Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India

Problem

India has the world’s largest number of maternal deaths estimated at 117 000 per year. Past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level.

Approach

We have documented an innovative public–private partnership scheme between the Government of Gujarat, in India, and private obstetricians practising in rural areas to provide delivery care to poor women.

Local setting

In April 2007, the majority of poor women delivered their babies at home without skilled care.

Relevant changes

More than 800 obstetricians joined the scheme and more than 176 000 poor women delivered in private facilities. We estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between April and October 2007. The programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor.

Lessons learned

At least in some areas of India, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. Poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.     

消旋15(R)-15-甲基PGE2甲酯的合成

d,l-15(R)-15-Methyl-PGF_2α methyl ester 11-trimethylsilyl ether(II)wasprepared from selective monosilylation of d,l-15(R)-15-methyl-PGF_2αmethyl ester(I) withtrimethylsilyldiethylamine in acetone. Oxidation of(II ) with Collin's reagent gave d,l-15(R)-15-methyl-PGE₂ methyl ester 11-trimethylsilyl ether(III)which,without purification,was converted to d,l-15(R)-15-methyl-PGE₂ methyl ester(IV)under mild acidic conditions.     

Colorectal Cancer Screening Adherence in African–American Men and Women 50 Years of Age and Older Living in Maryland

African Americans experience disproportionate incidence and mortality rates from colorectal cancer (CRC). This health disparity is partially explained by low participation in screening. This study aimed to identify factors influencing adherence to colorectal cancer screening among African Americans. Telephone interviews were conducted with African Americans living in Maryland (57% response rate). A total of 504 respondents agreed to participate. The survey primarily assessed participation in CRC screening, health beliefs and attitudes about CRC screening, and demographics. Nearly 77% of respondents reported being adherent to CRC screening guidelines. Of those not adherent, nearly 50% reported not ever receiving a physician recommendation to be screened. Having health insurance was a strong correlate of adherence. Study participants with greater perceived CRC risk were more likely to be adherent. Further, those who reported that they were caregivers were less likely to be adherent to screening. Findings indicate that those who were the primary care takers of children or disabled persons were less likely to participate in CRC screening. Efforts are needed to ensure that caregivers do not neglect their own preventive health, including CRC screening. Further, access to care and health insurance coverage also appear to be an important factor for participation in CRC screening. Ensuring that those who do not have adequate healthcare coverage are not excluded from participation in CRC screening due to cost should be an important priority if reduction in CRC health disparity is to be achieved.     

Toxicity and carcinogenicity studies of methylene blue trihydrate in F344N rats and B6C3F1 mice

Methylene blue trihydrate has a variety of biomedical and biologically therapeutic applications. Groups of 50 male and 50 female rats and mice were administered methylene blue trihydrate in 0.5% aqueous methylcellulose solution by gavage at doses of 0, 5, 25, or 50 mg/kg bw/day (rats) or 0, 2.5, 12.5, and 25 mg/kg bw/day (mice), 5 days per week for 2 years. In rats survival of all dosed groups was similar to that of the vehicle controls, whereas mice exhibited a dose-dependent increase in survival. Rats receiving 25 and 50 mg/kg bw/day and mice receiving 25 mg/kg bw/day developed mild anemia. The incidences of pancreatic islet cell adenoma and adenoma or carcinoma (combined) were increased in all dosed groups of male rats, but increases were statistically significant in 25 mg/kg bw/day males only and the dose–response was non-linear. There was a corresponding increase in the incidence of pancreatic islet cell hyperplasia but statistically significant only in the 50 mg/kg bw/day male rats. There were no significant increases in neoplastic transformation observed in the mice; however, positive trends were noted for adenoma or carcinoma (combined) of the small intestine and malignant lymphoma.     

Leukocyte counts in children with acute otitis media

Peripheral blood leukocyte counts were performed in 167 children with acute otitis media who underwent myringotomy with culture of the middle ear exudate. A markedly elevated (greater than 97th percentile for age) leukocyte count was noted at initial presentation among 28% of these children, and counts exceeded 20,000/microL among 9%. Children older than six years were more likely than younger children to have marked leukocyte (41 v 24%, P less than 0.1). Children with culture-positive and culture-negative acute otitis media had similar leukocyte counts. There was no difference in frequency of posttreatment leukocytosis between those children who had complete resolution of acute otitis media and those children who had persistent otitis media with effusion. At follow-up 10 to 14 days later, relative leukopenia was observed significantly more often than at initial presentation (13 v 2%, P less than 0.001), and was most common among children two to five years old. Absolute neutropenia was likewise more common at the follow-up than at initial presentation (10 v 2%, P less than 0.01). Children treated with the fixed combination of erythromycin ethyl succinate-sulfisoxazole acetyl were somewhat more likely to have absolute neutropenia than those children who were treated with amoxicillin, but this difference was not statistically significant (14 v 6%, P less than 0.1). Acute otitis media, and perhaps the specific antibiotic therapy prescribed for acute otitis media, may exert marked effects upon peripheral blood counts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plants used in traditional medicine in eastern Tanzania. III. Angiosperms (Euphorbiaceae to Menispermaceae)

Seventy-seven Angiosperms (Euphorbiaceae to Menispermaceae) are listed, which are used by traditional healers in five regions of Eastern Tanzania; namely, Coast, Dar es Salaam, Kilimanjaro, Morogoro and Tanga. For each species listed, the botanical name, vernacular name, collection number, locality, habit, distribution and medicinal uses are given. Additionally, information from the literature on medicinal uses, chemical constituents and pharmacological effects is also provided.