29 research outputs found
Household malaria knowledge and its association with bednet ownership in settings without large–scale distribution programs: Evidence from rural Madagascar
Background: Insecticide–treated bednets are effective at preventing malaria. This study focuses on household–level factors that are associated with bednet ownership in a rural area of Madagascar which had not been a recipient of large–scale ITN distribution. Methods: Data were gathered on individual and household characteristics, malaria knowledge, household assets and bednet ownership. Principal components analysis was used to construct both a wealth index based on household assets and a malaria knowledge index based on responses to questions about malaria. Bivariate and multivariate regressions were used to determine predictors of household bednet ownership and malaria knowledge. Results: Forty–seven of 560 households (8.4%) owned a bednet. In multivariate analysis, higher level of malaria knowledge among household members was the only variable significantly associated with bednet ownership (odds ratio 3.72, P < 0.001). Among respondents, predictors of higher malaria knowledge included higher education levels, female sex and reporting fever as the most frequent or dangerous illness in the community. Household wealth was not a significant predictor of bednet ownership or respondent malaria knowledge. Conclusion: In this setting of limited supply of affordable bednets, malaria knowledge was associated with an increased probability of household bednet ownership. Further studies should determine how such malaria knowledge evolves and if malaria–specific education programs could help overcome the barriers to bednet ownership among at–risk households living outside the reach of large–scale bednet distribution programs
Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review
Financial barriers can affect timely access to maternal health
services. Health insurance can influence the use and quality of these
services and potentially improve maternal and neonatal health outcomes.
We conducted a systematic review of the evidence on health insurance
and its effects on the use and provision of maternal health services
and on maternal and neonatal health outcomes in middle- and low-income
countries. Studies were identified through a literature search in key
databases and consultation with experts in healthcare financing and
maternal health. Twenty-nine articles met the review criteria of
focusing on health insurance and its effect on the use or quality of
maternal health services, or maternal and neonatal health outcomes.
Sixteen studies assessed demand-side effects of insurance, eight
focused on supply-side effects, and the remainder addressed both.
Geographically, the studies provided evidence from sub-Saharan Africa
(n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies
included examples from national or social insurance schemes (n=7),
government-run public health insurance schemes (n=4), community-based
health insurance schemes (n=11), and private insurance (n=3). Half of
the studies used econometric analyses while the remaining provided
descriptive statistics or qualitative results. There is relatively
consistent evidence that health insurance is positively correlated with
the use of maternal health services. Only four studies used methods
that can establish this causal relationship. Six studies presented
suggestive evidence of overprovision of caesarean sections in response
to providers\u2019 payment incentives through health insurance. Few
studies focused on the relationship between health insurance and the
quality of maternal health services or maternal and neonatal health
outcomes. The available evidence on the quality and health outcomes is
inconclusive, given the differences in measurement, contradictory
findings, and statistical limitations. Consistent with economic
theories, the studies identified a positive relationship between health
insurance and the use of maternal health services. However, more
rigorous causal methods are needed to identify the extent to which the
use of these services increases among the insured. Better measurement
of quality and the use of cross-country analyses would solidify the
evidence on the impact of insurance on the quality of maternal health
services and maternal and neonatal health outcomes
Association between malaria control and paediatric blood transfusions in rural Zambia: an interrupted time-series analysis
BACKGROUND: Blood transfusions can reduce mortality among children with severe malarial anaemia, but there is limited evidence quantifying the relationship between paediatric malaria and blood transfusions. This study explores the extent to which the use of paediatric blood transfusions is affected by the number of paediatric malaria visits and admissions. It assesses whether the scale-up of malaria control interventions in a facility catchment area explains the use of paediatric blood transfusions. METHODS: The study was conducted at a referral hospital for 13 rural health centres in rural Zambia. Data were used from facility and patient records covering all paediatric malaria admissions from 2000 to 2008. An interrupted time series analysis using an autoregression-moving-average model was conducted to assess the relationship between paediatric malaria outpatient visits and admissions and the use of paediatric blood transfusions. Further investigation explored whether the use of paediatric blood transfusions over time was consistent with the roll out of malaria control interventions in the hospital catchment area. RESULTS: For each additional paediatric malaria outpatient visit, there were 0.07 additional paediatric blood transfusions (95% CI 0.01-0.13; p < 0.05). For each additional paediatric admission for severe malarial anaemia, there were 1.09 additional paediatric blood transfusions (95% CI 0.95-1.23; p < 0.01). There were 19.1 fewer paediatric blood transfusions per month during the 2004–2006 malaria control period (95% CI 12.1-26.0; p < 0.01), a 50% reduction compared to the preceding period when malaria control was relatively limited. During the 2007–2008 malaria control period, there were 27.5 fewer paediatric blood transfusions per month (95% CI 14.6-40.3; p < 0.01), representing a 72% decline compared to the period with limited malaria control. CONCLUSIONS: Paediatric admissions for severe malarial anaemia largely explain total use of paediatric blood transfusions. The reduction in paediatric blood transfusions is consistent with the timing of the malaria control interventions. Malaria control seems to influence the use of paediatric blood transfusions by reducing the number of paediatric admissions for severe malarial anaemia. Reduced use of blood transfusions could benefit other areas of the health system through greater blood availability, particularly where supply is limited
Financial Incentives and Maternal Health: Where Do We Go from Here?
Health financing strategies that incorporate financial incentives are
being applied in many low- and middle-income countries, and improving
maternal and neonatal health is often a central goal. As yet, there
have been few reviews of such programmes and their impact on maternal
health. The US Government Evidence Summit on Enhancing Provision and
use of Maternal Health Services through Financial Incentives was
convened on 24-25 April 2012 to address this gap. This article, the
final in a series assessing the effects of financial
incentives\u2014performance-based incentives (PBIs), insurance, user
fee exemption programmes, conditional cash transfers, and
vouchers\u2014summarizes the evidence and discusses issues of context,
programme design and implementation, cost-effectiveness, and
sustainability. We suggest key areas to consider when designing and
implementing financial incentive programmes for enhancing maternal
health and highlight gaps in evidence that could benefit from
additional research. Although the methodological rigor of studies
varies, the evidence, overall, suggests that financial incentives can
enhance demand for and improve the supply of maternal health services.
Definitive evidence demonstrating a link between incentives and
improved health outcomes is lacking; however, the evidence suggests
that financial incentives can increase the quantity and quality of
maternal health services and address health systems and financial
barriers that prevent women from accessing and providers from
delivering quality, lifesaving maternal healthcare
Effect of incentives on insecticide-treated bed net use in sub-Saharan Africa: a cluster randomized trial in Madagascar
<p>Abstract</p> <p>Background</p> <p>Insecticide-treated bed nets (ITNs) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa. Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns. To date, behavioural incentives have been studied mostly in developed countries. No study has yet looked at the effect of incentives on the use of ITNs. Reported here are the results of a cluster randomized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar.</p> <p>Methods</p> <p>The study took place from July 2007 until February 2008. Twenty-one villages were randomized to either intervention or control clusters. Households in both clusters received a coupon redeemable for one ITN. After one month, intervention households received a bonus for ITN use, determined by visual confirmation of a mounted ITN. Data were collected at baseline, one month and six months. Both unadjusted and adjusted results, using cluster specific methods, are presented.</p> <p>Results</p> <p>At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups (99.5% vs. 99.4%), but net use was substantially higher in the intervention group (99% vs. 78%), with an adjusted risk ratio of 1.24 (95% CI: 1.10 to 1.40; p < 0.001). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%), with an adjusted risk ratio of 0.97 (p < 0.01). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%; p < 0.001).</p> <p>Conclusions</p> <p>Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term, but, over time, the use of ITNs is similar to households that did not receive incentives. Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.</p