Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

Introduction

Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar.

Methods

Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs.

Results

The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved.

Conclusion

SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Preparation and evaluation of sustained release microballoons of propranolol

BACKGROUND AND THE PURPOSE OF THE STUDY

The purpose of the present investigation was to characterize, optimize and evaluate microballoons of Propranolol hydrochloride and to increase its boioavailability by increasing the retention time of the drug in the gastrointestinal tract.

METHODS

Propranolol hydrochloride-loaded microballoons were prepared by the non-aqueous O/O emulsion solvent diffusion evaporation method using Eudragit RSPO as polymer. It was found that preparation temperature determined the formation of cavity inside the microballoon and this in turn determined the buoyancy. Microballoons were subjected to particle size determination, micromeritic properties, buoyancy, entrapment efficiency, drug loading, in vitro drug release and IR study. The correlation between the buoyancy, bulk density and porosity of microballoons were elucidated. The release rate was determined in simulated gastric fluid (SGF) of pH 1.2 at 37±0.5°C.

RESULTS

The microballoons presented spherical and smooth morphologies (SEM) and were porous due to presence of hollow cavity. Microballoons remained buoyant for >12 hrs for the optimized formulation. The formulation demonstrated favorable in vitro floating and release characteristics. The encapsulation efficiency was high. In vitro dissolution kinetics followed the Higuchi model. The drug release from microballoons was mainly controlled by diffusion and showed a biphasic pattern with an initial burst release, followed by sustained release for 12 hrs. The amount of the drug which released up to 12 hrs was 82.05±0.64%. Statistical analysis (ANOVA) showed significant difference (p<0.05) in the cumulative amount of drug released after 30 min, and up to 12 hrs from optimized formulations.

CONCLUSION

The designed system for propanolol would possibly be advantageous in terms of increased bioavailability and patient compliance.

Prevalence of hepatitis viruses among multi-transfused homogenous thalassaemia patients

Thalassaemic children being multi-transfused are at increased risk of parenterally transmissible hepatitis viruses and majority of them prone to develop chronic liver disease. The study is designed to find out the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) seromarkers and correlation of age, sex, number of transfusions and the viral aetiology in thalassaemics of central India. One hundred and four thalassaemic children were subjected to clinical, biochemical and serological analysis for the HBV, HCV and HDV viruses. The chi(2) test was applied to check the statistical significance of different variables. In the present study HBV markers were detected in 57 (56%) of the subjects while anti-HCV antibodies were observed in 21% of the patients. However, only four subjects were detected hepatitis B surface antigen (HBsAg) reactive but none of them were reactive for anti-HDV antibodies. Forty patients had raised alanine transaminase (ALT) levels and among them two were HBsAg reactive, 16 were anti-HBc antibody positive and 14 were anti-HCV reactive. The prevalence of hepatitis viruses and raised ALT levels are found to be significantly associated with the increasing age and number of blood units transfused to them. The present findings also document the excellent contribution of stringent screening of blood units and HBV vaccination programme for containing the HBV infection among thalassaemics.