Cash Transfers to Increase Antenatal Care Utilization in Kisoro, Uganda: A Pilot Study

The World Health Organization recommends four antenatal visits for pregnant women in developing countries. Cash transfers have been used to incentivize participation in health services. We examined whether modest cash transfers for participation in antenatal care would increase antenatal care attendance and delivery in a health facility in Kisoro, Uganda. Twenty-three villages were randomized into four groups: 1) no cash; 2) 0.20 United States Dollars (USD) for each of four visits; 3) 0.40 USD for a single first trimester visit only; 4) 0.40 USD for each of four visits. Outcomes were three or more antenatal visits and delivery in a health facility. Chi-square, analysis of variance, and generalized estimating equation analyses were performed to detect differences in outcomes. Women in the 0.40 USD/visit group had higher odds of three or more antenatal visits than the control group (OR 1.70, 95% CI: 1.13-2.57). The odds of delivering in a health facility did not differ between groups. However, women with more antenatal visits had higher odds of delivering in a health facility (OR 1.21, 95% CI: 1.03-1.42). These findings are important in an area where maternal mortality is high, utilization of health services is low, and resources are scarce. (Afr J Reprod Health 2015; 19[3]: 144-150). Keywords: Maternal mortality; conditional cash transfers; prenatal care; delivery location sub-sharan Africa L'Organisation mondiale de la Santé recommande quatre consultations prénatales pour les femmes enceintes dans les pays en développement. Les transferts de fonds ont été utilisés pour encourager la participation à des services de santé. Nous avons examiné si les transferts de fonds modestes pour la participation à des soins prénatals pourraient augmenter la fréquentation aux services des soins prénatals et d'accouchement dans un établissement de santé à Kisoro, en Ouganda. Vingt-trois villages ont été randomisés en quatre groupes: 1) pas d'argent; 2) 0,20 dollars américains (DA) pour chacune des quatre visites; 3) 0,40 DA pour une seule visite du première trimestre seulement; 4) 0,40 DA pour chacune des quatre visites. Les résultats étaient trois consultations prénatales ou plus et l’accouchement dans un établissement de santé. Nous avons mené une analyse de la variance Chi-carré et d'équations d'estimation généralisées pour détecter les différences dans les résultats. Les femmes du groupe de visite de 0,40 DA étaient plus susceptibles de trois consultations prénatales ou plus que le groupe de témoin (OR 1,70, IC à 95%: 1,13 à 2,57). Les chances de l’accouchement dans un établissement de santé ne sont pas différentes parmi les groupes. Cependant, les femmes avec plus de visites prénatales étaient plus susceptibles d’accoucher dans un établissement de santé (OR 1,21, IC à 95%: 1,03 à 1,42). Ces résultats sont importants dans une région où la mortalité maternelle est élevée, où l'utilisation des services de santé est faible, et les ressources sont rares. (Afr J Reprod Health 2015; 19[3]: 144-150). Mots-clés: mortalité maternelle; transferts monétaires conditionnels; soins prénatals; lieu d’accouchement, Afrique sub-saharienne

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

Background: Laboratory blood testing incurs financial costs and the blood draws can increase discomfort, yet minimal data exists regarding routine testing in gynecologic oncology surgical patients. Additionally, an increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. An increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. Objective: The aims of this study were (1) to evaluate the frequency and etiology of perioperative laboratory test abnormalities in patients undergoing laparoscopic and laparotomy surgery in a gynecologic oncology service, and (2) to establish an evidence-based algorithm to reduce unnecessary laboratory testing. Materials and Methods: A single-institution retrospective study was completed, investigating laparoscopic and laparotomic surgeries over 4 years. Information on preoperative and postoperative laboratory data, surgical parameters, perioperative interventions, and patient demographics was collected. Quality-assurance data were reviewed. Data were tabulated and analyzed using Statistical Product and Service Solutions (SPSS) version 22. A Student's t-test was used to test for group differences for continuous variables with equal variance, the Mann-Whitney?U test for continuous variables when unequal variance was detected, and Pearson's ?2 was used to investigate categorical variables of interest. p-Values 98% of patients underwent at least one preoperative and postoperative laboratory test, totaling 8060 preoperative and 5784 postoperative results. The laparoscopy group was significantly less likely to have postoperative metabolic abnormalities or to undergo perioperative blood transfusion. Patients taking an angiotensin-converting-enzyme inhibitor, angiotensin-II?receptor blocker, or diuretic were significantly more likely to have elevated creatinine preoperatively (odds ratio [OR]: 5.0; p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140101/1/gyn.2015.0106.pd

Trends in Birth Rates After Elimination of Cost Sharing for Contraception by the Patient Protection and Affordable Care Act

ImportanceReducing out-of-pocket costs is associated with improved patterns of contraception use. It is unknown whether reducing out-of-pocket costs is associated with fewer births.ObjectiveTo evaluate changes in birth rates by income level among commercially insured women before (2008-2013) and after (2014-2018) the elimination of cost sharing for contraception under the Patient Protection and Affordable Care Act (ACA).Design, setting, and participantsThis cross-sectional study used data from Clinformatics Data Mart database from January 1, 2008, to December 31, 2018, for women aged 15 to 45 years who were enrolled in an employer-based health plan and had pregnancy benefits for at least 1 year. Women without household income information and women with evidence of having undergone a hysterectomy were excluded.ExposureSection 2713 of the ACA.Main outcomes and measuresThe primary outcome was the proportion of reproductive-aged women with a live birth by year (measured yearly from 2008 to 2018 [11 time points]) within 3 income categories. The secondary outcome was the distribution of contraceptive method fills in 3 categories by year: (1) most effective methods (long-acting reversible contraception or sterilization), (2) moderately effective methods (pill, patch, ring, and injectable), and (3) no prescription or surgical method.ResultsThe analytic sample included 4 590 989 women (mean [SD] age; 30.8 [9.1] years in 2013; 3 069 053 White [66.9%]) enrolled in 47 721 health plans. A total of 500 898 participants (40.8%) resided in households with incomes less than 400% of the federal poverty level in 2013. In all 3 years (2008, 2013, and 2018), women in the lowest income category were younger than women in the other income groups (median range, 21-22 years vs 30-34 years) and in households with a higher median number of dependents (9-10 vs 2-4). There was an associated decrease in births in all income groups in the period after the elimination of out-of-pocket costs. The estimated probability of birth decreased most precipitously among women in the lowest income group from 8.0% (95% CI, 7.4%-8.5%) in 2014 to 6.2% (95% CI, 5.7%-6.7%) in 2018, representing a 22.2% decrease (P < .001). The estimated probability decreased in the middle income group by 9.4%, from 6.4% (95% CI, 6.3%-6.4%) to 5.8% (95% CI, 5.7%-5.8%) (P < .001), and in the highest income group by 1.8%, from 5.6% (95% CI, 5.6%-5.7%) to 5.5% (95% CI, 5.4%-5.5%) (P < .001) in the period after the elimination of cost sharing.Conclusions and relevanceIn this cross-sectional study, the elimination of cost sharing for contraception under the ACA was associated with improvements in contraceptive method prescription fills and a decrease in births among commercially insured women. Women with low income had more precipitous decreases than women with higher income, suggesting that enhanced access to contraception may address well-documented income-related disparities in unintended birth rates