Resource allocation for public hospitals in Andhra Pradesh, India

The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures.     

Survey to validate neonatal tetanus elimination in Andhra Pradesh, India

Neonatal Tetanus (NNT) elimination has been defined as an annual incidence of <1 case of NNT per 1,000 live births in each district of a province, state, or country. Reported incidence of NNT does not always reflect the true dimension of the problem. Thus, NNT mortality survey was planned during November 2003 to validate NNT elimination in the state of Andhra Pradesh. Firstly, based on review of records and recommended standard algorithm, two highest risk districts, namely Kurnool and Mahbubnagar were identified. In the second stage, NNT mortality survey was conducted in these two districts using lot quality assurance-cluster sampling (LQA-CS) methodology. In each of the two districts, 62 neonatal deaths were detected with no deaths due to NN, indicating incidence of NNT below 1/1000 LB. Thus, validation of NNT elimination may be concluded.     

State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India

In 2007 the state of Andhra Pradesh in southern India began rolling out Aarogyasri health insurance to reduce catastrophic health expenditures in households ??below the poverty line??. We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that within the first nine months of implementation Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.     

Consumer preferences for household water treatment products in Andhra Pradesh, India

Over 5 billion people worldwide are exposed to unsafe water. Given the obstacles to ensuring sustainable improvements in water supply infrastructure and the unhygienic handling of water after collection, household water treatment and storage (HWTS) products have been viewed as important mechanisms for increasing access to safe water. Although studies have shown that HWTS technologies can reduce the likelihood of diarrheal illness by about 30%, levels of adoption and continued use remain low. An understanding of household preferences for HWTS products can be used to create demand through effective product positioning and social marketing, and ultimately improve and ensure commercial sustainability and scalability of these products. However, there has been little systematic research on consumer preferences for HWTS products.     

Using hospital activity indicators to evaluate performance in Andhra Pradesh, India

The performance of secondary level public hospitals in Andhra Pradesh. India was evaluated with the help of input-output ratios of hospital activity and service mix. Indicators for emergency, clinical, diagnostic and medico-legal services have been defined. Wide variability of global hospital activities was observed. Variability of turnover rate and bed occupancy was much more than length of stay. Combined utilization and productivity analysis showed that all outlying hospitals were either in the low turnover, low occupancy group or in the high turnover, high occupancy group. Low productivity or inadequate hospital capacity seem to be the major problems. All low turnover, low occupancy hospitals also had low levels of outpatient consultations, and high turnover, high occupancy hospitals had above-average outpatient activity. About 40 per cent of hospitals did not provide emergency services. About 10 per cent of hospitals were not performing any diagnostic tests. Strengthening emergency service delivery capacity, as well as diagnostic facilities, could improve productivity and capacity utilization. Extremes of turnover and occupancy were not associated with any particular case-mix pattern. Thus, neither poor productivity and capacity utilization nor over-crowding can be explained by case-mix differences. Problems of poor performance and inadequate capacity seem to be real.     

Cost and effectiveness analysis of immunization service delivery support in Andhra Pradesh, India

The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110,630 (US$ 36,877 per round). The performance of health centre and immunization sessions was evaluated using 43- and 28-point checklists, respectively, and demonstrated significant improvement during and following the two-year implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12,760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit.     

Studies on dengue in rural areas of Kurnool District, Andhra Pradesh, India

A dengue case was reported for the 1st time in a rural area of Kurnool District, Andhra Pradesh, India. Entomological and serological investigations were carried out to determine the prevalence of dengue vectors and dengue virus. Aedes aegypti was recorded for the 1st time in rural areas of Andhra Pradesh. Breeding of Ae. aegypti was observed only in containers with nonpotable water. Cement cisterns and tanks, stone tubs, and clay pots were the major breeding habitats of Ae. aegypti. Larval indices for Ae. aegypti ranged as follows: house index 28-40%, container index 13-37%, and Breteau index 32-60. A serological survey indicated that humans in Kurnool District have been exposed to dengue virus infections. The potential threat of an outbreak of dengue fever in rural areas because of the prevalence of the vector (Ae. aegypti) and dengue virus is discussed.     

Mosquitoes of the mangrove forests of India: part four--Coringa, Andhra Pradesh

Mosquitoes of 12 species belonging to 5 subgenera and 9 genera--Aedes, Anopheles, Culex, Diceromyia, Lorrainea, Rhinoskusea, Stegomyia, Toxorhynchites, and Verrallina--were recorded in the Coringa mangrove forest in Andhra Pradesh, India. Tree holes, crab holes, and swamp pools constituted the larval habitats with Lo. fumida being predominant in tree holes. Adults were found resting in tree holes, tree trunks, root bases, and in crab holes. Species involved in daytime feeding on humans were Ae. cancricomes, Cx. sitiens, Lo. fumida, Rh. wardi, and Ve. lugubris.     

Investigation of atmospheric, mechanical and other pressure effects influencing the levels of radon and radon progeny in buildings.

Real-time data measurement and analysis have identified a number of influences affecting the variability and accumulation of radon and its progeny in indoor air. Observed cycles in radon concentrations were shown to be related to the influence of air-conditioning and water-heated central heating systems. The cyclical pattern, related to operation of the air-condition system, showed radon levels almost four times lower during the period when the system was switched On than when it was Off. When the heating system was switched On the radon and radon progeny levels were 40% lower than when it was switched Off. Under both regimes, it was possible to establish the over-riding influence of meteorological factors by separating the recurring cyclical component from the relevant data set. The general or trend level of indoor radon was determined substantially by the prevailing atmospheric conditions.     

Impact of socioeconomic factors on the prevalence of lymphatic filariasis in Andhra Pradesh,India

Aim

Lymphatic filariasis is an important public health problem that causes economic loss and poverty in many endemic regions of India. This study explores the influence of socioeconomic factors on filariasis prevalence in the Chittoor district of Andhra Pradesh.

Subjects and methods

To understand the influence of socioeconomic variables on lymphatic filariasis, a pilot-scale epidemiological and socioeconomic study was conducted in 30 villages of Chittoor district, Andhra Pradesh, India, from 2004 to 2007. Data were analyzed statistically by frequency distribution, multivariate logistic regression and principal component analysis (PCA).

Results

A total of 5133 blood samples were collected and screened for microfilaria; 77 were found to be positive (1.52 %). The multivariate analysis showed that variables such as age (OR?=?2.4, 95 % CI: 1.47–4.01), income [Indian rupees (INR): <1000: OR?=?4.2, 95 % CI: 1.48–11.76; INR: 1000–3000: OR?=?3.84, 95 % CI:1.92–7.68], drainage system (OR?=?3.5, 95 % CI: 1.62–7.5), mosquito avoidance (OR?=?1.41, 95 % CI: 0.69–2.87) and participation in mass drug administration (MDA) programs (OR?=?1.33, 95 % CI:0.74–2.38) were risk factors for filariasis. The socioeconomic index derived from the PCA was categorized into low (1.7 %), medium (1.7 %) and high (1.3 %) in relation to the percentage of parasite prevalence.

Conclusion

This study reveals that filariasis is largely associated with various socioeconomic factors. Hence, health officials should focus on improving the quality of life to minimize the filarial incidence in the endemic villages by considering the socioeconomic index as a marker for targeting low and medium socioeconomic level groups for disease control programs.

     

Immunization coverage in tribal and rural areas of Visakhapatnam district of Andhra Pradesh,India

Objective  This paper aims to report and compare the immunization coverage of various vaccines among tribal and rural children in a distinct socio-economic environment in India. Methods  The study was conducted in two tribal and two rural developmental blocks of Visakhapatnam district of Andhra Pradesh, India, by employing both qualitative and quantitative data collection techniques. Data collected included the immunisation coverage and the associated socio-demographic factors. Results  The majority of mothers was aware of vaccination of children, and usually the primary heath centres and their health workers were the source of vaccination. Vaccination cards were received by 79.2% of tribal and 71.3% of rural children. Some of the socio-demographic characters of mothers, such as habitat, caste and occupation, were associated with the reception of a vaccination card. The coverage of various vaccines was higher among the tribal than among the rural population. Of the eligible children aged above 9 months, 63.3% of tribal children and only 14.5% of rural children were fully vaccinated [three doses of diphtheria, pertussis and tetanus (DPT), four doses of oral polio vaccine, Bacille Calmette Guerin (BCG) and measles vaccine]. The coverage of vaccination against measles and vitamin-A supplementation were very low among rural children (19.6% and 15.2%, respectively) when compared to tribal children (69.2% and 64.2%, respectively). The qualitative data indicated that the community was not satisfied with regard to vaccination services, particularly in the rural area. Conclusion  The coverage of various vaccines was moderate in tribal areas and poor in rural areas. The sole dependence on and demand for public health services was responsible for relatively better coverage of immunisation in tribal areas compared to rural areas where the private sector plays a major role. The existing strategies of health-care delivery including delivery of vaccination services need to be examined and improved. Improvements in physical access, infrastructure, quality of care and increased use of mass media and interpersonal communication are indispensable for improvement in the provision of services.     

Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India

Background  

Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India.     

Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

Background

Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services.

Methods

Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated.

Results

18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$ 4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R² = 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision.

Conclusion

There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources.     

Outputs and cost of HIV prevention programmes for truck drivers in Andhra Pradesh, India

Background  

HIV prevention programmes for truck drivers form part of the HIV control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and use of resources.     

Fertility and contraceptive use in Tamil Nadu,Andhra Pradesh,and Uttar Pradesh

Rates of total fertility (TFR) in Tamil Nadu and Andhra Pradesh are 2.5 and 2.6 children per woman, respectively. The practice of family planning in these states has therefore successfully reduced overall fertility. Uttar Pradesh, however, with a TFR of 4.8, by far the highest fertility of any state in India, still has a long way to go before achieving replacement fertility. This paper compares findings from these three states to determine if any lessons can be learned about how to reduce fertility in Uttar Pradesh and other high-fertility states. The percentage of women receiving antenatal care and the percentage of girls aged 6-14 years who attend school are the most powerful predictors of total fertility and contraceptive prevalence. The importance of antenatal care most likely reflects the double role of auxiliary nurse-midwives in delivering both health and family planning services. Success in Andhra Pradesh demonstrates the ability of a strong family welfare program to reduce fertility close to replacement levels without much economic or social development. A potentially effective strategy to reduce fertility in Uttar Pradesh and other high-fertility states should include strengthening the health and family welfare programs, which are known to be weak in such states. Improving literacy and education levels, especially of girls, is another important element.     

Traditional food consumption and nutritional status of Dalit mothers in rural Andhra Pradesh, South India

OBJECTIVES: To describe prevalence of malnutrition and their correlates of nutrient and traditional food consumption in rural Dalit mothers. DESIGN: In a cross-sectional study, we used socio-cultural questionnaires, anthropometric measurements and clinical eye examinations during the rainy season in 2003. Food frequency questionnaires and 24-h recalls were conducted during both summer and rainy seasons. SETTING: Dalit mothers with young children were recruited from 37 villages in the Medak District of rural Andhra Pradesh, India. SUBJECTS: Dalit mothers (n = 220) participated. RESULTS:The prevalence of chronic energy-deficient (CED) mothers (body mass index <18.5 kg/m2) was 58%. Illiterate women and active women were more likely to have CED than those literate and non-active (relative risks (RR) = 1.6 and 1.4, respectively, P < or = 0.05), but literacy and activity level were not significant in multivariable analyses including sanitation and number of children < or =5 years of age. Increasing levels of fat intake, as a percent of total energy, was significantly associated with lower risk of CED (RR of the lowest 25th percentile compared to those in the 75th percentile or above was 1.6, P < or = 0.05), findings that remained significant in multivariable analyses. Consumption of pulses (g/day) was also inversely related to CED in univariate and multivariable analyses. Carbohydrate intake, as a percent of total energy, was inversely related to percent energy from fat (r = -0.96, P < or = 0.01), and, although positively related to CED in univariate analyses, carbohydrate consumption was not significant in multivariable analyses. Mothers' age in years and income was positively related to vitamin A deficiency. CONCLUSIONS: These results confirm that CED and vitamin A malnutrition among Dalit women are predominant problems in this area. Increased consumption of local traditional Dalit food (particularly sorghum, pulses, vegetables and animal source food) should be incorporated as an important component of intervention strategies to improve nutritional status.     

An epidemiological study on fluorosis in an urban slum area of Nalgonda, Andhra Pradesh, India

Fluorosis is an important public health problem in certain parts of India. Nalgonda is one of the fluorosis endemic districts of Andhra Pradesh. A cross-sectional study was undertaken to assess the prevalence of dental and skeletal fluorosis in Panagal, one of the urban slum areas of Nalgonda town of Andhra Pradesh. 265 individuals residing in 92 households of five colonies of Panagal were selected by multi-stage random sampling. Fluorosis was assessed by standard clinical methods and water samples were tested for fluoride level. It was observed that mean fluoride level in ground water samples in the area was 4.01 mg/l and that of Nagarjunsagar water was 0.74 mg/l. The mean age of the study subjects in the area was 34.73 years. The overall prevalence of skeletal fluorosis was 24.9% and that of dental fluorosis was 30.6%. The prevalence increased with age. Skeletal and dental fluorosis is endemic in the study area.     

Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India

ABSTRACT: BACKGROUND: Violence and mobility have been identified as critical factors contributing to the spread of HIV worldwide. This study aimed to assess the independent and combined associations of mobility and violence with sexual risk behaviors and HIV, STI prevalence among female sex workers (FSWs) in India. METHODS: Data were drawn from a cross-sectional, bio-behavioral survey conducted among 2042 FSWs across five districts of southern India in 2005--06. Regression models were used to estimate odds ratios and 95% confidence intervals (CIs) for sexual risk behaviors and HIV infection based on experience of violence and mobility after adjusting for socio-demographic and sex work related characteristics. RESULTS: One-fifth of FSWs (19%) reported experiencing violence; 68% reported travelling outside their current place of residence at least once in the past year and practicing sex work during their visit. Mobile FSWs were more likely to report violence compared to their counterparts (23% vs. 10%, p < 0.001). Approximately 1 in 5 tested positive for HIV. In adjusted models, FSWs reporting both mobility and violence as compared to their counterparts were more likely to be infected with HIV (Adjusted odds ratio (adjusted OR): 2.07, 95% CI: 1.42--3.03) and to report unprotected sex with occasional (adjusted OR: 2.86, 95% CI: 1.76--4.65) and regular clients (adjusted OR: 2.07, 95% CI: 1.40--3.06). CONCLUSIONS: The findings indicate that mobility and violence were independently associated with HIV infection. Notably, the combined effect of mobility and violence posed greater HIV risk than their independent effect. These results point to the need for the provision of an enabling environment and safe spaces for FSWs who are mobile, to augment existing efforts to reduce the spread of HIV/AIDS.