Santé (Montrouge, France)
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Santé (Montrouge, France) · Oct 2003
Review[Evolution and new perspectives of health care financing in developing countries].
Over the last twenty five years, the perspective of health care financing has dramatically changed in developing countries. In this context, it is worth reviewing the literature and the experiences in order to understand the major shifts on this topic. During the sixties, health care policies focused on fighting major epidemics. ⋯ In this early millenium, there is a general agreement on some major aspects of health care financing such as: Lack of resources for financing health care; cost recovery as a part of any sustainable health care system; health as a public good needing some extended subsidies; protecting people from the burden of disease as a part of financing schemes; equity in relation with the public private mix at the center of many debates; financing as a key mechanism for the regulation of the whole health care system and not only as a resource mobilization; HIV in bringing up new problems clearly shows how all these matters are related. Health care financing is at the heart of ongoing questions on health care reforms. Although developing countries have low insurance coverage and weak modern medical care, they share the same questions as developed countries: How to promote technical and allocative efficiency? What place for incentives? What role for the public sector? How can market and contracting bring results? What progress through stewardship and better governance?
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Santé (Montrouge, France) · Apr 2003
[Maternal deaths and anesthetics in the Lomé (Togo) University Hospital].
To assess the results of anesthesia practices in a department particularly inadequately staffed with physicians specializing in anesthesiology. ⋯ The results of this survey show that anesthetics play a role in maternal mortality in Togo. Good practice guidelines adapted to this setting must therefore be developed.
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Santé (Montrouge, France) · Oct 2002
Comparative Study[Intensive care in Africa: a report of the first two years of activity of the intensive care unit of Ouagadougou national hospital (Burkina Faso)].
Intensive care units (ICUs) are very expensive and their role and effectiveness in developing countries are discussed; yet, their performance in these countries was infrequently reported. We report the experience over the first two years of activity of the multidisciplinary intensive care unit of the Ouagadougou national hospital. The analysis of such experience raises the issues related to intensive care in a developing country in terms of technical and social efficiency. ⋯ Data was collected from medical records and related to length of stay (LOS), morbidity, mortality, therapy and patients' socio-demographic background. No severity score was given. Three hundred and thirty-eight patients, mainly males (73%), were admitted; the average bed occupancy rate was 25%. The average age of patients was 39.05 +/- 1.21; there was no sex-specific age difference. Distribution as per socio-professional category showed a high proportion of civil servants (38.0%); farmers (23.7%) and housewives (17.6%) were relatively few. Admission diagnoses included 146 traumas (43.2%) of which 105 cranial traumas, 121 post operative (35.8%) and 71 medical pathologies (21.0%). Forty-nine patients (14.5%) were mechanically ventilated. The average LOS was 4.69 0.42 days; half of the patients stayed under 48 hours. The overall mortality rate was 63.6%. The rate was 79% for medical pathologies, 70.5% for traumas and 48.5% for post operative patients. The LOS was significantly longer in survivors (7.24 +/- 1.02) than in deceased (3.54 +/- 0.38). The cumulative survival curve showed a high death probability density which decreased in time: 0.74 on the first day, 0.58 on the second, 0.36 on the sixth. The mortality rate was higher in ventilated patients than in non-ventilated ones. The highest mortality rate was observed among senior civil servants and farmers, and the lowest among craftsmen. The analysis of the first two years of operation of the ICUs of Ouagadougou national hospital reveals a low bed occupancy and a high mortality rate, particularly in the first days and for farmers. These results provide an opportunity to suggest the need for reorganization, with special emphasis on personnel availability and training, and for improved affordability of intensive care services.
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Santé (Montrouge, France) · Jul 2002
Clinical Trial[Validation of a method of blood pressure measurement for a study of hypertension in a black African population].
Hypertension is a major public health issue in Black Africa. It is also an important factor of cardiovascular risk. To determine the prevalence of hypertension in a large population in Burkina Faso, it is more practicable to use an automatic device for the measurement of BP. ⋯ It is important to test the reliability of a technique of BP measurement before the evaluation of hypertension prevalence in a large population. The reliability of the technique ensures a good estimation of the disease prevalence. It is also important to use statistically adapted tests, to avoid any wrong conclusion as to the reliability of the technique.
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Iron deficiency is the most prevalent nutritional disorder worldwide, especially in developing countries. It occurs when iron absorption cannot compensate iron requirements and losses. Requirements are especially high in pregnant women, infants, young children and adolescents who run a higher risk of being iron-deficient. ⋯ The success of most interventions requires the active participation of the individuals. Information and education of the populations, especially through social mobilization campaigns, are essential because iron deficiency induces few visible symptoms, not easily recognizable by individuals. The implementation of national nutrition plans including the control of iron deficiency as one of the priorities and the participation of the public health and education sectors, food industries, the community and the media should contribute to the success of the interventions and to the control of iron deficiency.