Health policy and planning
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Randomized Controlled Trial Comparative Study Clinical Trial
The impact of vitamin A supplementation on mortality inequalities among children in Nepal.
This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials. ⋯ We conclude that universal supplementation with vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.
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Proponents of user fees in the health sector in poor countries cite a number of often interrelated rationales, relating inter alia to cost recovery, improved equity and greater efficiency. Opponents argue that dramatic and sustained decreases in service utilization follow the introduction of user fees, highlighting evidence that user fees reduce service utilization when they fail to result in improved quality of care and/or when services are priced higher than those charged by private health care providers. Utilization of public health services in Cambodia is low. ⋯ It further demonstrates--for the first time that we are aware of from the available literature--that the introduction and subsequent increase in user fees created a 'medical poverty trap', which has significant health and livelihood impact (including untreated morbidity and long-term impoverishment). Addressing the medical poverty trap will require two interventions to be implemented immediately: regulation of the private sector, and reimbursing health facilities for services provided to patients who are exempted from paying user fees because of poverty. A third, longer-term initiative is also suggested: the establishment of a social health insurance mechanism.
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This study had a dual purpose of estimating population- and hospital-based caesarean section rates in 18 Arab countries and examining the association between these rates and important indicators of socioeconomic development. Data on caesarean section were based on the most recent population-based surveys undertaken in each country. Descriptive statistics and bivariate correlation coefficients were used for the analysis. ⋯ Highly significant associations were observed between population caesarean rates and female literacy, percentage urban, infant mortality rate, and the proportion of physicians per 100 000 people. The "caesarean section epidemic" observed in countries of Latin America is not yet evident in the 18 Arab countries examined. Rather, emphasis should be on improving access to appropriate obstetrical interventions in case of complications in a number of countries where rates were well below 5%.
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Comparative Study
The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania.
Integrated Management of Childhood Illness (IMCI) has been adopted by over 80 countries as a strategy for reducing child mortality and improving child health and development. It includes complementary interventions designed to address the major causes of child mortality at community, health facility, and health system levels. The Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (IMCI-MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. ⋯ There were few differences between IMCI and comparison districts in the level of health system support for child health services at facility level. This study suggests that IMCI, in the presence of a decentralized health system with practical health system planning tools, is feasible for implementation in resource-poor countries and can lead to rapid gains in the quality of case-management. IMCI is therefore likely to lead to rapid gains in child survival, health and development if adequate coverage levels can be achieved and maintained.