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Chirwa T, Malinga S, Ilukena M, Bwalya R, Chama-Chiliba CM. A cross-sectional study on factors associated with health care seeking for acute respiratory infection and fever in children under-five in Zambia. Pan Afr Med J 2023; 44:125. [PMID: 37275290 PMCID: PMC10237215 DOI: 10.11604/pamj.2023.44.125.35921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/21/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction mortality in under-five children remains a significant challenge in developing countries, including Zambia, where pneumonia and malaria account for twenty percent of under-five deaths. Poor health care seeking is one of the contributors to the high mortality rates. This study examined the predictors of health care seeking for acute respiratory infection (ARI) and fever among under-five children in Zambia. Methods the study used a population based cross-sectional survey program evaluation dataset with sample size of 12,507 households from 28 districts. Binary logistic regression was used to examine the determinants of appropriate care seeking for ARI or fever, ARI, and fever. Results the prevalence of fever or ARI in children under five was 22.9%, ARI 12.9%, and fever 13.4%. Educational status and non-participation in positive deviance hearth (PDH) were significant predictors in those with fever or ARI. Children whose household head had secondary education or higher were 4.5 times more likely to seek care than those whose household head did not have any education. Among those with ARI, educational status, women empowerment in decision-making and growth monitoring and promotion (GMP) were significant predictors while for fever only GMP was a significant predictor. Conclusion over two thirds of caregivers sought care appropriately for fever or ARI. Only educational status and GMP were associated with more than one appropriate care seeking outcome. Through GMP services, policymakers can improve healthcare seeking behavior in children under five.
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Affiliation(s)
| | | | | | - Richard Bwalya
- Institute of Economic and Social Research, Lusaka, Zambia
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2
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Ramadan M, Gutierrez JC, Feil C, Bolongaita S, Bernal O, Villar Uribe M. Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries. BMJ Open 2023; 13:e065223. [PMID: 36720573 PMCID: PMC9890757 DOI: 10.1136/bmjopen-2022-065223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association with intermediate health outputs such as coverage and access to care. DESIGN Observational cross-sectional study using matched subnational data from service provision assessment surveys and demographic health surveys from 2007 to 2019. SETTINGS 138 subnational areas with available survey data in 12 LMICs (Afghanistan, Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda). OUTCOMES Eight intermediate MCH outcomes/outputs were explored: (1) met need for family planning by modern methods; (2) attendance of four or more antenatal care visits; (3) perceived financial barriers to care; (4) perceived geographical barriers to care; (5) diphtheria-pertussis-tetanus (DPT) third dose coverage; (6) DPT dropout-rate; (7) care-seeking for pneumonia; and (8) oral rehydration solutions coverage. RESULTS Overall, moderate-to-poor PHC performance was observed across the 12 countries, with substantial heterogeneity between the different subnational areas in the same country as well as within the same subnational area across both capacity and quality subdomains. The analysis of the relationship between PHC service delivery and child health outcomes revealed that recent supervision (b=0.34, p<0.01) and supervisors' feedback (b=0.28, p<0.05) were each associated with increased care-seeking for pneumonia. We also observed the associations of several measures of capacity and quality with DPT immunisation. The analysis of maternal health outcomes yielded only a few statistically significant results at p<0.05 level, however, none remained significant after adjusting for other covariates. CONCLUSION The results of this analysis illustrate the heterogeneity in the capacity and quality of PHC service delivery within LMICs. Countries seeking to strengthen their PHC systems could improve PHC monitoring at the subnational level to better understand subnational bottlenecks in service delivery.
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Affiliation(s)
- Marwa Ramadan
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | | | - Cameron Feil
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | - Sarah Bolongaita
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | - Oscar Bernal
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
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Card EB, Morales CE, Ramirez JM, Billingslea M, Marroquín A, Trueblood E, Javia LR, McCormack SM, Friedland LR, Low DW, Schwartz AJ, Scott M, Jackson OA. Impact of Illustrated Postoperative Instructions on Knowledge and Retention During a Cleft Lip and Palate Surgical Mission. Cleft Palate Craniofac J 2022:10556656221100052. [PMID: 35711155 DOI: 10.1177/10556656221100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the impact of illustrated postoperative instructions on patient-caregiver knowledge and retention. DESIGN Prospective study with all participants receiving an educational intervention. SETTING Pediatric plastic surgical missions in Guatemala City, Guatemala, between 2019 and 2020. PARTICIPANTS A total of 63 majority-indigenous Guatemalan caregivers of patients receiving cleft lip and/or palate surgery. INTERVENTION Illustrated culturally appropriate postoperative care instructions were iteratively developed and given to caregivers who were surveyed on illustration-based and text-based information at preoperative, postoperative, and four-week follow-up time points. MAIN OUTCOME MEASURE Postoperative care knowledge of illustration-based versus text-based information as determined by the ability to answer 11 illustration- and 8 text-based all-or-nothing questions, as well as retention of knowledge as determined by the same survey given at four weeks follow-up. RESULTS Scores for illustration-based and text-based information both significantly increased after caregivers received the postoperative instructions (+13.30 ± 3.78 % SE, + 11.26 ± 4.81 % SE; P < .05). At follow-up, scores were unchanged for illustration-based (-3.42 ± 4.49 % SE, P > .05), but significantly lower for text-based information (-28.46 ± 6.09 % SE, P < .01). Retention of text-based information at follow-up correlated positively with education level and Spanish literacy, but not for illustration-based. CONCLUSIONS In the setting of language and cultural barriers on a surgical mission, understanding of illustration-based and text-based information both increased after verbal explanation of illustrated postoperative instructions. Illustration-based information was more likely to be retained by patient caregivers after four weeks than text-based information, the latter of which correlated with increased education and literacy.
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Affiliation(s)
- Elizabeth B Card
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Carrie E Morales
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Juan M Ramirez
- Partner for Surgery, Guatemala City, Guatemala, Guatemala
| | | | | | - Eo Trueblood
- Stream Studios, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luv R Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Susan M McCormack
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Leonard R Friedland
- Research and Development Department, 33139GlaxoSmithKline, Philadelphia, PA, USA
| | - David W Low
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Alan Jay Schwartz
- The Children's Hospital of Philadelphia, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Scott
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Oksana A Jackson
- Division of Plastic Surgery, 6569University of Pennsylvania Health System, Philadelphia, PA, USA
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Oresanya O, Counihan H, Nndaliman I, Alegbeleye A, Jiya J, Adesoro O, Dada J, Gimba P, Ozor L, Prosnitz D, Maxwell K. Effect of community-based intervention on improving access to treatment for sick under-five children in hard-to-reach communities in Niger State, Nigeria. J Glob Health 2019; 9:010803. [PMID: 31263548 PMCID: PMC6594663 DOI: 10.7189/jogh.09.010803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Access to prompt and appropriate treatment is key to survival for children with malaria, pneumonia and diarrhoea. Community-based services are vital to extending care to remote populations. Malaria Consortium supported Niger state Ministry of Health, Nigeria, to introduce and implement an integrated community case management (iCCM) programme for four years in six local government areas (LGAs). The objective was to increase coverage of effective treatment for malaria, pneumonia and diarrhoea among children aged 2-59 months. METHODS The programme involved training, equipping, ongoing support and supervision of 1320 community volunteers (CORPs) to provide iCCM services to their communities in all six LGAs. Demand creation activities were also conducted; these included community dialogues, household mobilization, sensitization and mass media campaigns targeted at programme communities. To assess the level of changes in care seeking and treatment, baseline and endline household surveys were conducted in 2014 and 2017 respectively. For both surveys, a 30×30 multi-stage cluster sampling method was used, the sampling frame being RAcE programme communities. RESULTS Care-seeking from an appropriate provider increased overall and for each iCCM illness from 78% to 94% for children presenting with fever (P < 0.01), from 72% to 91% for diarrhoea cases (P < 0.01), and from 76% to 89% for cases of cough with difficult or fast breathing (P < 0.05). For diagnosis and treatment, the coverage of fevers tested for malaria increased from 34% to 77% (P < 0.001) and ACT treatments from 57% to 73% (<0.005); 56% of cases of cough or fast breathing who sought care from a CORP, had their respiratory rate counted and 61% with cough or fast breathing received amoxicillin. At endline caregivers sought care from CORPs in their communities for most cases of childhood illnesses (84%) compared to other providers at hospitals (1%) or health centres (9%).This aligns with caregivers' belief that CORPs are trusted providers (94%) who provide quality services (96%). CONCLUSION Implementation of iCCM with focused demand creation activities can improve access to quality lifesaving interventions from frontline community providers in Nigeria. This can contribute towards achieving SDGs if iCCM is scaled up to hard-to-reach areas of all states in the country.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lynda Ozor
- World Health Organization, Abuja, Nigeria
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5
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Bawankule R, Shetye S, Singh A, Singh A, Kumar K. Epidemiological investigation and management of bloody diarrhea among children in India. PLoS One 2019; 14:e0222208. [PMID: 31518363 PMCID: PMC6743764 DOI: 10.1371/journal.pone.0222208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context. METHODS We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years. FINDINGS The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics. CONCLUSION The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.
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Affiliation(s)
- Rahul Bawankule
- International Institute for Population Sciences, Mumbai, India
- * E-mail:
| | - Sadanand Shetye
- B. K. L. Walawalkar Hospital and Rural Medical College, Kasarwadi-Sawarde, India
| | - Ashish Singh
- SJM School of Management, Indian Institute of Technology Bombay, Powai, Mumbai, India
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
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Yourkavitch J, Burgert-Brucker C, Assaf S, Delgado S. Using geographical analysis to identify child health inequality in sub-Saharan Africa. PLoS One 2018; 13:e0201870. [PMID: 30157198 PMCID: PMC6114521 DOI: 10.1371/journal.pone.0201870] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/24/2018] [Indexed: 01/24/2023] Open
Abstract
One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations. Analyzing health indicators in small geographic units aids the identification of hotspots where coverage lags behind neighboring areas. The purpose of these analyses is to identify areas of low coverage or high need in order to inform effective resource allocation to reduce child health inequity between and within countries. Using data from The Demographic and Health Survey Program surveys conducted in 27 selected African countries between 2010 and 2014, we computed estimates for six child health indicators for subnational regions. We calculated Global Moran's I statistics and used Local Indicator of Spatial Association analysis to produce a spatial layer showing spatial associations. We created maps to visualize sub-national autocorrelation and spatial clusters. The Global Moran's I statistic was positive for each indicator (range: 0.41 to 0.68), and statistically significant (p <0.05), suggesting spatial autocorrelation across national borders, and highlighting the need to examine health indicators both across countries and within them. Patterns of substantial differences among contiguous subareas were apparent; the average intra-country difference for each indicator exceeded 20 percentage points. Clusters of cross-border associations were also apparent, facilitating the identification of hotspots and informing the allocation of resources to reduce child health inequity between and within countries. This study exposes differences in health indicators in contiguous geographic areas, indicating that specific regional and subnational, in addition to national, strategies to improve health and reduce health inequalities are warranted.
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Affiliation(s)
| | | | - Shireen Assaf
- The DHS Program, ICF, Rockville, Maryland, United States of America
| | - Stephen Delgado
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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7
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van Velthoven MH, Wang W, Wu Q, Li Y, Scherpbier RW, Du X, Chen L, Zhang Y, Car J, Rudan I. Comparison of text messaging data collection vs face-to-face interviews for public health surveys: a cluster randomized crossover study of care-seeking for childhood pneumonia and diarrhoea in rural China. J Glob Health 2018; 8:010802. [PMID: 29899982 PMCID: PMC5997366 DOI: 10.7189/jogh.08.010802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To compare text messaging and face-to-face interviews to conduct a survey on childhood diarrhoea and pneumonia. METHODS Caregivers of young children able to send text messages in Zhao County in rural China were included in this crossover study. Villages (clusters) were randomized into two groups using the ratio 1:1.6 to account for an expected higher drop-out in group 2. In group 1, participants first completed the face-to-face and then text messaging survey; this order was reversed in group 2. We determined data equivalence of 17 questions that were answered by participants who were the same person in both surveys. For the text messaging survey, we assessed the overall and item response rate. RESULTS We included 1014 participants between 16 and 28 March 2013: 371 in 15 villages in group 1 and 643 in 27 villages in group 2. A total of 662 (65.3%) out of 1014 participants responded (first text message question) and a significantly higher proportion who did not respond were from rural areas (P = 0.005). Of 651 participants willing to participate, 356 (54.7%) completed the text messaging survey, which was marginally significantly different between the groups (P = 0.05). In total, 409 participants took part in both surveys: 183 in group 1 and 226 in group 2. There was a significantly higher proportion of caregivers from rural areas in Zhao County in the non-responder group compared to the responder group (P = 0.004). Kappas were substantial for six (0.61-0.80), moderate for two (0.58 and 0.60), and fair for three questions (0.31, 0.35 and 0.37). The proportion of agreement was >90% for five questions; 80.0%-90.0% for five questions; 70.0%, 65.0% and 45.5%. The remaining questions had too small numbers to calculate these values. CONCLUSIONS This study shows that text messaging data collection produces data similar to data from face-to-face interviews in a middle-income setting, but the response rate was insufficient for use in public health surveys. Improving the response rate is important, because text message surveys could be of greater value in rural remote areas due to the cost-saving potential.
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Affiliation(s)
- Michelle Helena van Velthoven
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- These authors contributed equally to this work
| | - Wei Wang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
- These authors contributed equally to this work
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Ye Li
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | | | - Xiaozhen Du
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Li Chen
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Edinburgh, United Kingdom
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Rice HE, Lou-Meda R, Saxton AT, Johnston BE, Ramirez CC, Mendez S, Rice EN, Aidar B, Taicher B, Baumgartner JN, Milne J, Frankel AS, Sexton JB. Building a safety culture in global health: lessons from Guatemala. BMJ Glob Health 2018; 3:e000630. [PMID: 29607099 PMCID: PMC5873535 DOI: 10.1136/bmjgh-2017-000630] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 01/16/2023] Open
Abstract
Programmes to modify the safety culture have led to lasting improvements in patient safety and quality of care in high-income settings around the world, although their use in low-income and middle-income countries (LMICs) has been limited. This analysis explores (1) how to measure the safety culture using a health culture survey in an LMIC and (2) how to use survey data to develop targeted safety initiatives using a paediatric nephrology unit in Guatemala as a field test case. We used the Safety, Communication, Operational Reliability, and Engagement survey to assess staff views towards 13 health climate and engagement domains. Domains with low scores included personal burnout, local leadership, teamwork and work–life balance. We held a series of debriefings to implement interventions targeted towards areas of need as defined by the survey. Programmes included the use of morning briefings, expansion of staff break resources and use of teamwork tools. Implementation challenges included the need for education of leadership, limited resources and hierarchical work relationships. This report can serve as an operational guide for providers in LMICs for use of a health culture survey to promote a strong safety culture and to guide their quality improvement and safety programmes.
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Affiliation(s)
- Henry E Rice
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Randall Lou-Meda
- Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital, Guatemala City, Guatemala
| | - Anthony T Saxton
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Bria E Johnston
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Carla C Ramirez
- Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital, Guatemala City, Guatemala
| | - Sindy Mendez
- Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital, Guatemala City, Guatemala
| | - Eli N Rice
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Bernardo Aidar
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Brad Taicher
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Judy Milne
- Duke University Medical Center, Durham, North Carolina, USA.,Patient Safety Training and Research Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Allan S Frankel
- Safe and Reliable Health Care, Inc., Boston, Massachusetts, USA
| | - J Bryan Sexton
- Duke University Medical Center, Durham, North Carolina, USA.,Patient Safety Training and Research Center, Duke University Medical Center, Durham, North Carolina, USA
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Flood D, Mathieu I, Chary A, García P, Rohloff P. Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff. BMC Health Serv Res 2017; 17:27. [PMID: 28086866 PMCID: PMC5234139 DOI: 10.1186/s12913-017-1991-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to low-cost essential generic medicines is a critical health policy goal in low-and-middle income countries (LMICs). Guatemala is an LMIC where there is both limited availability and affordability of these medications. However, attitudes of physicians and pharmacy staff regarding low-cost generics, especially generics for non-communicable diseases (NCDs), have not been fully explored in Guatemala. METHODS Semi-structured interviews with 30 pharmacy staff and 12 physicians in several highland towns in Guatemala were conducted. Interview questions related to perceptions of low-cost generic medicines, prescription and dispensing practices of generics in the treatment of two NCDs, diabetes and hypertension, and opinions about the roles of pharmacy staff and physicians in selecting medicines for patients. Pharmacy staff were recruited from a random sample of pharmacies and physicians were recruited from a convenience sample. Interview data were analyzed using a thematic approach for qualitative data as well as basic quantitative statistics. RESULTS Pharmacy staff and physicians expressed doubt as to the safety and efficacy of low-cost generic medicines in Guatemala. The low cost of generic medicines was often perceived as proof of their inferior quality. In the case of diabetes and hypertension, the decision to utilize a generic medicine was based on multiple factors including the patient's financial situation, consumer preference, and, to a large extent, physician recommendations. CONCLUSIONS Interventions to improve generic medication utilization in Guatemala must address the negative perceptions of physicians and pharmacy staff toward low-cost generics. Strengthening state capacity and transparency in the regulation and monitoring of the drug supply is a key goal of access-to-medicines advocacy in Guatemala.
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Affiliation(s)
- David Flood
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.
| | - Irène Mathieu
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Pablo García
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
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10
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Velarde López AA, Gerber JS, Leonard MB, Xie D, Schinnar R, Strom BL. Children with lower respiratory tract infections and serum 25-hydroxyvitamin D 3 levels: A case-control study. Pediatr Pulmonol 2016; 51:1080-1087. [PMID: 27133156 DOI: 10.1002/ppul.23439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of death in children under age of 5 years worldwide. The role of vitamin D in respiratory infections including pneumonia is unclear; therefore, we aimed to determine if children with lower respiratory tract infections had low serum 25-hydroxyvitamin D3 . METHODS We performed a case-control study of children ages 3-60 months from the Guatemala City metropolitan area, hospitalized with community-acquired pneumonia between September and December 2012. Controls were selected from the well-baby/care immunization clinics serving the population from which cases emerged. We analyzed serum 25-hydroxyvitamin D3 levels and conducted parental interviews to assess subject age, sex, race, feeding type, vitamin D supplementation, frequency of sun exposure, and maternal education. Height and weight were ascertained from medical records. Complete information was available for 70 (83%) of 84 eligible cases and 68 (60%) of 113 eligible controls. RESULTS The median (IQR) serum 25-hydroxyvitamin D3 concentration for cases was 23.2 ng/ml (14.4-29.9) compared to 27.5 ng/ml (21.4-32.3) in controls (P = 0.006). Multiple regression analysis using an a priori cut-point for vitamin D of <20 ng/ml showed that children with lower respiratory tract infections were more likely to have low 25-hydroxyvitamin D3 levels than controls (adjusted odds ratio 2.4, 95% confidence interval 1.1-5.2, P = 0.02). CONCLUSIONS Children with lower respiratory tract infections in Guatemala had low 25-hydroxyvitamin D3 levels. Pediatr Pulmonol. 2016;51:1080-1087. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Angel Alfonso Velarde López
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania. .,Department of Infectious Diseases, Hospital Roosevelt, Guatemala City.
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Divisions of Infectious Diseases and Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary B Leonard
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Divisions of Infectious Diseases and Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Divisions of Nephrology, Stanford University, California
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita Schinnar
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Biomedical and Health Sciences, Rutgers University, Newark, New Jersey
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11
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Emmerick ICM, Luiza VL, Camacho LAB, Vialle-Valentin C, Ross-Degnan D. Barriers in household access to medicines for chronic conditions in three Latin American countries. Int J Equity Health 2015; 14:115. [PMID: 26521237 PMCID: PMC4628239 DOI: 10.1186/s12939-015-0254-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries. METHODS This was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported. RESULTS A chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 - 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector. CONCLUSIONS The nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.
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Affiliation(s)
- Isabel Cristina Martins Emmerick
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA.
- Center for Pharmaceutical Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, (NAF/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil.
| | - Vera Lucia Luiza
- Center for Pharmaceutical Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, (NAF/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil.
| | - Luiz Antonio Bastos Camacho
- Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation (DEMEQS/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil.
| | - Catherine Vialle-Valentin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA.
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA.
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