Regional and temporal trends in malaria commodity costs: an analysis of Global Fund data for 79 countries

BACKGROUND: Although procurement consumes nearly 40% of Global Fund’s money, no analyses have been published to show how costs vary across regions and time. This paper presents an analysis of malaria-related commodity procurement data from 79 countries, as reported through the Global Fund’s price and quality reporting (PQR) system for the 2005–2012 period. METHODS: Data were analysed for the three most widely procured commodities for prevention, diagnosis and treatment of malaria. These were long-lasting insecticide-treated nets (LLINs), malaria rapid diagnostic tests (RDTs) and the artemether/lumefantrine (AL) combination treatment. Costs were compared across time (2005–2012), regions, and between individual procurement reported through the PQR and pooled procurement reported through the Global Fund’s voluntary pooled procurement (VPP) system. All costs were adjusted for inflation and reported in US dollars. RESULTS: The data included 1,514 entries reported from 79 countries over seven years. Of these, 492 entries were for LLINs, 330 for RDTs and 692 for AL. Considerable variations were seen by commodity, although none showed an increase in cost. The costs for LLINs, RDTs and AL all dropped significantly over the period of analysis. Regional variations were also seen, with the cost for all three commodities showing significant variations. The median cost for a single LLIN ranged from USD 4.3 in East Asia to USD 5.0 in West and Central Africa. The cost of a single RDT was lowest in West and Central Africa at US$0.57, and highest in the Latin American region at US$ 1.1. AL had the narrowest margin of between US$0.06 per tablet in sub-Saharan Africa and South Asia, and US$ 0.08 in the Latin American and Eastern Europe regions. CONCLUSION: This paper concludes that global procurement costs do vary by region and have reduced overall over time. This suggests a mature market is operating when viewed from the global level, but regional variation needs further attention. Such analyses should be done more often to identify and correct market insufficiencies

Sex differences in survival in patients with a hospital admission for acute myocardial infarction in Scotland 1990-2000

Background Acute myocardial infarction (AMI) is an important cause of morbidity and mortality in men and women. Much of the existing literature has either focussed on men or has examined men and women together. There is a growing evidence to suggest that men and women represent distinct entities in terms of the epidemiology of AMI. This study therefore aims to examine and compare the baseline characteristics, burden of disease and survival of men and women hospitalised between 1990 and 2000 following a first and second AMI and also to determine factors that influence survival in men and women. Methods The Scottish Linked Morbidity Record Database was used to identify all patients hospitalised with a first and a second AMI between 1990 and 2000. Baseline characteristics including demographics, comorbid diagnoses and the burden of disease (including incidence, length of stay and revascularisation rates) were examined in men and women. Sex specific case fatality was calculated at a number of time points from 30 days to five years. Multivariate modelling was then used to examine factors affecting prognosis in different age groups and determine trends over time in men and women separately. Results Between 1990 and 2000, a total of 110, 226 individuals were hospitalised with a first AMI (41% women) and 9,664 individuals (40%) were hospitalised with a second AMI. Comorbid diagnoses were coded in almost half of all men and women with a first AMI and two thirds of those with a second AMI. Between 1990 and 2000, first AMI incidence declined by about one half in men and by one third in women whilst hospitalisation rates for second AMI halved. Thus, burden of disease (incidence and length of stay) fell whilst revascularisation rates increased. Unadjusted short and longer term survival was greater in men than in women. After adjusting for age and other factors women with a first AMI fared worse than men in the short term but better than men in the longer term. Short term sex differences were restricted to younger age groups. In the multivariate analyses men and women had similar short and longer term outcomes following a second AMI. Between 1990 and 2000, short term case fatality declined by approximately half in men and by one third in women over the study period. These improvements were more evident following a first AMI and in younger age groups. Conclusions Younger women hospitalised with a first AMI have high levels of comorbid disease and a worse short term prognosis than men. However women fare better than men in the longer term. Sex differences are not apparent in survival following a second AMI. This may reflect differences in treatment and in secondary prevention, and merits further research

'My expectations remain the same. The student has to be competent to practise' : practice assessor perspectives on the new social work degree qualification in England

Research has emphasized the importance of practice learning to social work qualifying education but has tended to feature social work educator and student perspectives more strongly than the views of those responsible for assessing students' practice in the field. This article draws on 195 responses to a postal questionnaire sent at two points in time to practice assessors working with students from nine social work qualifying programmes run in six higher education institutions collected as part of the evaluation of the new social work degree qualification in England. While practice assessors described changes in their role and in the opportunities available to students, they also emphasized continuities, particularly in the skills that they expected students to possess. The key difficulty they identified was the heavy workload resulting from combining their role as practice assessors with their other responsibilities at work. Increases in the number of social work students and changes to the organization of services are likely to create further pressures on practice assessors. Given that these issues are faced by a number of different professions, the article concludes that there is potential for future studies to look at the experiences of practice educators across different professional qualifying programmes

Pregnant or positive: Adolescent childbearing and HIV risk in South Africa

In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model the probability of reporting that pregnancy would be a problem, using measures of HIV risk together with controls for individual and community measures that are also likely to affect pregnancy preferences. We find that educational and employment opportunities affect fertility preferences but also that the HIV pandemic, specifically adults’ perception of HIV risk for the young in the community and peer opinions about HIV risk, affect fertility preferences. Some significant differences by sex emerge concerning the influence of the perceptions of HIV risk. The analysis suggests that although individual and structural factors remain important, for some adolescents-and for girls more than for boys-the danger of HIV infection is becoming part of their calculus of the desirability of pregnancy. For both boys and girls, the unprotected sex required for conception puts them at danger of HIV transmission. For girls, the environment of risk may be particularly influential because the double threat of pregnancy and HIV infection carries an additional risk of HIV transmission to the infant, as well as the possibility of learning one’s serostatus at an antenatal clinic during pregnancy

A perspective of massive open online courses (MOOCs) and public health

Massive open online courses (MOOCs) have emerged as an innovative educational technology relevant to and affecting higher education, professional development, and lifelong learning. This paper introduces the principles of MOOCs and reviews the development of these platforms over time. We reflect upon the considerable investment by institutions to develop, deliver and promote such courses, particularly in public health. While open to interpretation, the inherent power, influence, and effectiveness of MOOCs is unquestionable. The potential contribution of MOOCs to public health education is immense, with almost universal reach and access. However, apart from research into participant engagement and knowledge, MOOC-related research and evaluation continue to lag with the rapid proliferation of these courses in response to emerging challenges, as seen with the Coronavirus Disease 19 (COVID-19) pandemic. This makes analyzing the contribution of MOOCs to public health education, health promotion and community programs challenging. This perspective article provides a robust rationale for the necessity of MOOCs and their utility in upskilling health professionals and the general public. It builds on current knowledge to comprehensively explore the factors influencing the development, and application of MOOCs

Interventions to reduce HIV/AIDS stigma: What have we learned?

Stigma is a common human reaction to disease. Throughout history many diseases have carried considerable stigma, including leprosy, tuberculosis, cancer, mental illness, and many sexually transmitted diseases. HIV/AIDS is only the latest disease to be stigmatized. This paper reviews 21 interventions that have explicitly attempted to decrease AIDS stigma both in the developed and developing countries and 9 studies that aim to decrease stigma related with other diseases. The studies selected met stringent evaluation criteria in order to draw common lessons for future development of interventions to combat stigma. This paper assesses published and reported studies through comparison of audiences, types of interventions, and methods used to measure change. Target audiences include both those living with or suspected of living with a disease and perpetrators of stigma. All interventions reviewed target subgroups within these broad categories. Types of programs include general information-based programs, contact with affected groups, coping skills acquisition, and counseling approaches. A limited number of scales and indices were used as indicators of change in AIDS stigma

Characterization of potential larval habitats for Anopheles mosquitoes in relation to urban land-use in Malindi, Kenya

BACKGROUND: This study characterized Anopheles mosquito larval habitats in relation to ecological attributes about the habitat and community-level drainage potential, and investigated whether agricultural activities within or around urban households increased the probability of water body occurrence. Malindi, a city on the coast of Kenya, was mapped using global positioning system (GPS) technology, and a geographic information system (GIS) was used to overlay a measured grid, which served as a sampling frame. Grid cells were stratified according to the level of drainage in the area, and 50 cells were randomly selected for the study. Cross-sectional household and entomological surveys were conducted during November and December 2002 within the 50 grid cells. Chi-square analysis was used to test whether water bodies differed fundamentally between well and poorly drained areas, and multi-level logistic regression was used to test whether household-level agricultural activity increased the probability of water body occurrence in the grid cell. RESULTS: Interviews were conducted with one adult in 629 households. A total of 29 water bodies were identified within the sampled areas. This study found that characteristics of water bodies were fundamentally the same in well and poorly drained areas. This study also demonstrated that household-level urban agriculture was not associated with the occurrence of water bodies in the grid cell, after controlling for potential confounders associated with distance to the city center, drainage, access to resources, and population density. CONCLUSIONS: Household-level urban agricultural activity may be less important than the other types of human perturbation in terms of mosquito larval habitat creation. The fact that many larvae were coming from few sites, and few sites in general were found under relatively dry conditions suggests that mosquito habitat reduction is a reasonable and attainable goal in Malindi

Temporal trends and risk factors for readmission for infections, gastrointestinal and immobility complications after an incident hospitalisation for stroke in Scotland between 1997 and 2005

Background: Improvements in stroke management have led to increases in the numbers of stroke survivors over the last decade and there has been a corresponding increase of hospital readmissions after an initial stroke hospitalisation. The aim of this study was to examine the one year risk of having a readmission due to infective, gastrointestinal or immobility (IGI) complications and to identify temporal trends and any risk factors.<p></p> Methods: Using a cohort of first hospitalised for stroke patients who were discharged alive, time to first event (readmission for IGI complications or death) within 1 year was analysed in a competing risks framework using cumulative incidence methods. Regression on the cumulative incidence function was used to model the risks of having an outcome using the covariates age, sex, socioeconomic status, comorbidity, discharge destination and length of hospital stay.<p></p> Results: There were a total of 51,182 patients discharged alive after an incident stroke hospitalisation in Scotland between 1997–2005, and 7,747 (15.1%) were readmitted for IGI complications within a year of the discharge. Comparing incident stroke hospitalisations in 2005 with 1997, the adjusted risk of IGI readmission did not increase (HR = 1.00 95% CI (0.90, 1.11). However, there was a higher risk of IGI readmission with increasing levels of deprivation (most deprived fifth vs. least deprived fifth HR = 1.16 (1.08, 1.26).<p></p> Conclusions: Approximately 15 in 100 patients discharged alive after an incident hospitalisation for stroke in Scotland between 1997 and 2005 went on to have an IGI readmission within one year. The proportion of readmissions did not change over the study period but those living in deprived areas had an increased risk