The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

<p>Abstract</p> <p>Background</p> <p>One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure.</p> <p>Methods</p> <p>We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance.</p> <p>Results</p> <p>At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample.</p> <p>Conclusions</p> <p>Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a similar policy to expand social health insurance. Ghana's experience also shows that instituting insurance by itself is not adequate to remove fully the out-of-pocket payment for health. Further works are needed to address the supply side's incentives and quality of care, so that the insured can enjoy the full benefits of insurance.</p

Fuzzy sliding mode control of an offshore container crane

© 2017 A fuzzy sliding mode control strategy for offshore container cranes is investigated in this study. The offshore operations of loading and unloading containers are performed between a mega container ship, called the mother ship, and a smaller ship, called the mobile harbor (MH), which is equipped with a container crane. The MH is used to transfer the containers, in the open sea, and deliver them to a conventional stevedoring port, thereby minimizing the port congestion and also eliminating the need of expanding outwards. The control objective during the loading and unloading process is to keep the payload in a desired tolerance in harsh conditions of the MH motion. The proposed control strategy combines a fuzzy sliding mode control law and a prediction algorithm based on Kalman filtering for the MH roll angle. Here, the sliding surface is designed to incorporate the desired trolley trajectory while suppressing the sway motion of the payload. To improve the control performance, the discontinuous gain of the sliding control is adjusted with fuzzy logic tuning schemes with respect to the sliding function and its rate of change. Chattering is further reduced by a saturation function. Simulation and experimental results are provided to verify the effectiveness of the proposed control system for offshore container cranes

Automatic interpretation of unordered point cloud data for UAV navigation in construction

© 2016 IEEE. The objective of this work is to develop a data processing system that can automatically generate waypoints for navigation of an unmanned aerial vehicle (UAV) to inspect surfaces of structures like buildings and bridges. The input includes data recorded by two 2D laser scanners, orthogonally mounted on the UAV, and an inertial measurement unit (IMU). To achieve the goal, algorithms are developed to process the data collected. They are separated into three major groups: (i) the data registration and filtering to generate a 3D model of the structure and control the density of point clouds for data completeness enhancement; (ii) the surface and obstacle detection to assist the UAV in monitoring tasks; and (iii) the waypoint generation to set the flight path. Experiments on different data sets show that the developed system is able to reconstruct a 3D point cloud of the structure, extract its surfaces and objects, and generate waypoints for the UAV to accomplish inspection tasks

Leukotriene A4 Hydrolase Genotype and HIV Infection Influence Intracerebral Inflammation and Survival From Tuberculous Meningitis.

BACKGROUND: Tuberculous meningitis (TBM) is the most devastating form of tuberculosis, yet very little is known about the pathophysiology. We hypothesized that the genotype of leukotriene A4 hydrolase (encoded by LTA4H), which determines inflammatory eicosanoid expression, influences intracerebral inflammation, and predicts survival from TBM. METHODS: We characterized the pretreatment clinical and intracerebral inflammatory phenotype and 9-month survival of 764 adults with TBM. All were genotyped for single-nucleotide polymorphism rs17525495, and inflammatory phenotype was defined by cerebrospinal fluid (CSF) leukocyte and cytokine concentrations. RESULTS: LTA4H genotype predicted survival of human immunodeficiency virus (HIV)-uninfected patients, with TT-genotype patients significantly more likely to survive TBM than CC-genotype patients, according to Cox regression analysis (univariate P = .040 and multivariable P = .037). HIV-uninfected, TT-genotype patients had high CSF proinflammatory cytokine concentrations, with intermediate and lower concentrations in those with CT and CC genotypes. Increased CSF cytokine concentrations correlated with more-severe disease, but patients with low CSF leukocytes and cytokine concentrations were more likely to die from TBM. HIV infection independently predicted death due to TBM (hazard ratio, 3.94; 95% confidence interval, 2.79-5.56) and was associated with globally increased CSF cytokine concentrations, independent of LTA4H genotype. CONCLUSIONS: LTA4H genotype and HIV infection influence pretreatment inflammatory phenotype and survival from TBM. LTA4H genotype may predict adjunctive corticosteroid responsiveness in HIV-uninfected individuals

Stag hunt game-based approach for cooperative UAVs

Unmanned aerial vehicles (UAVs) are being employed in many areas such as photography, emergency, entertainment, defence, agriculture, forestry, mining and construction. Over the last decade, UAV technology hasfound applicationsin numerous construction project phases, ranging from site mapping, progress monitoring, building inspection, damage assessments, and material delivery. While extensive studies have been conducted on the advantages of UAVs for various construction-related processes, studies on UAV collaboration to improve the task capacity and efficiency are still scarce. This paper proposes a new cooperative path planning algorithm for multiple UAVs based on the stag hunt game and particle swarm optimization (PSO). First, a cost function for each UAV is defined, incorporating multiple objectives and constraints. The UAV game framework is then developed to formulate the multi-UAV path planning into the problem of finding payoff-dominant e quilibrium. Next, a PSO-based algorithm is proposed to obtain optimal paths for the UAVs. Simulation results for a large construction site inspected by three UAVs indicate the effectiveness of the proposed algorithm in generating feasible and efficient flight paths for UAV formation during the inspection task

Partial food systems baseline assessment at the Vietnam benchmark sites

Using data collected from a cross-sectional study in Moc Chau, Dong Anh and Cau Giay districts in Vietnam, this report aims to elucidate specific components of local Vietnamese food systems along a rural to urban transect focusing specifically on (i) diets, (ii) nutrition status (anthropometry), (iii) consumer behavior, (iv) food environment, and (v) food flows

The evolution of HIV policy in Vietnam: from punitive control measures to a more rights-based approach

Aim: Policymaking in Vietnam has traditionally been the preserve of the political elite, not open to the scrutiny of those outside the Communist Party. This paper aims to analyse Vietnam&#x0027;s HIV policy development in order to describe and understand the policy content, policy-making processes, actors and obstacles to policy implementation. Methods: Nine policy documents on HIV were analysed and 17 key informant interviews were conducted in Hanoi and Quang Ninh Province, based on a predesigned interview guide. Framework analysis, a type of qualitative content analysis, was applied for data analysis. Results: Our main finding was that during the last two decades, developments in HIV policy in Vietnam were driven in a top-down way by the state organs, with support and resources coming from international agencies. Four major themes were identified: HIV policy content, the policy-making processes, the actors involved and human resources for policy implementation. Vietnam&#x0027;s HIV policy has evolved from one focused on punitive control measures to a more rights-based approach, encompassing harm reduction and payment of health insurance for medical costs of patients with HIV-related illness. Low salaries and staff reluctance to work with patients, many of whom are drug users and female sex workers, were described as the main barriers to low health staff motivation. Conclusion: Health policy analysis approaches can be applied in a traditional one party state and can demonstrate how similar policy changes take place, as those found in pluralistic societies, but through more top-down and somewhat hidden processes. Enhanced participation of other actors, like civil society in the policy process, is likely to contribute to policy formulation and implementation that meets the diverse needs and concerns of its population

Complete genome characterization of two wild-type measles viruses from Vietnamese infants during the 2014 outbreak

A large measles virus outbreak occurred across Vietnam in 2014. We identified and obtained complete measles virus genomes in stool samples collected from two diarrheal pediatric patients in Dong Thap Province. These are the first complete genome sequences of circulating measles viruses in Vietnam during the 2014 measles outbreak

Oseltamivir Is Adequately Absorbed Following Nasogastric Administration to Adult Patients with Severe H5N1 Influenza

In the absence of a parenteral drug, oral oseltamivir is currently recommended by the WHO for treating H5N1 influenza. Whether oseltamivir absorption is adequate in severe influenza is unknown. We measured the steady state, plasma concentrations of nasogastrically administered oseltamivir 150 mg bid and its active metabolite, oseltamivir carboxylate (OC), in three, mechanically ventilated patients with severe H5N1 (male, 30 yrs; pregnant female, 22 yrs) and severe H3N2 (female, 76 yrs). Treatments were started 6, 7 and 8 days after illness onset, respectively. Both females were sampled while on continuous venovenous haemofiltration. Admission and follow up specimens (trachea, nose, throat, rectum, blood) were tested for RNA viral load by reverse transcriptase PCR. In vitro virus susceptibility to OC was measured by a neuraminidase inhibition assay. Admission creatinine clearances were 66 (male, H5N1), 82 (female, H5N1) and 6 (H3N2) ml/min. Corresponding AUC0–12 values (5932, 10,951 and 34,670 ng.h/ml) and trough OC concentrations (376, 575 and 2730 ng/ml) were higher than previously reported in healthy volunteers; the latter exceeded 545 to 3956 fold the H5N1 IC50 (0.69 ng/ml) isolated from the H5N1 infected female. Two patients with follow-up respiratory specimens cleared their viruses after 5 (H5N1 male) and 5 (H3N2 female) days of oseltamivir. Both female patients died of respiratory failure; the male survived. 150 mg bid of oseltamivir was well absorbed and converted extensively to OC. Virus was cleared in two patients but two patients died, suggesting viral efficacy but poor clinical efficacy

Genome sequences of a novel Vietnamese bat bunyavirus

To document the viral zoonotic risks in Vietnam, fecal samples were systematically collected from a number of mammals in southern Vietnam and subjected to agnostic deep sequencing. We describe here novel Vietnamese bunyavirus sequences detected in bat feces. The complete L and S segments from 14 viruses were determined