indicators for Ireland (2000-LS-5.2.2-M1) ; final report

The Third Assessment Report of the Intergovernmental Panel on Climate Change represented a consensus among the world's leading climate scientists that rapid climate changes were occurring on a global scale. In particular, the marked warming that had occurred over the past half century was, they concluded, substantially caused by the build-up of greenhouse gases in the troposphere as a result of anthropogenic activities. Globally, 1998 was the warmest year of the warmest decade of the warmest century of at least the last millennium. Such fluctuations, the IPCC suggested, were already capable of being associated with changes in a diverse set of physical and biological indicators in many parts of the world. Indicators of climate change are primarily used to simplify a complex reality and to communicate, more succinctly, critical information regarding climatic trends. They also provide an essential early warning system by making available information that may point to an environmental problem which is capable of being ameliorated before it becomes critical. In establishing indicators, a distinction can be made between primary indicators, based on analysis of directly observed meteorological data, and secondary indicators, based on the responses of the living world to climate changes which provoke a response in living organisms.researc

Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches.

There is increasing global policy interest in estimating catastrophic costs incurred by households because of ill health, and growing need for information on disease-specific household cost data. There are several methodological approaches used to estimate income and no current consensus on the best method for estimating income in the context of a survey at the health facility. We compared six different approaches to estimate catastrophic cost among patients attending a health facility in South Africa. We used patient cost and income data collected June 2014-March 2015 from 66 participants enrolled in a clinical trial in South Africa (TB FastTrack) to explore the variation arising from different income estimation approaches and compared the number of households encountering catastrophic costs derived for each approach. The total proportion of households encountering catastrophic costs varied from 0% to 36%, depending on the estimation method. Self-reported mean annual income was significantly lower than permanent income estimated using an asset linking approach, or income estimated using the national average. A disproportionate number of participants adopting certain coping strategies, including selling assets and taking loans, were unable to provide self-reported income data. We conclude that the rapid methods for estimating income among patients attending a health facility are currently inconsistent. Further research on methods for measuring income, comparing the current recommended methods to 'gold standard' methods in different settings, should be done to identify the most appropriate measurement method

The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa.

BACKGROUND: This study describes the post-diagnosis care-seeking costs incurred by people living with TB and/or HIV and their households, in order to identify the potential benefits of integrated care. METHODS: We conducted a cross-sectional study with 454 participants with TB or HIV or both in public primary health care clinics in Ekurhuleni North Sub-District, South Africa. We collected information on visits to health facilities, direct and indirect costs for participants and for their guardians and caregivers. We define 'integration' as receipt of both TB and HIV services at the same facility, on the same day. Costs were presented and compared across participants with TB/HIV, TB-only and HIV-only. Costs exceeding 10% of participant income were considered catastrophic. RESULTS: Participants with both TB and HIV faced a greater economic burden (US$74/month) than those with TB-only (US$68/month) or HIV-only (US$40/month). On average, people with TB/HIV made 18.4 visits to health facilities, more than TB-only participants or HIV-only participants who made 16 and 5.1 visits, respectively. However, people with TB/HIV had fewer standalone TB (10.9) and HIV (2.2) visits than those with TB-only (14.5) or HIV-only (4.4). Although people with TB/HIV had access to 'integrated' services, their time loss was substantially higher than for other participants. Overall, 55% of participants encountered catastrophic costs. Access to official social protection schemes was minimal. CONCLUSIONS: People with TB/HIV in South Africa are at high risk of catastrophic costs. To some extent, integration of services reduces the number of standalone TB and HIV of visits to the health facility. It is however unlikely that catastrophic costs can be averted by service integration alone. Our results point to the need for timely social protection, particularly for HIV-positive people starting TB treatment

TB Fast Track patient cost data

A tabular dataset containing information provided by 99 HIV-positive individuals – men and women aged 18 or above who had a low CD4 count and were not yet on TB or HIV treatment - enrolled in the TB FastTrack trial, a cluster randomised trial to establish the direct and indirect costs of illness incurred at the patient/household level. Data was collected through patient interviews conducted at the health facility where they were receiving treatment in North West Limpopo and Gauteng provinces between June 2014 and March 2015. The dataset contains 450+ variables, including details on quantity of visits, time spent in seeking care, direct medical and non-medical costs incurred, and individual and estimated household income. Household income was established using 4 approaches: (1) self-reported (detail), (2) self-reported (brackets), (3) by matching through an asset index, and (4) national average income