Illness reporting and demand for medical care in rural Burkina Faso

This is the post-print version of the final paper published in Social Science & Medicine. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.The issue of illness reporting in modelling demand for health care in low- and middle-income countries can be handled according to either of two conceptually-different constructs: (a) considering illness reporting behaviour as endogenous to demand; or (b) considering demand itself as the outcome of a sample selection phenomenon. In this paper, we take the second viewpoint and estimate the demand for medical care with an estimator that uses Heckman-type. Empirical estimates based on household survey data from rural Burkina Faso suggest that there are some implications of illness reporting behaviour for modelling the demand for medical care.German Science Foundatio

Step-wedge cluster-randomised community-based trials: An application to the study of the impact of community health insurance

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI) scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness. Our exclusive focus on the description and discussion of the methods is justified by the fact that the study relies on a methodology previously applied in the field of disease control, but never in the field of health financing. METHODS: First, we clarify how clusters were defined both in respect of statistical considerations and of local geographical and socio-cultural concerns. Second, we illustrate how households within clusters were sampled. Third, we expound the data collection process and the survey instruments. Finally, we outline the statistical tools to be applied to estimate the impact of CHI. CONCLUSION: We discuss all design choices both in relation to methodological considerations and to specific ethical and organisational concerns faced in the field. On the basis of the appraisal of our experience, we postulate that conducting relatively sophisticated trials (such as our step-wedge cluster-randomised community-based trial) aimed at generating sound public health evidence, is both feasible and valuable also in low income settings. Our work shows that if accurately designed in conjunction with local health authorities, such trials have the potential to generate sound scientific evidence and do not hinder, but at times even facilitate, the implementation of complex health interventions such as CHI

Theoretical and Experimental Investigations Regarding Open Volumetric Receivers of CRS

AbstractConcentrated sunlight is absorbed in solar thermal power plants by heat resistant absorbers and converted into usable heat which is transferred to a carrier medium. In solar tower power plants such as the plant in Jülich porous absorbers can reach temperatures up to 1000°C and higher. At this power plant air as heat transfer medium is sucked in through the absorber and heated up to about 700°C. The absorber is composed of highly porous ceramic or metal wire structures. The SIJ investigates the optimization of solar absorption and the convective heat transfer to the air using thermo and fluid mechanical calculations. In such simulations the key quantities are the penetration depth of solar radiation κ and the volumetric heat transfer coefficient αv, which indicates how much energy - depending on the volume and temperature difference - is transferred by convection between solid and fluid. The attenuation of the radiation into the depth of the absorber is described generally by an exponential function with parameter κ. This is accompanied by heat transfer to the structure. Existing models of the key quantities have been validated by experimental data

The aggregation of cytochrome C may be linked to its flexibility during refolding

Large-scale expression of biopharmaceutical proteins in cellular hosts results in production of large insoluble mass aggregates. In order to generate functional product, these aggregates require further processing through refolding with denaturant, a process in itself that can result in aggregation. Using a model folding protein, cytochrome C, we show how an increase in final denaturant concentration decreases the propensity of the protein to aggregate during refolding. Using polarised fluorescence anisotropy, we show how reduced levels of aggregation can be achieved by increasing the period of time the protein remains flexible during refolding, mediated through dilution ratios. This highlights the relationship between the flexibility of a protein and its propensity to aggregate. We attribute this behaviour to the preferential urea-residue interaction, over self-association between molecules

The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993–2007

The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries. The health facilities consist of one hospital and 13 basic health centres (locally known as CSPS). The Nouna HDSS has been used as a sampling frame for numerous studies in the fields of clinical research, epidemiology, health economics, and health systems research. In this paper we review some of the main findings, and we describe the effects that almost 20 years of health research activities have shown in the population in general and in terms of the perception, economic implications, and other indicators. Longitudinal data analyses show that childhood, as well as overall mortality, has significantly decreased over the observation period 1993–2007. The under-five mortality rate dropped from about 40 per 1,000 person-years in the mid-1990s to below 30 per 1,000 in 2007. Further efforts are needed to meet goal four of the Millennium Development Goals, which is to reduce the under-five mortality rate by two-thirds between 1990 and 2015

Adaptation to climate change: a comparative analysis of modelling methods for heat-related mortality

Background: Multiple methods are employed for modelling adaptation when projecting the impact of climate change on heat-related mortality. The sensitivity of impacts to each is unknown because they have never been systematically compared. In addition, little is known on the relative sensitivity of impacts to “adaptation uncertainty” (i.e. the inclusion/exclusion of adaptation modelling), relative to using multiple climate models and emissions scenarios. Objectives: (1) Compare the range in projected impacts that arises from using different adaptation modelling methods; (2) compare the range in impacts that arises from adaptation uncertainty to ranges from using multiple climate models and emissions scenarios; (3) recommend modelling method(s) to use in future impact assessments. Methods: We estimated impacts for 2070-2099, for 14 European cities, applying six different methods for modelling adaptation; also with climate projections from five climate models, run under two emissions scenarios to explore the relative effects of climate modelling and emissions uncertainty. Results: The range of the difference (%) in impacts between including and excluding adaptation, irrespective of climate modelling and emissions uncertainty, can be as low as 28% with one method and up to 103% with another (mean across 14 cities). In 13 of 14 cities the ranges in projected impacts due to adaptation uncertainty are larger than those associated with climate modelling and emissions uncertainty. Conclusions: Researchers should carefully consider how to model adaptation because it is a source of uncertainty that can be greater than the uncertainty in emissions and climate modelling. We recommend absolute threshold shifts and reductions in slope

Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso

Objective: To examine whether the community-based health insurance (CBHI) scheme in Burkina Faso has been effective in providing equitable healthcare access to poor individuals, women, children and those living far from health facilities. Methods: We used the Nouna Health District Household Survey to collect panel data on 990 households during 2004?08. By applying a series of random effects regressions and using concentration curves, we first studied determinants of CBHI enrolment and then assessed differences in healthcare utilization between members and non-members. We studied differences with regard to rich and poor, men and women, children and adults and those living far vs those living close to health facilities. Findings: With regard to enrolment, we found that poor (odds ratio [OR] = 0.274) and children (OR = 0.456) were less likely to enrol while gender and distance were not significantly correlated to enrolment. In terms of utilization, poor (coefficient = 0.349), women (coefficient = 0.131) and children (coefficient = 0.190) with CBHI had higher utilization than the group without CBHI. We also found that there was no significant difference in utilization between members and non-members if they were living far from health facilities. Conclusion: The CBHI scheme in this case was only partially successful in achieving the equity objectives. This study advises policy makers in Burkina Faso and elsewhere, who see CBHI schemes as a silver bullet to achieve universal health coverage, to be mindful of the chronically low enrolment rates and more importantly the lack of equity across the various groups that this study has highlighted