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1.
Jose Gaby Tshikuka Léon Okenge Albert Lukuka Bibi Mengema Jacqueline Mafuta Jerry Itetya Kimole Ne-Kimole Gérard Eloko 《Ethiopian journal of health sciences》2014,24(4):299-306
Background
For the past decades, developing countries have received considerable support to fight infectious illnesses in their homelands. This global effort has tremendously reduced case fatality rates associated with illnesses such as HIV/AIDS, tuberculosis and malaria in many countries. However, this information is still missing in some developing countries, hindering international effort for control programs; we designed this study in effort to close this gap.Methods
Data on 23,487 inpatients from Kinshasa hospitals were gathered and analyzed using EpiData and SPSS. Major illnesses affecting inpatients were identified; mortality and case fatality rates associated with each such illness were estimated. Case fatality rates associated with each illness were compared between consecutive years. Socio demographic and economic factors associated with mortality due to HIV/AIDS, TB and malaria were investigated using logistic regression.Results
The outstanding findings were that case fatality rates associated with major illnesses were relatively higher in 2008 than in the previous year; inpatients hospitalized for HIV/AIDS, TB and malaria in 2008 were more likely to die than those hospitalized in the previous year. Low socioeconomic status inpatients hospitalized for malaria, HIV/AIDS or TB were more likely to die than high socioeconomic status inpatients (AOR 0.29, 95% CI 0.22–0.40; AOR 0.20, 95%CI0.12–0.33; AOR 0.33, 95%CI 0.21–0.53), even though both groups presumably had access to free life-saving treatment and care.Conclusion
These results indicate that while improvement in health indicators greatly depends on funds availability and sustainability, these alone might not be enough in resource poor developing countries. Other factors, i.e., population SES also need to be addressed before needed changes may occur. 相似文献2.
Manjula Lusti-Narasimhan Camille Collin Michael Mbizvo 《Bulletin of the World Health Organization》2009,87(11):816-823
Objective
To assess the sexual and reproductive health interventions included by countries in HIV-related proposals approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).Methods
We examined the Global Fund database for elements and indicators of sexual and reproductive health in all approved HIV-related proposals (214) submitted by 134 countries, from rounds 1 to 7, and in an illustrative sample of 35 grant agreements.Findings
At least 70% of the HIV-related proposals included one or more of the four broad elements: sexual and reproductive health information, education and communication; condom promotion/distribution; diagnosis and treatment of sexually transmitted infections; and prevention of mother-to-child transmission of HIV. Between 20% and 30% included sexual health counselling, gender-based violence, and the linking of voluntary counselling and testing for HIV with sexual and reproductive health services. Less than 20% focused on adolescent sexual and reproductive health, the rights and needs of people living with HIV, or safe abortion services. All these elements were rarely featured, if at all, in the grant agreements reviewed. Overall, however, sexual and reproductive health indicators did appear in most HIV-related proposals and in more than 80% of the grant agreements.Conclusion
Country coordinating mechanisms and national-level stakeholders see in funding for sexual and reproductive health a means to address the problem of HIV infection in their respective national settings. However, we highlight some missed opportunities for linking HIV and sexual and reproductive health services. 相似文献3.
4.
Bruno Pereira Nunes Elaine Thumé Elaine Tomasi Suele Manjourany Silva Duro Luiz Augusto Facchini 《Revista de saúde pública》2014,48(6):968-976
OBJECTIVE
To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status.METHODS
This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses.RESULTS
The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status.CONCLUSIONS
Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services. 相似文献5.
Kathryn O’Neill Marina Takane Ashley Sheffel Carla Abou-Zahr Ties Boerma 《Bulletin of the World Health Organization》2013,91(12):923-931
Objective
To describe the Service Availability and Readiness Assessment (SARA) and the results of its implementation in six countries across three continents.Methods
The SARA is a comprehensive approach for assessing and monitoring health service availability and the readiness of facilities to deliver health-care interventions, with a standardized set of indicators that cover all main programmes. Standardized data-collection instruments are used to gather information on a defined set of selected tracer items from public and private health facilities through a facility sample survey or census. Results from assessments in six countries are shown.Findings
The results highlight important gaps in service delivery that are obstacles to universal access to health services. Considerable variation was found within and across countries in the distribution of health facility infrastructure and workforce and in the types of services offered. Weaknesses in laboratory diagnostic capacities and gaps in essential medicines and commodities were common across all countries.Conclusion
The SARA fills an important information gap in monitoring health system performance and universal health coverage by providing objective and regular information on all major health programmes that feeds into country planning cycles. 相似文献6.
Duff Gillespie Heather Bradley Metiku Woldegiorgis Aklilu Kidanu Sabrina Karklins 《Bulletin of the World Health Organization》2009,87(11):866-870
Problem
Governments and donors encourage the integration of family planning into voluntary testing and counselling (VCT) services. We aimed to determine if clients of VCT services have a need for and will accept quality family planning services.Approach
“Voluntary HIV counselling and testing integrated with contraceptive services” is a proof-of-concept study that interviewed 4019 VCT clients before the addition of family planning services and 4027 different clients after family planning services were introduced. Clients attended eight public VCT facilities in the Oromia region, Ethiopia. The intervention had four components: development of family planning counselling messages for VCT clients, VCT provider training, contraceptive supply provision and monitoring.Local setting
Ethiopia’s population of 80 million is increasing rapidly at an annual rate of 2.5%. Contraceptive prevalence is only 15%. The estimated adult HIV prevalence rate is 2.1%, with more than 1.1 million people infected. The number of VCT facilities increased from 23 in 2001 to more than 1000 in 2007, and the number of HIV tests taken doubled from 1.7 million tests in 2007 to 3.5 million in 2008.Relevant changes
Clients interviewed after the introduction of family planning services received significantly more family planning counselling and accepted significantly more contraceptives than those clients served before the intervention. However, three-quarters of the clients were not sexually active. Of those clients who were sexually active, 70% were using contraceptives.Lessons learned
The study demonstrated that family planning can be integrated into VCT clinics. However, policy-makers and programme managers should carefully consider the characteristics and reproductive health needs of target populations when making decisions about service integration. 相似文献7.
K. C. Takarinda A. D. Harries S. Srinath T. Mutasa-Apollo C. Sandy O. Mugurungi 《Public Health Action》2011,1(2):34-39
Setting:
All public health facilities in Chitungwiza District, Zimbabwe.Objective:
To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status.Design:
Retrospective cohort study.Results:
Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males.Conclusion:
In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients. 相似文献8.
Giseli Nogueira Damacena Célia Landmann Szwarcwald Paulo Roberto Borges de Souza Júnior 《Revista de saúde pública》2014,48(3):428-437
OBJECTIVE
To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence.METHODS
Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence.RESULTS
The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure.CONCLUSIONS
The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues. 相似文献9.
Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results
Seidenberg P Nicholson S Schaefer M Semrau K Bweupe M Masese N Bonawitz R Chitembo L Goggin C Thea DM 《Bulletin of the World Health Organization》2012,90(5):348-356
Objective
To see if, in the diagnosis of infant infection with human immunodeficiency virus (HIV) in Zambia, turnaround times could be reduced by using an automated notification system based on mobile phone texting.Methods
In Zambia’s Southern province, dried samples of blood from infants are sent to regional laboratories to be tested for HIV with polymerase chain reaction (PCR). Turnaround times for the postal notification of the results of such tests to 10 health facilities over 19 months were evaluated by retrospective data collection. These baseline data were used to determine how turnaround times were affected by customized software built to deliver the test results automatically and directly from the processing laboratory to the health facility of sample origin via short message service (SMS) texts. SMS system data were collected over a 7.5-month period for all infant dried blood samples used for HIV testing in the 10 study facilities.Findings
Mean turnaround time for result notification to a health facility fell from 44.2 days pre-implementation to 26.7 days post-implementation. The reduction in turnaround time was statistically significant in nine (90%) facilities. The mean time to notification of a caregiver also fell significantly, from 66.8 days pre-implementation to 35.0 days post-implementation. Only 0.5% of the texted reports investigated differed from the corresponding paper reports.Conclusion
The texting of the results of infant HIV tests significantly shortened the times between sample collection and results notification to the relevant health facilities and caregivers. 相似文献10.
Jessica Cohen Günther Fink Kathleen Maloney Katrina Berg Matthew Jordan Theodore Svoronos Flavia Aber William Dickens 《Bulletin of the World Health Organization》2015,93(3):142-151
Objective
To evaluate the impact – on diagnosis and treatment of malaria – of introducing rapid diagnostic tests to drug shops in eastern Uganda.Methods
Overall, 2193 households in 79 study villages with at least one licensed drug shop were enrolled and monitored for 12 months. After 3 months of monitoring, drug shop vendors in 67 villages randomly selected for the intervention were offered training in the use of malaria rapid diagnostic tests and – if trained – offered access to such tests at a subsidized price. The remaining 12 study villages served as controls. A difference-in-differences regression model was used to estimate the impact of the intervention.Findings
Vendors from 92 drug shops successfully completed training and 50 actively stocked and performed the rapid tests. Over 9 months, trained vendors did an average of 146 tests per shop. Households reported 22 697 episodes of febrile illness. The availability of rapid tests at local drug shops significantly increased the probability of any febrile illness being tested for malaria by 23.15% (P = 0.015) and being treated with an antimalarial drug by 8.84% (P = 0.056). The probability that artemisinin combination therapy was bought increased by a statistically insignificant 5.48% (P = 0.574).Conclusion
In our study area, testing for malaria was increased by training drug shop vendors in the use of rapid tests and providing them access to such tests at a subsidized price. Additional interventions may be needed to achieve a higher coverage of testing and a higher rate of appropriate responses to test results. 相似文献11.
Problem
High out-of-pocket payments and user fees with unfunded exemptions limit access to health services for the poor. Health equity funds (HEF) emerged in Cambodia as a strategic purchasing mechanism used to fund exemptions and reduce the burden of health-care costs on people on very low incomes. Their impact on access to health services must be carefully examined.Approach
Evidence from the field is examined to define barriers to access, analyse the role played by HEF and identify how HEF address these barriers.Local setting
Two-thirds of total health expenditure consists of patients’ out-of-pocket spending at the time of care, mainly for self-medication and private services. While the private sector attracts most out-of-pocket spending, user fees remain a barrier to access to public services for people on very low incomes.Relevant changes
HEF brought new patients to public facilities, satisfying some unmet health-care needs. There was no perceived stigma for HEF patients but many of them still had to borrow money to access health care.Lessons learned
HEF are a purchasing mechanism in the Cambodian health-care system. They exercise four essential roles: financing, community support, quality assurance and policy dialogue. These roles respond to the main barriers to access to health services. The impact is greatest where a third-party arrangement is in place. A strong and supportive policy environment is needed for the HEF to exercise their active purchasing role fully. 相似文献12.
Peer Reviewed: Prenatal HIV Testing in the US-Mexico Border Region, 2005: The Brownsville-Matamoros Sister City Project for Women’s Health 下载免费PDF全文
Christopher H Johnson Ginger L Gossman Castrucci Brian C Kayan L Lewis Gita G Mirchandani Carillo Garza Carlos Alberto McDonald Jill A Joanna J Nichols 《Preventing chronic disease》2008,5(4)
Introduction
Routine prenatal human immunodeficiency virus (HIV) screening provides a critical opportunity to diagnose HIV infection, begin chronic care, and prevent mother-to-child transmission. However, little is known about the prevalence of prenatal HIV testing in the US-Mexico border region. We explored the correlation between prenatal HIV testing and sociodemographic, health behavior, and health exposure characteristics.Methods
The study sample consisted of women who delivered live infants in 2005 in hospitals with more than 100 deliveries per year and resided in Matamoros, Tamaulipas, Mexico (n = 489), or Cameron County, Texas (n = 458). We examined univariate and bivariate distributions of HIV testing in Matamoros and Cameron County and quantified the difference in odds of HIV testing by using logistic regression.Results
The prevalence of prenatal HIV testing varied by place of residence — 57.6% in Matamoros and 94.8% in Cameron County. Women in Cameron County were significantly more likely than those in Matamoros to be tested. Marital status, education, knowledge of methods to prevent HIV transmission (adult-to-adult), discussion of HIV screening with a health care professional during prenatal care, and previous HIV testing were significantly associated with prenatal HIV testing in Matamoros, although only the latter 2 variables were significant in Cameron County.Conclusion
Although national policies in both the United States and Mexico recommend prenatal testing for HIV, a greater proportion of women in Cameron County were tested, compared with women in Matamoros. Efforts between Matamoros and Cameron County to improve HIV testing during pregnancy in the border region should consider correlates for testing in each community. 相似文献13.
Dube C Nozaki I Hayakawa T Kakimoto K Yamada N Simpungwe JB 《Bulletin of the World Health Organization》2010,88(10):788-791
Problem
Despite the Government’s effort to expand services to district level, it is still hard for people living with HIV to access antiretroviral treatment (ART) in rural Zambia. Strong demands for expanding ART services at the rural health centre level face challenges of resource shortages.Approach
The Mumbwa district health management team introduced mobile ART services using human resources and technical support from district hospitals, and community involvement at four rural health centres in the first quarter of 2007. This paper discusses the uptake of the mobile ART services in rural Mumbwa.Local setting
Mumbwa is a rural district with an area of 23 000 km2 and a population of 167 000. Before the introduction of mobile services, ART services were provided only at Mumbwa District Hospital.Relevant changes
The mobile services improved accessibility to ART, especially for clients in better functional status, i.e. still able to work. In addition, these mobile services may reduce the number of cases “lost to follow-up”. This might be due to the closer involvement of the community and the better support offered by these services to rural clients.Lessons learnt
These mobile ART services helped expand services to rural health facilities where resources are limited, bringing them as close as possible to where clients live. 相似文献14.
Authors Olusesan Ayodeji Makinde Aderemi Azeez Samson Bamidele Akin Oyemakinde Kolawole Azeez Oyediran Wura Adebayo Bolaji Fapohunda Abimbola Abioye Stephanie Mullen 《Online Journal of Public Health Informatics》2014,6(2)
Abstract
Introduction
Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.Methods
The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.Results
The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.Discussion
Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS.Conclusion
Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort. 相似文献15.
Background
Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) remains a significant international public health challenge. The Statewide HIV/AIDS Information Network (SHINE) Project was created to improve HIV/AIDS health information use and access for health care professionals, patients, and affected communities in Indiana.Objective:
Our objective was to assess the information-seeking behaviors of health care professionals and consumers who seek information on the testing, treatment, and management of HIV/AIDS and the usability of the SHINE Project’s resources in meeting end user needs. The feedback was designed to help SHINE Project members improve and expand the SHINE Project’s online resources.Methods:
A convenience sample of health care professionals and consumers participated in a usability study. Participants were asked to complete typical HIV/AIDS information-seeking tasks using the SHINE Project website. Feedback was provided in the form of standardized questionnaire and usability “think-aloud” responses.Results:
Thirteen participants took part in the usability study. Clinicians generally reported the site to be “very good,” while consumers generally found it to be “good.” Health care professionals commented that they lack access to comprehensive resources for treating patients with HIV/AIDS. They requested new electronic resources that could be integrated in clinical practice and existing information technology infrastructures. Consumers found the SHINE website and its collected information resources overwhelming and difficult to navigate. They requested simpler, multimedia-content rich resources to deliver information on HIV/AIDS testing, treatment, and disease management.Conclusions:
Accessibility, usability, and user education remain important challenges that public health and information specialists must address when developing and deploying interventions intended to empower consumers and support coordinated, patient-centric care. 相似文献16.
J. P. Tripathy S. Srinath P. Naidoo R. Ananthakrishnan R. Bhaskar 《Public Health Action》2013,3(3):235-239
Setting:
All designated microscopy centres (DMCs) in Fatehgarh Sahib District, Punjab, India.Objective:
To study the association of distance (physical access) to DMCs with loss to follow-up (LTFU) of presumptive tuberculosis (TB) cases while undergoing diagnostic sputum examination and failure to initiate treatment among smear-positive TB patients after diagnosis.Design:
A cross-sectional, record-based study was undertaken to analyse patient records from routine laboratory registers in all DMCs from January to June 2012.Result:
More than 50% of presumptive TB cases had to travel >7 km to reach the DMC, totalling >28 km for two sputum examinations for the evaluation of an episode. The distance (>10 km) to the diagnostic facility was found to be significantly associated (P < 0.01), both with LTFU during diagnosis and with a delay (>7 days) in initiating treatment after diagnosis. There was a significant correlation (r = 0.7) between distance to the DMC and time to initiate treatment among smear-positive TB cases.Conclusion:
Distance from the nearest facility represents a significant risk for LTFU during diagnosis and delayed initiation of treatment after diagnosis. Further decentralisation of TB care services to the community level is required by expanding the network of DMCs or by organising sputum collection and transportation. 相似文献17.
Ulrika Baker Stefan Peterson Tanya Marchant Godfrey Mbaruku Silas Temu Fatuma Manzi Claudia Hanson 《Bulletin of the World Health Organization》2015,93(6):380-389
Objective
To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania.Methods
Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi’s model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care.Findings
Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts.Conclusion
The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context. 相似文献18.
R Baggaley B Hensen O Ajose KL Grabbe VJ Wong A Schilsky Y-R Lo F Lule R Granich J Hargreaves 《Bulletin of the World Health Organization》2012,90(9):652-658B
Objective
To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients’ experiences of and views about PITC.Methods
A review of the published literature and of national HIV testing policies, strategic frameworks, plans and other relevant documents was carried out.Findings
Of the African countries reviewed, 42 (79.2%) had adopted a PITC policy. Of the 42, all recommended PITC for the prevention of mother-to-child HIV transmission, 66.7% recommended it for tuberculosis clinics and patients, and 45.2% for sexually transmitted infection clinics. Moreover, 43.6% adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients’ experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However, women in antenatal clinics were not always aware that they had the right to decline an HIV test.Conclusion
Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However, other approaches are needed to reach people who do not consult health-care services. 相似文献19.
20.
Imtiaz Jehan Hillary Harris Sohail Salat Amna Zeb Naushaba Mobeen Omrana Pasha Elizabeth M McClure Janet Moore Linda L Wright Robert L Goldenberg 《Bulletin of the World Health Organization》2009,87(2):130-138