Change in willingness to pay for normal delivery and caesarean section during pregnancy and after delivery in Kathmandu

Objectives To determine the change in willingness to pay (WTP) measured at pregnancy and at postpartum before and after knowing hospital costs among women who gave birth by normal delivery (NL) and caesarean section (CS) and to identify factors affecting the change in WTP. Methods A prospective study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. WTP for total costs was measured by double‐bound dichotomous contingent valuation and an open‐ended technique. The trend of WTP over time was tested using longitudinal analysis. Associated factors to the positive or negative change in WTP were analysed by logistic regression. Results Of 438 pregnant women followed up both at pregnancy and postpartum, two‐thirds were willing to pay for services at the initial bid of the double‐bound method by $60–$85 for NL and $110–$170 for CS. There were no significant differences in the median WTP measured during pregnancy between NL and CS. The WTP of both groups changed significantly over time (P < 0.001). Caesarean section, perception of good care, information provided on delivery costs and discussion with family about cost were significantly associated with changes from pregnancy to the postpartum period. Conclusions In low‐income countries such as Nepal, where out‐of‐pocket health care expenditures are common, women perceived the health benefit of delivery care in hospital, especially for emergency CS. Their WTP had changed substantially after delivery, and awareness of the associated factors is essential for further policy and planning to improve the services and utilization.     

Neurological evaluation of newborn infants of mothers working in citrus groves in Northern Thailand

The purpose of this pilot study was to assess neurological function in newborn infants born to mothers working in citrus orchards in Northern Thailand for a period in excess of one year where pesticide applications average 35 times a year. Forty-one infants from uncomplicated term births at the community hospital in Fang, Thailand, were given neurological evaluations during the first four days of life. This was a cross-sectional study in which nine mothers worked in citrus orchards and 32 mothers did not. Examiners were not given the exposure history of the mothers. Twelve infants--five of them born to mothers from citrus orchards--had examinations demonstrating abnormal muscle tone. Using logistic regression, the final model showed that maternal citrus grove exposure and anesthesia use were significant predictors (p < 0.05) of abnormal muscle tone with adjusted odds ratios of 9.82 (CI = 1.42, 68.07) and 5.99 (CI = 1.003, 35.85) for exposure and anesthesia respectively.     

Incidence Rate and Risk Factors for Contralateral Eye Involvement among Patients with AIDS and Cytomegalovirus Retinitis Treated with Local Therapy

Purpose: To calculate the incidence of, and to identify the risk factors for developing contralateral eye involvement among patients with AIDS and unilateral cytomegalovirus retinitis (CMV retinitis), who were treated, in the era of highly-active antiretroviral therapy (HAART), with repetitive intravitreal ganciclovir injections.

Materials and Methods: The clinical records of 119 patients were included. The main outcome measurement was the occurrence of contralateral eye involvement.

Results: Over a mean follow-up period of 1.6 years, the overall incidence rate of contralateral involvement was 0.17/person-year. The cumulative incidence of contralateral involvement at 6 months and 1 year was 23.8% and 28.4%, respectively. Receiving HAART at the visit before the event was associated with a decreased risk of developing contralateral retinitis (hazard ratio [HR]?=?0.26, P?=?0.002).

Conclusions: The use of HAART, associated with subsequent immune recovery, significantly reduced the incidence of contralateral eye involvement by approximately 75% among patients in our setting.     

Identification of psychological behaviours among children having parental HIV infection and their determinants in Myanmar: a comparative study with neighbourhood peers

Psychological impact is one of the direct and indirect consequences of HIV and AIDS on children. A national survey applying a cross-sectional comparative design was conducted among children aged 4–16 years with parental HIV infection and age-group matched neighbourhood peers without parental HIV infection to identify and compare their psychological behaviours and determinants. A multistage sampling method was used. Face-to-face interviews were conducted with parents/guardians of the children to obtain family characteristics and children’s psychological behaviours using the modified Strengths and Difficulties Questionnaire. Factor analysis identified three domains of psychological behaviours, namely social, emotional and conduct behaviours. Comparison of these behaviours was done using Chi-squared test with Rao–Scott adjustment. Determinants of these behaviours were identified using survey-weighted logistic regression adjusted for socio-demographic variables. A total of 1280 children with parental HIV infection and 1279 neighbourhood peers participated in the study. Social conditions of the two groups differed in terms of family displacement (24.6% vs. 8.9%, p < 0.001), family dispersion (12.4% vs. 3.7%, p < 0.001), and child displacement (10.3% vs. 3.5%, p < 0.001). Emotional behaviour was significantly different between the two groups (31.3% vs. 24.0%, p < 0.01) but no difference in social or conduct behaviours was evident. Children from extended families (adjusted odds ratio (AOR): 1.34, 95% CI: 1.07–1.67), females (AOR: 1.37, 95% CI: 1.07–1.75), orphans (AOR: 1.62, 95% CI: 1.29–2.05) and children who experienced family displacement (AOR: 1.38, 95% CI: 1.11–1.72) were more likely to have abnormal emotional behaviour. Children from extended families (AOR: 0.77, 95% CI: 0.62–0.97) had less chance of having abnormal conduct behaviour. In contrast, preschool (AOR: 2.73, 95% CI: 1.92–3.87) and out-of-school children (AOR: 1.47, 95% CI: 1.01–2.27) were more likely to have abnormal conduct behaviour. Development of long-term strategies for reducing the risk of behavioural problems among children with parental HIV infection is suggested.