcare doctor (52% in the last year), and over 70% access to radio and TV suggesting the opportunity to expand community-based screening interventions and awareness exists. CONCLUSIONS Despite national increases in cancer cases, we highlight a deficiency in cancer screening and universal healthcare coverage within a community-based adult Nigerian population. Subject to availability of governmental resources, increasing financial risk protection, awareness and targeted resource allocation may help expand access in Nigeria.
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Affiliation(s)
- Avinash Sharma
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olusegun Isaac Alatise
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Kelli O'Connell
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samson Gbenga Ogunleye
- Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | | | - Marquerite L Samson
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Funmilola Wuraola
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olalekan Olasehinde
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - T Peter Kingham
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mengmeng Du
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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16
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Ibrahim RL, Ajide KB. The role of income level and institutional quality in the non‐renewable energy consumption and life expectancy nexus: evidence from selected oil‐producing economies in Africa. ACTA ACUST UNITED AC 2021. [DOI: 10.1111/opec.12212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ridwan Lanre Ibrahim
- Department of Economics University of Lagos P.O. Box, 100213, Akoka Lagos Nigeria
| | - Kazeem Bello Ajide
- Department of Economics University of Lagos P.O. Box, 100213, Akoka Lagos Nigeria
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17
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Suchman L, Montagu D. Recognizing and mediating bureaucratic barriers: increasing access to care through small private providers in Kenya. Gates Open Res 2021; 5:95. [DOI: 10.12688/gatesopenres.13313.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Equitable access to health services can be constrained in countries where private practitioners make up a large portion of primary care providers, making affordability a challenge. Expanding purchasing arrangements in many countries has helped integrate private providers into government-supported payment schemes and reduced financial barriers to care. However, private providers often must go through an onerous accreditation process to enroll in government-supported financing arrangements. The difficulties of this process can be exacerbated where health policy is changed often and low-level bureaucrats must navigate these shifts at their own discretion, effectively re-interpreting or re-making policy in practice. This paper analyzes one initiative to increase private provider accreditation with social health insurance (SHI) in Kenya by creating an intermediary between providers and SHI officials. Methods: This paper draws on 126 semi-structured interviews about SHI accreditation experience with private providers who were members of a franchise network in Kenya. It also draws on four focus group discussions conducted with franchise representatives who provided accreditation support to the providers and served as liaisons between the franchised providers and local SHI offices. There was a total of 20 participants across all four focus groups. Results: In a regulatory environment where regulations are weak and impermanent, officials created an accreditation process that was inconsistent and opaque: applying rules unevenly, requesting bribes, and minimizing communication with providers. The support provided by the implementing organizations clarified rules, reduced the power of local bureaucrats to apply regulations at their own discretion, gave providers greater confidence in the system, and helped to standardize the accreditation process. Conclusions: We conclude that intermediary organizations can mitigate institutional weaknesses, reduce barriers to effective care expansion caused by street-level bureaucrats, and facilitate the adoption of systems which reduce rent-seeking practices that might otherwise delay or derail initiatives to reach universal health coverage.
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18
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Popli P, Gutterman EM, Omene C, Ganesan S, Mills D, Marlink R. Receptor-Defined Breast Cancer in Five East African Countries and Its Implications for Treatment: Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:289-301. [PMID: 33591798 PMCID: PMC8081496 DOI: 10.1200/go.20.00398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) are determinants of treatment and mortality for patients with breast cancer (BC). In East Africa, the estimated 5-year survival (37.7%) is far lower than the US average (90%). This meta-analysis investigates BC receptor subtypes within five East African countries to ascertain cross-country patterns and prioritize treatment needs. METHODS From a PubMed search, January 1, 1998-June 30, 2019, for all English-only BC articles for Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, eligible studies had receptor distributions for female BC samples ≥ 30 patients. Outcomes were proportions of ER+, PR+, and HER2-positive (HER2+), and/or molecular subtypes. Data included study characteristics and mean or median patient age. Using metaprop, Stata 16, we estimated pooled proportions (ES) with 95% CIs and assessed heterogeneity. RESULTS Among 36 BC studies with receptor data, 21 met criteria. Weighted mean age was 47.5 years and median, 48. Overall ES were as follows: 55% for ER-positive (ER+) (95% CI, 47 to 62), 23% for HER2+ (95% CI, 20 to 26), and 27% for triple-negative BC (TNBC) (95% CI, 23 to 32). CONCLUSION We found differences between countries, for example, lower distribution of TNBC in Ethiopia (21%) compared with Uganda (35%). ER+, the dominant BC subtype overall at 55%, emphasizes the need to prioritize endocrine therapy. Overall proportions of HER2+ BC (with or without ER+ or PR+), 23%, approached proportions of TNBC, 27%, yet HER2 testing and treatment were infrequent. Testing and reporting of receptor subtypes would promote delivery of more effective treatment reducing the mortality disparity.
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Affiliation(s)
- Pallvi Popli
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Coral Omene
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Shridar Ganesan
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Richard Marlink
- Rutgers Global Health Institute, and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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19
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Shelter in place? Depends on the place: Corruption and social distancing in American states. Soc Sci Med 2020; 269:113569. [PMID: 33309154 DOI: 10.1016/j.socscimed.2020.113569] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022]
Abstract
We investigate the links between corruption and compliance with social distancing during COVID-19 pandemic in America. Both theory and empirical evidence point to a corrosive effect of corruption on trust/social capital which in turn determine people's behavior towards compliance with public health policies. Using data from 50 states we find that people who live in more corrupt states are less likely to comply with so called shelter in place/stay at home orders. Our results are robust to different measures of corruption.
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20
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Langat S, Njuguna F, Kaspers G, Mostert S. Health insurance coverage for vulnerable children: two HIV orphans with Burkitt lymphoma and their quest for health insurance coverage in Kenya. BMJ Case Rep 2020; 13:13/8/e230508. [PMID: 32843443 DOI: 10.1136/bcr-2019-230508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The United Nations and WHO have summoned governments from low-income and middle-income countries to institute universal health coverage and thereby improve their population's healthcare access and outcomes. Until now, few countries responded favourably to this international plea. The HIV/AIDS epidemic, a major global public health challenge, resulted in over 11 million orphans in sub-Saharan Africa. Extended families have taken responsibility for more than 90% of these children. HIV orphans are likely to be poorer and less healthy. Burkitt lymphoma is the most common childhood cancer in sub-Saharan Africa. If orphans need lifesaving chemotherapy, appointing legal guardians becomes necessary to access health insurance. However, rules and regulations involved may be unclear and costly. This hinders its access for poor families who need it most. Uninsured children risk hospital detention over unpaid medical bills and have lower survival. Our case report depicts the quest for health insurance coverage of two HIV orphans with Burkitt lymphoma in Kenya.
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Affiliation(s)
- Sandra Langat
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Festus Njuguna
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gertjan Kaspers
- Department of Pediatric Oncology-Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands .,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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21
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Handayani K, Sijbranda TC, Westenberg MA, Rossell N, Sitaresmi MN, Kaspers GJ, Mostert S. Global Problem of Hospital Detention Practices. Int J Health Policy Manag 2020; 9:319-326. [PMID: 32613805 PMCID: PMC7500386 DOI: 10.15171/ijhpm.2020.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/18/2020] [Indexed: 11/18/2022] Open
Abstract
Although an official definition by the World Health Organization (WHO) or any other authority is currently lacking, hospital detention practices (HDP) can be described as: "refusing release of either living patients after medical discharge is clinically indicated or refusing release of bodies of deceased patients if families are unable to pay their hospital bills." Reports of HDP are very scarce and lack consistent terminology. Consequently, the problem’s scale is unknown. This study aimed to find evidence of HDP worldwide, explore characteristics of HDP reports, and compare countries with or without reports. PubMed and Google were examined for relevant English, Spanish, and French publications up to January 2019. Of 195 countries, HDP reports were found in 46 countries (24%) in Africa, Asia, South-America, Europe, and North-America. Most reports were published by journalists in newspapers. In most countries reports concern living adults and children who are imprisoned in public hospitals. A majority (52%) of reports were of individuals detained for at least a month. Almost all countries, with or without HDP reports, have signed the Universal Declaration of Human Rights. Countries with reported HDP have larger population size (P <.001), worse Corruption Perception Index score (P=.025), higher out-of-pocket expenditure (P =.024), lower Universal Health Coverage Index score (P =.015), and worse Press Freedom Index score (P =.012). We conclude that HDP are more widespread than currently acknowledged. Urgent intervention by stakeholders is required to stop HDP.
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Affiliation(s)
- Krisna Handayani
- Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Tyas C Sijbranda
- Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | | | - Nuria Rossell
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Mei N Sitaresmi
- Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan Jl Kaspers
- Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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22
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Yaya S, Uthman OA, Kunnuji M, Navaneetham K, Akinyemi JO, Kananura RM, Adjiwanou V, Adetokunboh O, Bishwajit G. Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa. BMJ Glob Health 2020; 5:e002042. [PMID: 32133174 PMCID: PMC7042587 DOI: 10.1136/bmjgh-2019-002042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
Background There is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries. Methods We analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child's age, survey year, child's sex, birth order and country random effect, and presented adjusted and unadjusted ORs. Results We included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=-0.606, p<0.0001). In the unadjusted model for full sample, for every US$1000 increase in GDP per capita, the odds of stunting decreased by 23% (OR=0.77, 95% CI 0.76 to 0.78). The magnitude of the association between GDP per capita and stunting was stronger among children in the richest quintile. After adjustment was made, the association was not significant among children from the poorest quintile. However, the magnitude of the association was more pronounced among children from low-income countries, such that, in the model adjusted for child's age, survey year, child's sex, birth order and country random effect, the association between GDP per capita and stunting remained statistically significant; for every US$1000 increase in GDP per capita, the odds of stunting decreased by 12% (OR=0.88, 95% CI 0.87 to 0.90). Conclusion There was no significant association between economic growth and child nutritional status. The prevalence of stunting decreased with increasing GDP per capita. This was more pronounced among children from the richest quintile. The magnitude of the association was higher among children from low-income countries, suggesting that households in the poorest quintile were typically the least likely to benefit from economic gains. The findings could serve as a building block needed to modify current policy as per child nutrition-related programmes in Africa.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | | | - Rornald Muhumuza Kananura
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Visseho Adjiwanou
- Département de Sociologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Olatunji Adetokunboh
- The South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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23
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Kirya MT. Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes. Glob Health Action 2020; 13:1701326. [PMID: 32194012 PMCID: PMC7170355 DOI: 10.1080/16549716.2019.1701326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/03/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers.Objectives: This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems.Methods: The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers.Results: Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes.Conclusion: Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.
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24
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Parry L, Radel C, Adamo SB, Clark N, Counterman M, Flores-Yeffal N, Pons D, Romero-Lankao P, Vargo J. The (in)visible health risks of climate change. Soc Sci Med 2019; 241:112448. [PMID: 31481245 PMCID: PMC8033784 DOI: 10.1016/j.socscimed.2019.112448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/20/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023]
Abstract
This paper scrutinizes the assertion that knowledge gaps concerning health risks from climate change are unjust, and must be addressed, because they hinder evidence-led interventions to protect vulnerable populations. First, we construct a taxonomy of six inter-related forms of invisibility (social marginalization, forced invisibility by migrants, spatial marginalization, neglected diseases, mental health, uneven climatic monitoring and forecasting) which underlie systematic biases in current understanding of these risks in Latin America, and advocate an approach to climate-health research that draws on intersectionality theory to address these inter-relations. We propose that these invisibilities should be understood as outcomes of structural imbalances in power and resources rather than as haphazard blindspots in scientific and state knowledge. Our thesis, drawing on theories of governmentality, is that context-dependent tensions condition whether or not benefits of making vulnerable populations legible to the state outweigh costs. To be seen is to be politically counted and eligible for rights, yet evidence demonstrates the perils of visibility to disempowered people. For example, flood-relief efforts in remote Amazonia expose marginalized urban river-dwellers to the traumatic prospect of forced relocation and social and economic upheaval. Finally, drawing on research on citizenship in post-colonial settings, we conceptualize climate change as an 'open moment' of political rupture, and propose strategies of social accountability, empowerment and trans-disciplinary research which encourage the marginalized to reach out for greater power. These achievements could reduce drawbacks of state legibility and facilitate socially-just governmental action on climate change adaptation that promotes health for all.
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Affiliation(s)
- Luke Parry
- Lancaster Environment Centre, Lancaster University, UK; Nucleus of Advanced Amazonian Studies (NAEA), Federal University of Pará, Brazil.
| | - Claudia Radel
- Department of Environment and Society, Utah State University, UT, USA
| | | | - Nigel Clark
- Lancaster Environment Centre, Lancaster University, UK
| | | | - Nadia Flores-Yeffal
- Department of Sociology, Anthropology & Social Work, Texas Tech University, TX, USA
| | - Diego Pons
- Department of Geography and the Environment, University of Denver, CO, USA
| | | | - Jason Vargo
- Global Health Institute and the Nelson Institute for Environmental Studies, University of Wisconsin-Madison, WI, USA
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Engdahl Mtango S, Lugazia E, Baker U, Johansson Y, Baker T. Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. PLoS One 2019; 14:e0224355. [PMID: 31661506 PMCID: PMC6818781 DOI: 10.1371/journal.pone.0224355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 10/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors' experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania. METHODS We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories. RESULTS Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions. CONCLUSION Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.
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Affiliation(s)
- Sofia Engdahl Mtango
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Edwin Lugazia
- Department of Anaesthesia & Intensive Care, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ulrika Baker
- College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Yvonne Johansson
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tim Baker
- College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS One 2019; 14:e0220583. [PMID: 31433821 PMCID: PMC6703670 DOI: 10.1371/journal.pone.0220583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022] Open
Abstract
Background Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. Methods Using survey data in adults from 32 sub-Saharan African countries in 2014–2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. Results Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70–4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77–11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. Conclusions We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures—which are needed in many countries to achieve UHC—should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC.
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Affiliation(s)
- Amber Hsiao
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
- * E-mail:
| | - Verena Vogt
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
| | - Wilm Quentin
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
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Priority setting in head and neck oncology in low-resource environments. Curr Opin Otolaryngol Head Neck Surg 2019; 27:198-202. [PMID: 30870186 DOI: 10.1097/moo.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Most information about priority setting comes from developed countries. In low-resource settings, many factors should be considered to select the best candidate for the treatments that are available. The physician is always under pressure to obtain better results in spite of the lower quantity of resources. This exposes physicians to daily ethical dilemmas and increases their anxiety and burnout. RECENT FINDINGS Most low-resource settings have restrictions in major treatments, and the number of specialized centers that have all the services is low. The surgeon has to navigate through the system as a patient advocate, taking the responsibilities of other health system actors, has to 'negotiate' to design a treatment based on outdated results or to wait for new results and has to decide whether to start or to wait for other treatments to be ready to comply with protocol recommendations. SUMMARY The surgeons face the dilemma of offering the best treatment with scarce resources but with a higher possibility of completion. Finally, we must do the best we can with what we have.
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Davis EC, Menser T, Cerda Juarez A, Tomaszewski LE, Kash BA. Examining healthcare systems: a market analysis for Kenya. EUROPEAN JOURNAL OF TRAINING AND DEVELOPMENT 2019. [DOI: 10.1108/ejtd-06-2016-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to present a literature review of the health workforce, hospital and clinic systems, infrastructure, primary care, regulatory climate, the pharmaceutical industry and community health behavior of the Kenyan health-care system with the purpose of providing a thorough background on the health-care environment in Kenya.
Design/methodology/approach
A systematic literature review was conducted using Pub Med, searching for “Kenya” in the title of articles published from January 1, 2015 to February 24, 2016; this provided a broad overview of the type of research being conducted in Kenya. Other data provided by governmental agencies and non-governmental agencies was also reviewed to describe the current state of population health in Kenya.
Findings
An initial review of 615 Pubmed articles included 455 relevant articles. A complete review of these studies was conducted, resulting in a final sample of 389 articles. These articles were categorized into three main subject areas with 14 secondary subject areas (Figure 1).
Research limitations/implications
The narrow scope of the search parameters set for the systematic review was a necessary limitation to focus on the most relevant literature. The findings of this study provide a thorough background on health care in Kenya to researchers and practitioners.
Originality/value
This compilation of data specific to Kenya provides a detailed summary of both the country’s health-care services and health status, focusing on potential means of realizing increased quality and length of life.
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Kohi TW, von Essen L, Masika GM, Gottvall M, Dol J. Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: a qualitative study. BMC Cancer 2019; 19:82. [PMID: 30654794 PMCID: PMC6337797 DOI: 10.1186/s12885-019-5279-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of morbidity and mortality worldwide. Seventy percent of deaths of cancer occur in low or middle-income countries, where the resources to provide cancer treatment and care are minimal. Tanzania currently has very inadequate facilities for cancer treatment as there are only five sites, some with limited services; two are in Dar es Salaam and one each in Mwanza, Kilimanjaro and Mbeya that offer cancer treatment. Despite cancer being a prevalent problem in Tanzania, there is a significant shortage of information on the experiences of young people who receive cancer treatment and care. The aim of this study was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania. METHODS Using an explorative, qualitative design, two focus group discussions (FGDs) with young adults (18 to 25 years) and four FGDs with children (9 to 17 years) were held. Data were transcribed into English and analyzed using content analysis. RESULTS Identified concerns included physical effects, emotional effects, financial impacts, poor early care, and poor treatment. Identified needs included the need for improved care in hospital by the staff, need for community support, financial needs, needs for improved cancer care and treatment in the hospitals, and the need for increased education about cancer. Resilience was identified, particularly around hope or faith, having hope to be healed, and receiving good care from staff. CONCLUSION Young adults and children receiving cancer treatment in Tanzania have many needs and concerns. Improvements with regard to the care provided in hospital by the staff, the cancer care and treatment in the hospital, and population-wide education about cancer are necessary to address the identified needs and concerns. Further studies on specific approaches to address the concerns and needs are also warranted.
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Affiliation(s)
- Thecla W Kohi
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Golden M Masika
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Maria Gottvall
- Clinical Psychology in Healthcare, Department of Women and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada
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Pediatric oncology-hematology outreach: Evaluation of patient consultations by teleconferences between Indonesian and Dutch academic hospitals. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Joarder T, Rawal LB, Ahmed SM, Uddin A, Evans TG. Retaining Doctors in Rural Bangladesh: A Policy Analysis. Int J Health Policy Manag 2018; 7:847-858. [PMID: 30316233 PMCID: PMC6186485 DOI: 10.15171/ijhpm.2018.37] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 04/15/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes.
Methods: Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n=11), and stakeholder analysis/position-mapping.
Results: In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector).
Conclusion: Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors.
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Affiliation(s)
- Taufique Joarder
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Aftab Uddin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Timothy G Evans
- Health Nutrition and Population, Human Development Network, The World Bank, Washington, DC, USA
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Mostert S, Njuguna F, van der Burgt RHM, Musimbi J, Langat S, Skiles J, Seijffert A, Sitaresmi MN, Vik TA, van de Ven PM, Kaspers GJL. Health-care providers' perspectives on health-insurance access, waiving procedures, and hospital detention practices in Kenya. Pediatr Blood Cancer 2018; 65:e27221. [PMID: 29741267 DOI: 10.1002/pbc.27221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. PROCEDURE A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care. RESULTS The perspectives of respondents were as follows: all children with cancer should have health insurance according to 96% of HCP. After parents apply for health insurance, it takes too long before treatment costs are covered (67% agree). Patients with childhood cancer without health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving procedures take too long (75%). Parents are scared by waiving procedures and may decide never to return to the hospital again (68%). Poor families delay visiting the hospital because they fear hospital detention and first seek alternative treatment (92%). When poor families finally come to the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at the hospital if parents cannot pay their medical bills is not approved by 84% of HCP. CONCLUSIONS HCP acknowledge that access to health insurance needs improvement and that waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospital detention practices. These factors warrant urgent attention and adjustment.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Renske H M van der Burgt
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Joyce Musimbi
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anneloes Seijffert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mei N Sitaresmi
- Department of Pediatrics, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Terry A Vik
- Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Argent AC. Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions. Front Pediatr 2018; 6:68. [PMID: 29637061 PMCID: PMC5880905 DOI: 10.3389/fped.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC) in low- and middle-income countries (LMICs), and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available), likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.
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Affiliation(s)
- Andrew C Argent
- Paediatric Critical Care, Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Agyepong IA, Sewankambo N, Binagwaho A, Coll-Seck AM, Corrah T, Ezeh A, Fekadu A, Kilonzo N, Lamptey P, Masiye F, Mayosi B, Mboup S, Muyembe JJ, Pate M, Sidibe M, Simons B, Tlou S, Gheorghe A, Legido-Quigley H, McManus J, Ng E, O'Leary M, Enoch J, Kassebaum N, Piot P. The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa. Lancet 2017; 390:2803-2859. [PMID: 28917958 DOI: 10.1016/s0140-6736(17)31509-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Accra, Ghana; Ghana College of Physicians and Surgeons, Public Health Faculty, Accra, Ghana
| | | | | | | | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nduku Kilonzo
- National AIDS Control Council, Ministry of Health, Nairobi, Kenya
| | - Peter Lamptey
- FHI360, Durham, NC, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | | | | | | | | | - Sheila Tlou
- Regional Support Team for Eastern and Southern Africa, UNAIDS, Johannesburg, South Africa
| | - Adrian Gheorghe
- London School of Hygiene & Tropical Medicine, London, UK; Oxford Policy Management, Oxford, UK
| | - Helena Legido-Quigley
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Edmond Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jamie Enoch
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK.
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Kirigia JM, Mburugu GN. The monetary value of human lives lost due to neglected tropical diseases in Africa. Infect Dis Poverty 2017; 6:165. [PMID: 29249201 PMCID: PMC5733961 DOI: 10.1186/s40249-017-0379-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are an important cause of death and disability in Africa. This study estimates the monetary value of human lives lost due to NTDs in the continent in 2015. METHODS The lost output or human capital approach was used to evaluate the years of life lost due to premature deaths from NTDs among 10 high/upper-middle-income (Group 1), 17 middle-income (Group 2) and 27 low-income (Group 3) countries in Africa. The future losses were discounted to their present values at a 3% discount rate. The model was re-analysed using 5% and 10% discount rates to assess the impact on the estimated total value of human lives lost. RESULTS The estimated value of 67 860 human lives lost in 2015 due to NTDs was Int$ 5 112 472 607. Out of that, 14.6% was borne by Group 1, 57.7% by Group 2 and 27.7% by Group 3 countries. The mean value of human life lost per NTD death was Int$ 231 278, Int$ 109 771 and Int$ 37 489 for Group 1, Group 2 and Group 3 countries, respectively. The estimated value of human lives lost in 2015 due to NTDs was equivalent to 0.1% of the cumulative gross domestic product of the 53 continental African countries. CONCLUSIONS Even though NTDs are not a major cause of death, they impact negatively on the productivity of those affected throughout their life-course. Thus, the case for investing in NTDs control should also be influenced by the value of NTD morbidity, availability of effective donated medicines, human rights arguments, and need to achieve the NTD-related target 3.3 of the United Nations Sustainable Development Goal 3 (on health) by 2030.
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Affiliation(s)
| | - Gitonga N Mburugu
- Meru University of Science and Technology, P.O. Box 972-60200, Meru, Kenya
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Mansell R, Purssell E. Treatment abandonment in children with cancer in Sub-Saharan Africa: Systematic literature review and meta-analysis. J Adv Nurs 2017; 74:800-808. [DOI: 10.1111/jan.13476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 01/01/2023]
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Lan CW, Tavrow P. Composite measures of women's empowerment and their association with maternal mortality in low-income countries. BMC Pregnancy Childbirth 2017; 17:337. [PMID: 29143614 PMCID: PMC5688512 DOI: 10.1186/s12884-017-1492-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women's empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women's advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants. METHODS Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures - the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) - with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive. RESULTS Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = -0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = -0.04, P = 0.04). No gender measure was significant. CONCLUSIONS In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women's motivation to deliver in a hospital setting. Improving gender equality and SBA rates is unlikely to reduce MMR in Africa unless corruption is addressed. In other regions, increasing SBA rates can be expected to lower MMRs.
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Affiliation(s)
- Chiao-Wen Lan
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA USA
| | - Paula Tavrow
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA USA
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Martijn HA, Njuguna F, Olbara G, Langat S, Skiles J, Martin S, Vik T, van de Ven PM, Kaspers GJ, Mostert S. Influence of health insurance status on paediatric non-Hodgkin's lymphoma treatment in Kenya. BMJ Paediatr Open 2017; 1:e000149. [PMID: 29637157 PMCID: PMC5862191 DOI: 10.1136/bmjpo-2017-000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes. DESIGN This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected. RESULTS Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063). CONCLUSIONS Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.
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Affiliation(s)
- Hugo A Martijn
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Martin
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry Vik
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Jl Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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40
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The Landscape of Randomised Controlled Trials of Therapies in Breast Cancer in Low and Middle Income Countries. Int J Breast Cancer 2017; 2017:4259704. [PMID: 28487775 PMCID: PMC5401736 DOI: 10.1155/2017/4259704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/23/2017] [Indexed: 01/20/2023] Open
Abstract
Objectives. The objectives of this study were to identify the randomised controlled trials in breast cancer occurring in low and middle income countries (LMICs) generally and within Sub-Saharan Africa specifically, to describe the current status and identify opportunities for further research in these areas. Materials and Methods. Data for this study were obtained from ClinicalTrials.gov. The search term "Breast Cancer Research" was used, and relevant information extracted and analysed. Results. 2414 trials were identified, of which 1099 were eligible for inclusion. 69 of these trials occurred in LMICs. Of the 52 LMICs globally, 30% were participating in breast cancer research. Of the 17 LMICs in Africa, 77% are situated in Sub-Saharan Africa; 23% were participating in breast cancer research, which accounted for 9% of total Sub-Saharan African studies. Conclusion. This study provides current evidence for the need for breast cancer research in LMICs globally and within Sub-Saharan Africa. Within LMIC regions where research is active, the type and numbers of studies are unevenly distributed. High quality research within such areas should be encouraged as the results may have both local and global applications, particularly in the provision of affordable health care.
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41
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Handayani K, Sitaresmi MN, Supriyadi E, Widjajanto PH, Susilawati D, Njuguna F, van de Ven PM, Kaspers GJL, Mostert S. Delays in diagnosis and treatment of childhood cancer in Indonesia. Pediatr Blood Cancer 2016; 63:2189-2196. [PMID: 27510358 DOI: 10.1002/pbc.26174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/22/2016] [Accepted: 07/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emphasizing timely diagnosis and treatment of cancer are important themes in pediatric cancer management, as delays adversely impact survival. This study explores various delay types among children with cancer and determines factors that influence delays. METHODS This cross-sectional study was conducted at an Indonesian academic hospital. Parents of newly diagnosed patients were interviewed between October 2013 and September 2014 using semistructured questionnaires. Patient, physician, diagnosis, treatment, healthcare system (HCS), and total delay were analyzed. RESULTS Parents of 145 children (response rate 89%) with cancer were interviewed. Median total delay was 70 days (range 5-4,055). Patient delay (median 5 days, range 0-189) was significantly shorter than HCS delay (median 49 days, range 4-4,025, P < 0.001). Diagnosis delay (median 58 days, range 3-4,015) was significantly longer than treatment delay (median 3 days, range 1-89, P < 0.001). Older age at diagnosis significantly lengthened patient delay (P = 0.044). Using alternative treatment was associated with significantly longer patient and total delay (P = 0.025, 0.024, respectively). Cancer type significantly influenced physician, diagnosis, treatment, HCS, and total delay (P = 0.001, P = 0.004, P < 0.001, P < 0.001, P < 0.001, respectively). Neurological tumors had the longest delays, whereas hematological tumors had the shortest. Sex, parents' education or income level, disease stage at diagnosis, health insurance status, distance from hospital, and first attended health-facility type did not significantly impact the length of any delay type. CONCLUSIONS Healthcare providers need training to improve recognition of cancer symptoms and speed up subsequent diagnostic processes. Using alternative treatment increased patient and total delays. Community campaigns to encourage families to seek conventional cancer treatments are recommended.
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Affiliation(s)
- K Handayani
- Department of Pediatrics, Nyi Ageng Serang District Hospital, Yogyakarta, Indonesia.
| | - M N Sitaresmi
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E Supriyadi
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P H Widjajanto
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - D Susilawati
- Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - F Njuguna
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - P M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - G J L Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Return Migrants' Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090924. [PMID: 27657096 PMCID: PMC5036757 DOI: 10.3390/ijerph13090924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.
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