This study presents a new approach to defining high and low motivation groups of contraceptive users by stated intention to use, past use, and unmet need, to determine how these groups differ in characteristics and in region of residence. Data came from 23 DHS surveys in sub-Saharan countries. The low motivation non-users, with less past use and less intention to use in the future, are more rural, less educated, and closer to poverty. When used to guide planning, unmet need should be augmented with motivation, since the two classifications do not entirely overlap. Between 10 and 17 percent of current non-users of family planning are likely highly motivated to use, but are not captured in the unmet need classification. Programme implications for these non-using groups are discussed.
Equitable health services
This research paper reviews individual case histories of children who have died of pneumonia in rural Uganda and investigates why these children did not survive. The research was conducted in the Lganga/Mayuge region in Uganda, where 67,000 people were visited once every three months for population-based data. Children aged 1-59 months from November 2005 to August 2007 were included in the study. The paper finds that of the pneumonia deaths that were registered, half occurred in hospital and one-third at home. Median duration of pneumonia illness was seven days, and median time taken to seek care outside the home was two days. Most children first received drugs at home: 52% antimalarials and 27% antibiotics. The paper concludes that many children with fatal pneumonia experienced mistreatment with antimalarials, delays in seeking care and low quality of care. To improve access to and quality of care, the feasibility and effectiveness of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.
Despite the availability of many treatment options, depressive disorders remain a global public health problem, according to this study. In developing countries, the World Health Organisation estimates that less than 10% of those suffering from depression receive proper care due to poverty, stigma and lack of governmental mental health resources and providers. Positive activity interventions (PAIs) are a type of low-cost intervention that teaches individuals ways to increase their positive thinking, positive emotions and positive behaviours. In this article, the authors review the relevant literature on the effectiveness of various types of PAIs, draw on social psychology, affective neuroscience and psychophamacology research to propose neural models for how PAIs might relieve depression, and discuss the steps needed to translate the potential promise of PAIs as clinical treatments for individuals with major and minor depressive disorders.
This review examined approaches for delivering child and newborn interventions to large populations and how research can help achieve universal coverage of essential maternal, newborn and child health interventions. The literature review included 87 articles, which described 79 discrete studies, mostly in developing countries. The authors found that interventions are available that can prevent serious illness and save the lives of millions of infants and children living in low- and middle-income countries but achieving universal coverage of these interventions depends on a functional health system, the delivery approach used by that system, and community or individual considerations such as access, demand for and acceptability of the intervention, and ability to comply. The authors found that little is known about the process of scaling up, namely, moving from delivery in one district to national coverage – more research is needed. They recommend that any intervention aimed at reducing financial or physical barriers should consider questions of affordability, equity and sustainability. Strategies taking health interventions directly to communities and individual homes can increase the uptake and improve the quality of local services, helping to reduce maternal, newborn and infant mortality, though findings were inconsistent. The authors call for knowledge and training to be linked with establishing conditions that encourage health workers to change their practices in terms of leadership, motivation, opportunity and accountability.
This paper, covering the period 2002–2008, describes how multisectoral teams at district level in Kenya have provided post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. The paper also found that, between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$27, with numbers increasing each year. Almost half (43%) of these were children younger than 15. The paper outlines how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
A cross-sectional survey was conducted in neonatal and maternity units of five Kenyan district public hospitals. Data for 1 year were obtained: A fifth of the admitted neonates died. Compared with normal birth weight, odds of death were significantly higher in all of the low birth weight (LBW, <2500 g) categories, with the highest odds for the extremely LBW (<1000 g) category. The observed maternal mortality, stillbirths and neonatal mortality rates are argued to call for implementation of the continuum of care approach to intervention delivery with particular emphasis on LBW babies.
The authors of this study aimed to establish delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya, to determine whether mothers were receiving appropriate delivery care. A hospital-based cross-sectional survey was conducted among 409 mothers who had delivered while in the study area between August and October 2009. A total of 1,170 deliveries were reported, with 51.8% attended by unskilled birth attendants and 11.7% self administered. Mothers who had unskilled birth attendance were more likely to have less than three years of education and more than three deliveries in a lifetime. The authors conclude that, among the mothers interviewed, utilisation of skilled delivery attendant services was still low. They call for cost effective and sustainable measures to improve the quality of maternal health services.
Using the 2002/3 Uganda National Household Survey data, this study examines the nature and determinants of individuals' decisions to seek care on condition of reporting illness. A nested logit model, which captures correlations among health care provider alternatives, is used to estimate a behavioural model for health care demand. The three options in the model are: no-care, and formal care (public or private health care).
In 2010 and 2011, Tanzania ran a universal coverage campaign to distribute long-lasting insecticidal nets (LLINs) nationally and free-of-charge. Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. A total of 18.2 million LLINs were delivered at an average cost of US$ 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one insecticide-treated net (ITN) increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Close collaboration among the Ministry of Health and Social Welfare, external funders, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. The authors predict that, through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania.
After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidised insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania. The ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions.