Factors influencing job preferences of health workers providing obstetric care : results from discrete choice experiments in Malawi, Mozambique and Tanzania

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas

Clinical diagnosis of West Nile Fever in equids by classification and regression tree analysis and comparative study of clinical appearance in three European countries

International audienceThis retrospective study describes risk/protection factors for the development of clinical West Nile Fever (WNF) in equids, compares clinical presentation in three European countries, France, Italy and Hungary, and creates classification and regression trees (CART) to facilitate clinical diagnosis. The peak of WNF occurrence was observed in September whatever the country. A significant difference between Italy and France was observed in the delay between initial clinical signs and veterinary consultation. No clinical sign was significantly associated with WNF. Despite similar clinical presentations in the three countries, occurrence of hyperthermia was more frequently reported in France. Classification and regression tree demonstrated the major importance of geographical locality and month to reach a diagnosis and emphasized differences in predominant clinical signs depending on the period of detection of the suspected case (epizootic or not). However, definite diagnosis requires specific serological tests. Centralized reporting system and time-space risk mapping should be promoted in every country

Clinical diagnosis of West Nile Fever in equids by classification and regression tree analysis and comparative study of clinical appearance in three European countries

National audienceThis retrospective study describes risk/protection factors for the development of clinical West Nile Fever (WNF) in equids, compares clinical presentation in three European countries, France, Italy and Hungary, and creates classification and regression trees (CART) to facilitate clinical diagnosis. The peak of WNF occurrence was observed in September whatever the country. A significant difference between Italy and France was observed in the delay between initial clinical signs and veterinary consultation. No clinical sign was significantly associated with WNF. Despite similar clinical presentations in the three countries, occurrence of hyperthermia was more frequently reported in France. Classification and regression tree demonstrated the major importance of geographical locality and month to reach a diagnosis and emphasized differences in predominant clinical signs depending on the period of detection of the suspected case (epizootic or not). However, definite diagnosis requires specific serological tests. Centralized reporting system and time-space risk mapping should be promoted in every country

Clinical diagnosis of West Nile Fever in equids by classification and regression tree (CART) analysis and comparative study of clinical appearance in three European countries

This retrospective study describes risk/protection factors for the development of clinical West Nile Fever (WNF) in equids, compares clinical presentation in three European countries, France, Italy and Hungary, and creates classification and regression trees (CART) to facilitate clinical diagnosis. The peak of WNF occurrence was observed in September whatever the country. A significant difference between Italy and France was observed in the delay between initial clinical signs and veterinary consultation. No clinical sign was significantly associated with WNF. Despite similar clinical presentations in the three countries, occurrence of hyperthermia was more frequently reported in France. Classification and regression tree demonstrated the major importance of geographical locality and month to reach a diagnosis and emphasized differences in predominant clinical signs depending on the period of detection of the suspected case (epizootic or not). However, definite diagnosis requires specific serological tests. Centralized reporting system and time-space risk mapping should be promoted in every country

Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol

INTRODUCTION: Cancer causes a substantial burden to our society, both from a health and an economic perspective. To improve cancer patient outcomes and lower society expenses, early diagnosis and timely treatment are essential. The recent COVID-19 crisis has disrupted the care trajectory of cancer patients, which may affect their prognosis in a potentially negative way. The purpose of this paper is to present a flexible decision-analytic Markov model methodology allowing the evaluation of the impact of delayed cancer care caused by the COVID-19 pandemic in Belgium which can be used by researchers to respond to diverse research questions in a variety of disruptive events, contexts and&nbsp;settings. METHODS: A decision-analytic Markov model was developed for 4 selected cancer types (i.e. breast, colorectal, lung, and head and neck), comparing the estimated costs and quality-adjusted life year losses between the pre-COVID-19 situation and the COVID-19 pandemic in Belgium. Input parameters were derived from published studies (transition probabilities, utilities and indirect costs) and administrative databases (epidemiological data and direct medical costs). One-way and probabilistic sensitivity analyses are proposed to consider uncertainty in the input parameters and to assess the robustness of the model&#8217;s results. Scenario analyses are suggested to evaluate methodological and structural&nbsp;assumptions. DISCUSSION: The results that such decision-analytic Markov model can provide are of interest to decision makers because they help them to effectively allocate resources to improve the health outcomes of cancer patients and to reduce the costs of care for both patients and healthcare systems. Our study provides insights into methodological aspects of conducting a health economic evaluation of cancer care and COVID-19 including insights on cancer type selection, the elaboration of a Markov model, data inputs and&nbsp;analysis.</p