Making Health Markets Work Better for Poor People: the Case of Informal Providers

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.ESR

An Improved Model for Estimating Productivity of Horizontal Drain Hole

Horizontal wells have become a popular alternative for the development of hydrocarbon fields around the world because of their high flow efficiency caused by a larger contact area made with the reservoir. Most of the analytical model existing in the literature on horizontal productivity either assumed that the well is infinitely conductive or the flow is uniform along the entire well length. Guo et al (2007) formulation is one the most recent and accurate models reported in the literatures for predicting production rate in horizontal well considering the frictional pressure drop along long horizontal drain hole. In this paper, an improved predictive model that takes into account the effect of other possible wellbore pressure losses on production rate variation of long horizontal well was developed. Results show that the discrepancies in the predictions of the previous models and field results were not only due to effect of friction pressure losses as opined by previous authors but may also be due to loss due to fluid accumulation experienced by the flowing fluid in a conduit. The effect is most pronounced at the early production time where initial transience at the onset of flow is experienced. The improved model was applied to the same field case study used by Guo et al and results is much more accurate and show that the error of the new model is less than 4% compared to 20% reported by Guo et al. This work provides reservoir engineers an accurate and handy tool for prediction and evaluation of horizontal wells

DESIGN AND FABRICATION OF A LOW-COST CENTRIFUGAL HONEY EXTRACTOR

The traditional and screw press techniques were adopted and utilized extensively by Nigerian honey producers and these have led to the absence of a good quality and timely produced honey devoid of foreign materials and marketable by international standard. Ample information from literature survey showed that the Langstroth hive which is beyond the reach of common Nigerian bee farmer due to its high cost. A 750 W indigenous centrifugal honey extractor was developed using locally sourced materials.. The machine was tested at extraction speed levels of 272, 287, 351, 1445, 1730, 2300 and 2575 rpm. Quantifiable extractions were obtained at all speed levels except at a speed of 2575 rpm where a vicious crushed extract of honey and comb was observed. High speed extraction was not favorable as it resulted in the destruction of the honey comb. Honey extracted at the two lower speeds of 272 and 287 rpm were found to be purer with less foreign materials and of high quality.  This indigenous centrifugal honey extractor is also favorable for extraction of honey from other types of hives apart from the Langstroth hive and is marketable

HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: Prevalence and risk factors

<p>Abstract</p> <p>Background</p> <p>Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2). Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence.</p> <p>Methods</p> <p>We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15–49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent) of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR) and reactive samples confirmed by <it>Treponema pallidum </it>haemagglutination assay (TPHA).</p> <p>Results</p> <p>Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53–23.00) and 1.6% (95% CI: 1.03–2.51), respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 – 3.01) and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 – 2.41). Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 – 15.76) and previous spontaneous abortion (OR 4.3, 95% CI: 1.52–12.02).</p> <p>Conclusion</p> <p>The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.</p

Poverty and fever vulnerability in Nigeria: a multilevel analysis

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels.</p> <p>Methods</p> <p>Determinants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted. </p> <p>Results</p> <p>About 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6months), whereas the effect of wealth no longer reached statistical significance.</p> <p>Conclusion</p> <p>While, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation. </p

Exploring evidence-policy linkages in health research plans: A case study from six countries

The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. The cross-country research consortium provides a unique opportunity to explore the research-policy interface. Three key activities were undertaken during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon. These three activities yielded interesting findings. First, developmental consideration with four dimensions – poverty, vulnerabilities, capabilities, and health shocks – provides an entry point in examining research-policy interfaces in the six settings. Second, research plans focused upon on the ground realities in specific countries strengthens the interface. Third, focusing on research prioritized by decision-makers, within a politicized health arena, enhances chances of research influencing action. Lastly, early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface. The approach described has four main utilities: first, systematic analyses of research proposals using key considerations ensure such issues are incorporated into research proposals; second, the exact meaning, significance, and inter-relatedness of these considerations can be explored within the research itself; third, cross-country learning can be enhanced; and finally, translation of evidence into action may be facilitated. Health systems research proposals in low and middle income countries should include reflection on transferring research findings into policy. Such deliberations may be informed by employing the four key considerations suggested in this paper in analyzing research proposals

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.</p> <p>Methods</p> <p>This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.</p> <p>Results</p> <p>Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.</p> <p>Conclusion</p> <p>Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.</p

Sexual dimorphism and phenotypic correlations among growth traits of exotic turkey (Meleagris gallopavo)

This study was conducted to determine sexual dimorphism and phenotypic correlations among growth traits of six month old exotic turkeys raised at the Turkey Unit, Teaching and Research Farm of Ondo State University of Science and Technology, Okitipupa. Bodyweight, shank length, thigh length, body length, wing length, wing span and breast girth for Meleagris gallopavo (female and male) were measured using standard methods. Data collected on 102 exotic turkeys comprised of 61 female and 41 male were subjected to analysis of variance and Pearson's correlation. Bodyweight, shank length, thigh length, body length, wing length, wing span and breast girth for females were 8.16 kg, 8.31 cm, 22.29 cm, 68.47 cm, 32.93 cm, 73.65 cm and 57.24 cm respectively, while the corresponding values for males were 8.84 kg, 9.97 cm, 23.40 cm, 76.27 cm, 35.87 cm, 80.27 cm and 60.20 cm. The effect of sex on the variables was significant (p&lt;0.05) except on bodyweight and thigh length. The bodyweight and thigh length were numerically higher in males (8.84 and 23.40) and lower values observed in females (8.16 and 22.29). The correlation coefficients were all positive for both sexes except in females where the correlation between bodyweight and shank length was negative (-0.031). Among the males the correlation coefficients ranged between 0.447 and 0.859 while in the females it ranged between -0.031 and 0.539. Sexual dimorphism was displayed virtually in all the variables considered and in a similar trend bodyweight could be predicted virtually by all the linear body measurements considered

Effect of Training Programme on Secondary Schools Teachers' Knowledge and Attitude towards Reproductive Health Education in Rural Schools IIe-Ife, Nigeria Attitude towards Reproductive Health Education in Rural Schools IIe-Ife, Nigeria

This study assessed the effect of training programme on teachers' knowledge of and attitude towards reproductive health education /sexuality education [RHE/SE] in five randomly selected rural schools in Ife-North local government area [IFLGA], Southwest, Nigeria .All the 84 teachers in the selected schools in the LGA were recruited for the study. They [84 teachers] were all given training in RHE/SE for one month. Their knowledge and attitude towards RHE/SE were assessed pre-and post-training programme. The results show a significant increase in percentage of those who had good knowledge in general areas of RHE/SE at post-training assessment compared with pre-training assessment[from 14.3% to 53.6%,p=0.0001].Also, pre-post attitudinal disposition assessments show that there was an increase in percentage of those who were favourably disposed to the teaching of RHE/SE in Nigeria Schools at post-training assessment [from 17.9% to 45.2%, p=0.0011].The study suggests that RHE/SE should be included and made compulsory in all training programme for all teachers in Nigeria. African Journal of Reproductive Health Vol. 10 (2) 2006: pp. 98-10