An analysis of the determinants of access to medicines and health care in developing country settings

The research question of this thesis is what are the determinants of access to medicines and health care in developing countries? First, this thesis hypothesises that income is an important determinant of access to medicines and health care and that access is low for low income individuals. Second, this thesis hypothesises that an expectation of a high level of expenditure on medicines reduces the propensity to consume which implies a negative price elasticity. This thesis sets out to understand demand structures to answer this research question. The first chapter conducts an exploratory exercise to study government demand for medicines using price procurement data across a sample of developing countries. A different approach is used to impute price elasticities for medicines and range from -1.0 and -2.0. This means that a 1% increase in medicine prices, government demand for medicines will drop from 1% to 2%. The thesis begins the econometric analysis at the patient level using household survey data across a cross-section of 35 developing countries. Demand for health care is inelastic ranging from -0.19 to 0.6. The next two stages of empirical work use national household level data from India as a country case study. Price elasticities for outpatient care range from -0.17 to 0.43 and for inpatient care range from -0.13 to 0.03. Overall, the statistically significant price elasticity results are intuitive with a negative sign but are inelastic and at the lower end of the range found in the literature. The main determinants of health seeking behaviour are similar across different health settings studied in this thesis. These include having insurance and high household expenditure which implies that the poor will experience access problems. Other drivers include health status, gender, marital status, geographical location, education, employment and regulation. This thesis contributes to the evidence base because current research is limited and has typically drawn from smaller datasets. With a particular focus on medicines, the empirical findings offer policy implications in settings where pharmaceutical policies are not well developed. A broader approach to pharmaceutical policy making is necessary that considers reform measures on the demand and supply side from a health systems perspective

What role should AI play in global health?

Artificial intelligence (AI) has many potential applications in health care. Divya Srivastava writes that as policymakers grapple with the question of how to regulate AI health solutions, there is a clear need for international collaboration founded on robust research

Effects of total parenteral nutrition on postnatal growth in very low birth weight and extremely low birth weight newborns

Background: Prematurity is the most important cause of mortality in Under-5 children responsible for one million deaths/ year. Premature babies are not able to store enough nutrients for their optimal survival; it is essential to provide them total parenteral nutrition. Intravenous lipid infusion in neonates is linked with high risk of sepsis and thrombocytopenia. PN with amino acids and glucose can be imparted to achieve nutritional goal. This trial was intended to assess the effects of various components of amino acid PN on postnatal growth in VLBW and ELBW newborns.Methods: A prospective observational study was conducted from January 2018 - May 2019 in NICU of TMMC and RC which included preterm newborns with birth weight of less than 1500gms who received aminoven infusion. Anthropometric measurements, incidence of hypo/hypercalcaemia, hypo/hyperglycaemia, direct hyperbilirubinemia, incidence of sepsis were evaluated.Results: Out of 22 patients, 12 neonates received high dose aminoven therapy whereas 10 neonates received low dose aminoven therapy. It was seen that rapid rate of increment of amino acids had adequate weight on discharge, 72.72% have adequate growth among the rapid group compared to 36.36% among slower group. No significant changes in calcium metabolism or glucose metabolism were seen in both the groups.Conclusions: In resource limited settings, parenteral nutrition with intravenous amino acids have a better effect on the weight of preterm newborns at discharge when high doses of amino acids infusion started early with rapid increment in the dose

Community as an antidote to “Broken Britain”

In London’s poorest boroughs, there is increasingly a sense that public services can no longer be relied on. People look instead to their local community for support. Shani Orgad, Divya Srivastava and Diana Olaleye offer three policy proposals for harnessing the power and value of communities

Childhood retroperitoneal teratomas: 5 years of experience in a tertiary-care hospital

Background Retroperitoneal teratomas are rare paediatric neoplasms. One should be well versed with the presenting features, relationship with surrounding vital organs and the extent of tumour before operating.Aim The present study was planned to highlight the presenting symptoms, preoperative investigatory findings, intraoperative findings, follow-up protocol and the surgeons’ experience in handling these huge tumours.Setting and design This was a retrospective, tertiary-care hospital-based study.Patients and methods Patients with retroperitoneal teratomas operated between 2010 and 2015 were studied in detail. All the data were collected from case files.Results During the mentioned period, there were seven patients including four males and three females. There was no side predilection (three right, two midline, one left and one lesser omentum). All the tumours were completely excised, and histopathology confirmed the benign nature in all cases. All patients were followed-up with postoperative ultrasound and were found to be normal.Conclusion Retroperitoneal teratomas are benign tumours, and complete excision is curative

Effectiveness of Honey and Aloe Vera on the Post Extraction Healing Among Young Adults: A Randomized Clinical Trial

INTRODUCTION: "Dry socket" was first described by Crawford in literature in 1896. When people are recognizing that current medicine is not the soul cure for diseases, we look back to the past for potential remedies with the least possible side-effectiveness. So the objective of this study was to evaluate the effectiveness of honey and aloevera on healing of post extraction wounds. MATERIAL AND METHODS: Honey and aloe-vera were prepared by mixing with sterilized cotton. The socket involved was separated by dry autoclaved cotton rolls from the rest of the oral cavity, then honey/aloe-vera was inserted into the respective groups. All patients were advised to avoid solid and liquid diets for 30 minutes after the treatment. Dressings were changed on 3rd day and on 7th day and sockets were evaluated. RESULTS: When the intra-group comparison of honey (p-value=0.003) and aloe-vera (p-value=0.000) was done, both were found to be statistically significant in the healing of dry socket. When the inter-group comparison was done between honey and aloe-vera, Aloe-vera had high healing capacity and was found to be highly statistically significant (p-value=0.001). DISCUSSION: When the intra-group comparison of honey and aloe-vera was done, both were found to be statistically significant in the reduction of dry socket. When the inter-group comparison was done between honey and aloe-vera, Aloe-vera had high healing capacity and was found to be highly statistically significant (p-value=0.00). CONCLUSION: From the analysis, it can be inferred that aloe vera and honey are healthy, natural and user-friendly substitute adjuncts that might be feasible to promote healing of extraction sockets

RIDDHI (HABENARIA INTERMEDIA D. WEAR): SIGNIFICANCE AND VERSATILITY IN VARIOUS ANCIENT AYURVEDIC NIGHNATU SCRIPTURES

In Ayurveda treatment combines products derived from plants, animal, mineral, etc. Amongst all types of Ayurvedic preparations plant-based preparations play a significant and important role in the Ayurvedic healing process. Healing with medicinal plants is as old as mankind itself. We have been using medicinal plants since extremely long time. The use of plant based medicinal products and supplements have increased tremendously over the past three decades. Ṛddhi is an important member of Aṣṭavarga group of plants. Traditionally it is used in many herbal preparations for its rejuvenating and health promoting properties. Polyherbal formulation containing tubers of this herb possess properties viz. full of vital energy, high in antioxidants, and boosting immunity. The demand of this herb is increasing day by day but due to scarcity of this plant in wild, unaware about authentic botanical source, non-existing cultivation practices there is widespread problem of adulteration or substitution with other plants. So by taking into account the above situation this systematic review has conducted to find out authentic botanical source of Ṛddhi

The Impact of Using Social Media on Dental Treatment: An Online Survey

INTRODUCTION: Social media is a mode of communication that allows a person to create and share information with others. Facebook, WhatsApp, Twitter, Google+, YouTube etc are some examples of social media applications and they allow people to communicate across the world. There is very less literature available that shows the effect of social media in esthetics in India. AIM: To conduct an online survey to see the impact of using social media on esthetic dental treatments. MATERIALS AND METHOD: 477 questionnaires were returned with responses and the data was entered into the MS excel sheet. Descriptive statistics was used for the frequency distribution and Chi Square was applied for the statistical relationship between male and female variables (at 5% significance). RESULTS:  Four hundred seventy seven participants responded to this study through online forms. Most of the participants belonged to the age group of 26-35 years (n=256), followed by 18-25 years (n= 137), 36-45 years and > 45 years (n= 55 & 29 respectively). The response of females was high (63.5%) when compared to males. CONCLUSION: Females tend to follow dentists more as compare to males on social media. In dental practice, social media has become a widely used for exchanging and obtaining information

Effect of Summer Temperature on the Work Efficiency of Dentists

INTRODUCTION AND AIM: Environment is closely related to human health. While the effects of temperature on comfort are broadly recognized, the effects on worker productivity have received much less attention. Thus this research was planned to investigate the effects of heat stress on job satisfaction, job performance, occupational stress among dentists. MATERIALS AND METHOD: This research was designed to be cross-sectional in nature where a convenience sampling of 70 interns, 88 post-graduate students and 49 faculty members of IDS Bareilly were selected. Questionnaires were self-administered and contained twelve points for job satisfaction (Minnesota Satisfaction Questionnaire), thirteen points for occupational stress and twelve for job performance RESULTS: The subjects were moderately satisfied with their jobs, were less stressed and had a moderate job performance. After descriptive tests, the Chi-squared test,  Pearson and Spearman Correlation Coefficient was applied to test statistical significance and p value was set to be significant at p<0.5. DISCUSSION: The present study showed that most of the dentists (60.9%) had a high sense of heat and such results may be because of the current hospital framework which includes lack of air conditioners, continuous patient workload in hospital, high sense of heat among the dentists working in top floors etc. CONCLUSION: If effective prevention measures are taken in the hospitals, dentists may perform more efficiently and also the increase the job satisfaction

A scientometric analysis of health and population research in South Asia: focus on two research organizations

ABSTRAC