Ghana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population. While many studies have focused on predictors of enrolment this study offers a novel analysis of NHIS members’ perceptions of service provision at the national level.
Using data from the 2008 Ghana Demographic Health Survey we analyzed the perceptions of service provision as indicated by members enrolled in the NHIS at the time of the survey (n = 3468; m = 1422; f = 2046). Ordinal Logistic Regression was applied to examine the relationship between perceptions of service provision and theoretically relevant socioeconomic and demographic variables.
Results demonstrate that wealth, gender and ethnicity all play a role in influencing members’ perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, our study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. As well, when compared to Akan women, women from all other ethnic groups were about half as likely to perceive the service provision to be better/same.
Findings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. We conclude that understanding the nature of this relationship is essential for Ghana’s NHIS to ensure its longevity and meet its pro-poor mandate. As national health insurance systems are a relatively new phenomenon in sub-Saharan Africa little is known about their long term viability; understanding user perceptions of service provision is an important piece of that puzzle.
Health care; Ghana; Health insurance; National health insurance scheme; Perceptions; Service
Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level.
Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9.
The 95% one-sided confidence interval for Cronbach’s alpha was between 0.69 and 0.74 for the 16 items.
The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies.
The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach’s alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.
Child sexual abuse (CSA) is a considerable public health problem. Less focus has been paid to the role of community level factors associated with CSA. The aim of this study was to examine the association between neighbourhood-level measures of social disorganization and CSA.
We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 adolescents from six countries in sub-Saharan Africa between 2006 and 2008.
The percentage of adolescents that had experienced CSA ranged from 1.04% to 5.84%. There was a significant variation in the odds of reporting CSA across the communities, suggesting 18% of the variation in CSA could be attributed to community level factors. Respondents currently employed were more likely to have reported CSA than those who were unemployed (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.48 to 2.83). Respondents from communities with a high family disruption rate were 57% more likely to have reported CSA (OR=1.57, 95% CI 1.14 to 2.16).
We found that exposure to CSA was associated with high community level of family disruption, thus suggesting that neighbourhoods may indeed have significant important effects on exposure to CSA. Further studies are needed to explore pathways that connect the individual and neighbourhood levels, that is, means through which deleterious neighbourhood effects are transmitted to individuals.
Childhood sexual abuse; Sub-Saharan Africa; Socio-demographic factors; Demographic and health survey; Neighborhood; Social disorganization
Some studies show orphanhood to be associated with increased sexual risk-taking while others have not established this relationship, but have found factors other than orphanhood as predictors of sexual risk behaviours and outcomes among adolescents. This study examines community members’ perceptions of how poverty influences adolescent sexual behaviour and outcomes in four districts of Nyanza Province, Kenya.
Eight study sites within the four districts were randomly selected. Focus group discussions were conducted with a purposive sample of adolescents, parents and caregivers. Key informant interviews were undertaken with a purposive sample of community leaders, child welfare and healthcare workers, and adolescents. The two methods elicited information on factors perceived to predispose adolescent orphans and non-orphans to sexual risks. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes.
Participants included 147 adolescents and parents/caregivers in 14 focus groups and 13 key informants. Poverty emerged as a key predisposing factor to sexual risk behaviour among orphans and non-orphans. Poverty was associated with lack of food, poor housing, school dropout, and engaging in income generating activities, all of which increase their vulnerability to transactional sex, early marriage, sexual experimentation, and the eventual consequences of increased risk of unintended pregnancies and STI/HIV.
Poverty was perceived to contribute to increasing sexual risks among orphan and non-orphan adolescents through survival strategies adopted to be able to meet their basic needs. Policies for prevention and intervention that target adolescents in a generalized poverty and HIV epidemic should integrate economic empowerment for caregivers and life skills for adolescents to reduce vulnerabilities of orphan and non-orphan adolescents to sexual risk behaviour.
Poverty; Orphan; Non-orphan; Adolescents; Sexual risk behaviour
In South Africa, it is illegal for adolescents under age 16 years to engage in any sexual behaviour whether kissing, petting, or penetrative sex, regardless of consent. This cross-sectional study investigated the extent to which young adolescents engage in various sexual behaviours and the associations between dating status and sexual behaviours.
Grade 8 adolescents (N = 474, ages 12–15 years, mean = 14.14 years) recruited from Cape Town schools completed surveys providing information about their sociodemographic backgrounds, dating experience, sexual behaviour, and substance use.
Lower hierarchy sexual behaviours, such as kissing (71.4% of girls; 88.4% of boys), were more common than oral (3.9% of girls; 13.8% of boys), vaginal (9.3% of girls; 30.0% of boys), or anal (1.4% of girls; 10.5% of boys) sex. Currently dating girls and boys were more likely to engage in sexual behaviours including several risk behaviours in comparison to their currently non-dating counterparts. These risk behaviours included penetrative sex (21.1% of dating vs. 4.5% of non-dating girls; 49.4% of dating vs. 20.2% of non-dating boys), sex with co-occurring substance use (22.2% of dating vs. 0 non-dating girls; 32.1% of dating vs. 40% of non-dating boys), and no contraceptive use (26.1% of sexually experienced girls; 44.4% of sexually experienced boys). Among girls, there were significant associations between ever having penetrative sex and SES (OR = 2.592, p = 0.017) and never dating (OR = 0.330, p = 0.016). Among boys, there were significant associations between ever having penetrative sex and never dating (OR = 0.162, p = 0.008). Although the currently dating group of young adolescents appear to be a precocious group in terms of risk behaviour relative to the currently non-dating group, teenagers in both groups had experience in the full range of sexual behaviours.
Many young adolescents are engaging in a variety of sexual behaviours ranging from kissing and touching to intercourse. Of particular concern are those engaging in risky sexual behaviour. These findings indicate that adolescents need to be prepared for sexual negotiation and decision-making from an early age through comprehensive and accessible education and health services; sections of current legislation may be a barrier to adopting such policies and practices.
Adolescent; Sexual behaviour; Courtship; South Africa; Health policy; Health legislation
Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico.
Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect.
12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI95% 2.8-8.3), for influenza 6.9% (CI95% 3.8-9.6), for pneumococcal 7.2% (CI95% 4.3-10.2), and for tetanus 6.6% (CI95% 4.1-9.2).
The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people.
Older people; Vaccination coverage; Conditional cash transfer; Propensity score matching
Foreign policy holds great potential to improve the health of a global citizenship. Our contemporary political order is, in part, characterized by sovereign states acting either in opposition or cooperation with other sovereign states. This order is also characterized by transnational efforts to address transnational issues such as those featured so prominently in the area of global health, such as the spread of infectious disease, health worker migration and the movement of health-harming products. These two features of the current order understandably create tension for truly global initiatives.
National security has become the dominant ethical frame underlying the health-based foreign policy of many states, despite the transnational nature of many contemporary health challenges. This ethical approach engages global health as a means to achieving national security objectives. Implicit in this ethical frame is the version of humanity that dichotomizes between “us” and “them”. What has been left out of this discourse, for the most part, is the role that foreign policy can play in extending the responsibility of states to protect and promote health of the other, for the sake of the other.
The principal purpose of this paper is to review arguments for a cosmopolitan ethics of health-based foreign policy. I will argue that health-based foreign policy that is motivated by security interests is lacking both morally and practically to further global health goals. In other words, a cosmopolitan ethic is not only intrinsically superior as a moral ideal, but also has potential to contribute to utilitarian ends. This paper draws on the cosmopolitanism literature to build robust support for foreign policies that contribute to sustainable systems of global health governance.
Uncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to understand what bearing uncertainty has on this process.
The study was conducted in six purposively selected rural communities in Lao PDR. In each community, two focus group discussions were held: first with mothers and then with fathers of children younger than five years old. Eleven in-depth interviews with caregivers of severely sick children were conducted. Subsequently, traditional healers, drug vendors, community health workers, nurses and medical doctors were recruited for interviews or group discussions. The data were transcribed and key themes and similarities were identified. Additional readings were conducted to better understand the interactions of factors during which uncertainty was identified as one of several factors mentioned during interviews and focus group discussions.
Care-seekers expressed a strong preference for initially seeking local providers. Subsequently, multiple providers were consulted to increase the chances of recovery. This resulted in patients leaving the health facilities before recovery and in ending the recommended treatment regime prematurely. These healthcare-seeking decisions reflect the social significance of being a responsible caregiver and of showing respect for household norms. In general, healthcare-seeking was shrouded in uncertainty when it came to selecting the right provider, the likelihood of finding the real cause of the illness, spending savings on treatments and ultimately the likelihood of recovery.
Care-seekers’ initial strong preference for local providers irrespective of the providers’ legitimacy indicates the need for a robust primary healthcare system. Care-seekers’ subsequent consultations must be understood in the light of their uncertainty regarding the skills of the available providers. The social connotations of seeking healthcare including the vulnerability of poor households in public health facilities were taken into account to only a limited extent by health workers. Health workers should have greater awareness of the social and cultural aspects of seeking care.
Healthcare-seeking behavior; Uncertainty; Maternal and child mortality; Qualitative interviews; Lao PDR
The failure to reduce preventable maternal deaths represents a violation of women’s right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks.
Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman’s death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women’s lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients’ rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques.
In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.
Maternal mortality; HIV; Health systems; Quality of obstetric care; Southern Africa; Integrated HIV and maternity services
Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services.
We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children’s receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents’ exposure to CGPP, communication activities against their children’s receipt of key vaccinations in order to identify determinants of routine immunization coverage.
Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children’s receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers’ exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT.
A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage.
Sexual abuse of boys is a neglected problem in many developing countries including Ethiopia. As a result, its prevalence, contributing factors and circumstance in which sexual abuse occurs are largely unknown. The objective of this study is to determine the prevalence and factors associated with sexual abuse of male high school students in Addis Ababa city administration.
A cross-sectional descriptive study involving 884 randomly selected students of nine high schools in Addis Ababa was conducted in March 2009. A pre-tested questionnaire was used to collect data. Analysis of the data was made using SPSS for windows version 15.
This study indicates the life time prevalence of rape and sexual harassment of boys in Addis Ababa were 4.3%, and 68.2%, respectively. The chance of experiencing sexual coercion was higher among students who live alone (AOR = 2.87; 95% CI; 1.07, 7.66) and among students who live with others (AOR =1.80; 95% CI = 1.04, 3.11) than those living with both parents. Similarly, the odds of experiencing rape in their life time was higher among students who live with others (AOR=2.20; 95% CI; 1.04, 4.68) than those who live with their parents.
Sexual abuse of male students is not uncommon in Addis Ababa. It is higher in those living alone or not living with their parents. Due attention is needed by schools, parents and other concerned bodies. Designing a program to fight against sexual abuse should include young school boys.
Sexual abuse; Rape; Male students
Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the ‘Communicate to vaccinate’ taxonomy.
The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided.
The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers.
Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes.
Childhood; Vaccination; Immunisation; Communication; Low- and middle-income country; Intervention; Consumer; Taxonomy; Parents
Millions of African children are having to grow up under harsh and adverse psychosocial conditions but it’s not fully understood how this negative psychosocial environment is affecting their mental health. This paper examines the prevalence and risk factors of depression in childhood and adolescence as seen in a community sample derived from four disadvantaged districts in north-eastern Uganda.
1587 children were assessed using a structured instrument administered by trained psychiatric nurses to collect data on psychiatric disorders (DSM IV criteria), adverse psychosocial factors and socio-demographic factors.
The point prevalence of depressive disorder syndromes (DDS) in this study was 8.6% (95% CI 7.2%–10.1%) with a point prevalence for major depressive episode of 7.6% (95% CI 6.3%–9.0%) and dysthymia of 2.1% (95% CI 1.5%–3.0%). At multiple logistic regression, the factors that were independently significantly associated with DDS were: district (representing ecological factors), nature of living arrangements, domestic violence and psychiatric co-morbidities/psychiatric problems of emotional distress (assessed by the SDQ), suicidality and marginally, anxiety disorder syndromes, eating disorder syndromes, motor disorder syndromes and behavioral and developmental disorder syndromes (the later being protective against depression).
Disadvantaged north-eastern Uganda had a high prevalence of childhood depressive disorders. Ecological factors, markers of the quality of the child-principal caregiver relationship (nature of living arrangements and domestic violence) and the presence of psychiatric co-morbidities/psychiatric problems were the important independent determinants of childhood depression in this study.
The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system.
This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors.
Analysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system.
This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.
Primary health care; Q-methodology; Providers; Assessment
The editors of BMC International Health and Human Rights would like to thank all our reviewers who have contributed to the journal in Volume 12 (2012).
This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa.
Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions.
Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports.
A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
Psychosocial disability; Rights; Participation barriers; Policy development; South Africa
The utilization of medical care for gastrointestinal diseases increased over the past decade worldwide. The aim of the study was to investigate the difference between rural and urban patients in seeking medical service for gastrointestinal diseases at ambulatory sector in Taiwan.
From the one-million-people cohort datasets of the National Health Insurance Research Database, the utilization of ambulatory visits for gastrointestinal diseases in 2009 was analyzed. Rural patients were compared with urban and suburban patients as to diagnosis, locality of visits and choice of specialists.
Among 295,056 patients who had ambulatory visits for gastrointestinal diseases in 2009, rural patients sought medical care for gastrointestinal diseases more frequently than urban and suburban patients (1.60 ± 3.90 vs. 1.17 ± 3.02 and 1.39 ± 3.47). 83.4% of rural patients with gastrointestinal diseases were treated by non-gastroenterologists in rural areas. Rural people had lower accessibility of specialist care, especially for hepatitis, esophageal disorders and gastroduodenal ulcer.
The rural–urban disparity of medical care for gastrointestinal diseases in Taiwan highlighted the importance of the well communication between rural physicians and gastroenterologists. Besides the establishment of the referral system, the medical teleconsultation system and the arrangement of specialist outreach clinics in rural areas might be helpful.
Healthcare disparities; Gastroenterology; Rural health services; Utilization
Over the last fifty years, the number of centenarians has dramatically increased. The centenarian rate (CR) is representative of the general longevity prevalent in a nation; it indicates the number of individuals aged 100 years or above at a given date divided by the size of the corresponding cohort of a given age. Two important attributes of the CR (50–54) are that it reflects both unchanged age-specific fertility and the absence of migration in populations. It can generally be used in longevity-based evaluations of the broader concept of successful ageing. As such, this retrospective analysis of the social factors that contribute to the CR (50–54) may help to identify the factors associated with successful ageing.
This study estimates the CR (50–54) and elucidates the influence of social factors on successful ageing and the CR (50–54), examining 32 member countries of the Organization for Economic Co-operation and Development (OECD).
The social indicators for this study were obtained from the United Nations database. The data for the analysis of centenarians in the 32 OECD countries were obtained from the world population prospects conducted by the United Nations. Associations between social factors and CR (50–54) were assessed using Pearson correlation coefficients and regression models.
Significant positive correlations were found between the CR (50–54) and the social factors of expenditure on health as a percentage of gross domestic product (HEGDP: r = 0.411, p < 0.021), general government expenditure on health as a percentage of total government expenditure (GGEH: r = 0.474, p < 0.006), the proportion of fixed-telephone subscriptions in the population (FTS: r = 0.489, p < 0.005), and the human development index (HDI: r = 0.486, p < 0.005). Finally, these CR (50–54) predictors were used to form a model of successful ageing, with higher HEGDP and GGEH as health expenditure, higher FTS as standard of living, and higher HDI as social well-being (R2 = 0.573, P < 0.025).
The findings suggest that an increased CR (50–54) is affected by multiple social factors involved in successful ageing. Therefore, if they wish to improve their country’s CR (50–54), governments must strengthen their existing support services for the elderly through making improvements to standards of living, social well-being and through increased financing of the health sector.
Centenarian rate; Expenditure on health; Fixed-telephone; Human development index
One approach to delivering healthcare in developing countries is through voucher programs, where vouchers are distributed to a specific population for free or subsidized health care. Recent evaluations suggest that vouchers have the potential to extend coverage of priority health services to the poor in developing countries. In Cambodia, a reproductive health voucher program was implemented in January 2011. This study aims to explore women’s early experiences accessing health services with their vouchers at accredited clinics.
This qualitative exploratory study used focus group methodology to gather information from five groups of older (>25 years) and four groups of younger (18–25 years) women who were eligible for the voucher program in three rural provinces. Focus groups were digitally recorded, transcribed and translated from Khmer into English. Data analysis was an iterative process, which comprised of open coding to find commonalities that reflected categories or themes and axial coding to relate initial themes to each other. Next, a basic framework for analysis was formed by integrating the themes into the framework.
Two overarching themes were identified in the data: 1) factors that facilitate voucher use and 2) factors that inhibit voucher use. Within each of these themes, three subthemes were identified: 1) pre-existing factors, 2) distribution factors, and 3) redemption factors. Overall, women expressed positive feelings towards the voucher program, while several areas for program improvement were identified including the importance of addressing pre-existing demand-side barriers to using reproductive health services, the need for more comprehensive counselling during voucher distribution, and the persistent cost of unofficial payments expected by midwives after delivery irrespective of voucher use.
Early information from program beneficiaries can lead to timely and responsive changes that can help to maximize program success. This study highlights the importance of tailoring voucher programs to specific community needs, a strategy that can lead to better program uptake.
People have the right to make choices regarding their own sexuality, as far as they respect the rights of others. The knowledge of those rights is critical to youth’s ability to protect themselves from unwanted reproductive outcomes. Reproductive health targeted Millennium Development Goals will not be achieved without improving access to reproductive health. This study was aimed to assess knowledge of reproductive and sexual rights as well as associated factors among Wolaita Sodo University students.
An institution-based cross-sectional survey was conducted among 642 regular undergraduate Wolaita Sodo University students selected by simple random sampling. A pretested and structured self-administered questionnaire was used for data collection. Data were entered using EPI info version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. Descriptive statistics was used to describe the study population in relation to relevant variables. Bivariate and multivariate logistic regression was also carried out to see the effect of each independent variable on the dependent variable.
More than half (54.5%) of the respondents were found to be knowledgeable about reproductive and sexual rights. Attending elementary and high school in private schools [AOR: 2.08, 95% CI: 1.08, 3.99], coming from urban areas [AOR: 1.46, 95% CI: 1.00, 2.12], being student of faculty of health sciences [AOR: 2.98, 95% CI: 1.22, 7.30], participation in reproductive health clubs [AOR: 3.11, 95% CI: 2.08, 4.65], utilization of reproductive health services [AOR: 2.34, 95% CI: 1.49, 3.69] and discussing sexual issues with someone else [AOR: 2.31, 95% CI: 1.48, 3.62], were positively associated with knowledge of reproductive and sexual rights.
The level of knowledge of students about reproductive and sexual rights was found to be low. The Ministry of Education has to incorporate reproductive and sexual rights in the curricula of high schools and institutions of higher learning.
Reproductive Health; Reproductive and Sexual Rights; Youths; Ethiopia
A third of sub-Saharan Africa’s (SSA) population comprises persons aged 10–24 years. These youth are growing up in a context marked by pervasive poverty, limited educational opportunities, high HIV/AIDS prevalence, widespread conflict, and weak social controls. Published research on the broad issues that affect youth health and wellbeing in SSA is limited and centers heavily on sexual and reproductive health. In this commentary, we provide a broad overview of sub-Saharan African youth, highlight research gaps with respect to youth health and wellbeing, and describe potential avenues to develop the region’s research capacity on youth health and wellbeing.
Youth; Sub-Saharan Africa; Research
HIV/AIDS is the major problem and an obstacle to both the health and development of people in Ethiopia today. It is also indicated that the use of substances have dramatically increased despite the serious concern about HIV infection.
Unmatched case control study was conducted in South West Ethiopia using a sample of 105 cases and 305 controls. Multivariate logistic regression was used to assess the degree of association between dependent and independent variables.
HIV infection was positively associated with being in the age of 20 – 24 years [OR & (95% CI) = 2.892 (1.266, 6.607)], being female [OR & (95% CI) = 2.013 (1.061, 3.822)], alcohol use [OR & (95% CI) = 5.883 (3.034, 11.408)], having no education [OR & (95% CI) = 3.193 (1.523, 6.695)] and primary education level [OR & (95% CI) = 3.160 (1.351, 7.388)]. Early sexual initiation was also positively associated with being not employed Adj. HR & (95% CI) = 7.372 (1.455, 37.357)], not having comprehensive knowledge on HIV/AIDS [Adj. HR & (95% CI) = 8.247 (2.121, 32.067)], alcohol use [Adj. HR & (95% CI) = 3.815 (1.315, 11.070)] and khat use [Adj. HR & (95% CI) = 7.241 (1.871, 28.016)].
Strategies should be designed to control the use of alcohol and khat which were found to be predictors of HIV infection and early sexual initiation in this study.
HIV risks for women who inject drugs and those who engage in sex work are well documented. Women who are dependent on non-injecting drugs and alcohol are also likely to have increased vulnerability to HIV infection, but until they actually inject drugs or engage in sex work, are unlikely to come to the attention of HIV prevention programs.
We undertook a qualitative study involving nine focus group discussions (FGDs) and 27 key informant interviews to investigate the context of female drug and alcohol use in two high HIV prevalence states of India (Manipur and Nagaland) and to describe their HIV risks. The FGD and interview transcripts were thematically analyzed
The women were relatively young (mean age 31 years in Manipur and 28 years in Nagaland), but 64% in Manipur and 35% in Nagaland were widowed or divorced. Both heroin and alcohol were commonly used by the women from Manipur, while alcohol was primarily used by the women from Nagaland, especially in the context of ‘booze joints’ (illicit bars). Reasons for drug and alcohol use included: to avoid symptoms of withdrawal, to suppress emotional pain, to overcome the shame of sex work, pleasure, and widowhood. HIV vulnerability was clearly described, not only in relation to injecting drug use and sex work, but also alcohol consumption.
The contribution of alcohol use to the HIV vulnerability of women is not currently considered when HIV prevention programs are being designed and implemented leaving a group of high-risk women uncovered by much needed services such as treatment for a range of health problems including alcohol dependence.
Alcohol; HIV; India; Substance use; Women
Although much attention has been given to increasing the number of health workers, less focus has been directed at developing models of training that address real-life workplace needs. Makerere University School of Public Health (MakSPH) with funding support from the Centers for Disease Control and Prevention (CDC) developed an eight-month modular, in-service work-based training program aimed at strengthening the capacity for monitoring and evaluation (M&E) and continuous quality improvement (CQI) in health service delivery.
This capacity building program, initiated in 2008, is offered to in-service health professionals working in Uganda. The purpose of the training is to strengthen the capacity to provide quality health services through hands-on training that allows for skills building with minimum work disruptions while encouraging greater involvement of other institutional staff to enhance continuity and sustainability. The hands-on training uses practical gaps and challenges at the workplace through a highly participatory process. Trainees work with other staff to design and implement ‘projects’ meant to address work-related priority problems, working closely with mentors. Trainees’ knowledge and skills are enhanced through short courses offered at specific intervals throughout the course.
Overall, 143 trainees were admitted between 2008 and 2011. Of these, 120 (84%) from 66 institutions completed the training successfully. Of the trainees, 37% were Social Scientists, 34% were Medical/Nursing/Clinical Officers, 5.8% were Statisticians, while 23% belonged to other professions. Majority of the trainees (80%) were employed by Non-Government Organizations while 20% worked with the public health sector. Trainees implemented 66 projects which addressed issues such as improving access to health care services; reducing waiting time for patients; strengthening M&E systems; and improving data collection and reporting. The projects implemented aimed to improve trainees’ skills and competencies in M&E and CQI and the design of the projects was such that they could share these skills with other staff, with minimal interruptions of their work.
The modular, work-based training model strengthens the capacity of the health workforce through hands-on, real-life experiences in the work-setting and improves institutional capacity, thereby providing a practical example of health systems strengthening through health workforce capacity building.
Work-based; Health workforce development; Capacity building; Training; Uganda