Objective To investigate the relationship between uses of highly active antiretroviral therapy (HAART) and sexual behavior among people living with HIV (PLHIV) in northeast Thailand. Methods Data were collected both by interviews using a structured questionnaire and by a self-administered questionnairewith HIV positive patients who made an outpatient visit to a public hospital in northeast Thailand between March2004 and January 2005. Fisher's exact test and multiple logistic regression analysis were conducted to identify thefactors associated with regular condom use when these patients had sex with their spouse/partner. Results Among 289 patients (146 with HAART and 143 without HAART) who participated in the study, 122 had sex with their spouse/partner in the three months before the survey. Among them, 70 used a condom every time, 17 used a condom sometimes, 32 never, and 3 unknown. Excluding the 6 patients who did not answer all of the questions, 116 patients remained in the analysis. In the multiple logistic regression analysis, sex, education, employment, years since HIV infection, illness episode in the past one month, and use of HAART were entered as the explanatory factors. Use of HAART (odds ratio=9.8, 95% CI: 2.9 - 32.9) and current employment (odds ratio= 5.2, 95%CI: 1.3 - 20.9) were significantly associated with regular condom use. Conclusion Use of HAART was positively associated with use of condoms when PLHIV had sex with their spouse or partner.
Background Under resource-limited circumstances, standard clinical practice for prioritized illnesses and conditions were introduced to nurses and midwives in primary health care (PHC) facilities in Timor-Leste. This research aims to asses the use of medicines and standard treatment guidelines (STGs) in community health centers (CHCs) in Timor-Leste and to analyze factors that influence adherence to STGs. Methods Randomly sampled 20 CHCs without beds were visited from February to August, 2006. In each CHC, 100 retrospective samples from patient registration books and 30 prospective observations were collected and then quantitatively analyzed. Open-ended interviews to three members of health personnel per CHC were qualitatively analyzed. Results Use of injections in Timor-Leste was extremely low when compared to results from other countries that used the same international indicators. The percentage of encounters with an antibiotic prescribed was significantly lower for prescribers with clinical nurse training than those without the training. A significantly higher level of prescribing adherence was observed among clinical nurse prescribers. None of the facility characteristics investigated was associated with the CHC's overall prescribing adherence to STGs. Open-ended interviews to CHC health personnel revealed that changes brought about by the introduction of STGs were positively perceived by respondents, especially clinical nurses. Discussion Unlike previous studies on physician adherence to STGs in western countries, changes brought about by the introduction of STGs were positively perceived by PHC health personnel in Timor-Leste. STGs were developed and introduced in a policy framework that reflected local needs and reality and related with the Basic Package of Health Services policy and other policies and programs, such as human resource development, medicines policy and resource allocation plans. That fact was considered to have produced positive results in this study. Timor-Leste's experience implies a potential of STGs for non-physician health personnel working at PHC level in other resource-limited areas.
Background According to the state of the world's children 2006, 28% of children under five years of age in sub-Sahara Africa are malnourished, which has serious effects on these children's health and lives. Extensive research has been conducted on child malnutrition in a variety of developing countries. These studies have established scientific indexes to lead and coordinate international action to assist the needy. Central African Republic, however, has been a blind spot. Therefore, the present study was conducted in order to clarify the nutritional status and associated factors of 6 to 24-month-old children in the district of Boy-rabe, Bangui, Central African Republic. Methods Participants were mothers with children aged 6-24 months who visited either a government-run clinic or the NGO-run clinic, Amis d'Afrique, between August 26th and September 16th of 2006. Mothers were interviewed using a structured questionnaire and measurements of the children's weight and length were collected. Weight, length, and age data were compared with child growth standards proposed by the WHO to calculated z-scores for evaluating length-for-age (wasting), weight-for-length (stunted growth), and weight-for-age (underweight). The following factors were investigated for their association to malnutrition in children: “demographic characteristics”, “access to food”, “maternal and child-care practices”, and “poor water/sanitation and inadequate health services”. Results A total of 126 mother-child pairs participated in this study and valid data from 109 pairs were subjected to analysis. The rates of wasting, stunted growth, and underweight children were 20.2%, 61.5% and 42.2%, respectively. Incomplete vaccination (p=0.043) and the mother not having a partner (p=0.046) were significantly associated with wasting. Stunted growth was found to be associated with older child's age (p<0.001), older mothers' age (p=0.005), mothers who had stopped breast-feeding (p=0.031), insufficient breast-feeding (p=0.032), mothers with child death experience (p=0.022), mothers with a number of delivery experiences (p=0.026) and mothers with a partner (p=0.042). Underweight children were associated with incomplete vaccination (p=0.043) and mothers with child death experience (p=0.046). Conclusion In total, 8 factors were found to be significantly associated with child's malnutrition and household/family level. In particular, severe acute malnutrition, or wasting, was related to insufficient vaccination, while chronic malnutrition, or stunted growth, was significantly associated with breast-feeding.
Introduction On 8 March 2009, the Workshop on Infectious Diseases Control Programmes and Health System Strengthening (HSS) was conducted in the 24th East Japan Regional Conference of the Japan Association for International Health. This article reports the discussion in the Workshop and the internet-based open forum that followed. Method After four presentations reflecting on the field-based experiences regarding the relation between disease-specific programmes and HSS, following three aspects were discussed: 1) health system-wide barriers perceived through the implementation of disease-specific programmes; 2) shortcomings of the disease-specific initiatives in light of the HSS; and 3) how the disease-specific initiatives can contribute to the HSS. Results As the system-wide barriers, insufficient quantity and quality of health human resources, lack of health infrastructure and material resources and limitation of the technology applicable to community level of developing countries were commonly perceived. Shortfall of disease-specific programmes in light of the HSS included the lacked coordination between different programmes and donors, duplicated heavy workload put on community health workers especially in recording and reporting, dissociation between local health needs and programme priorities, lack of contributions to strengthening mid-level health administration, deviation of resources to the priority programmes and lack of sharing of potentially sharable material resources. It was proposed that the disease-specific initiatives should contribute to resource mobilization, programme management models, capacity building of mid-level health administration, supplementing personnel cost and presenting hardware and software outcome resources to the HSS. Conclusions The disease-specific initiatives need to pursue the above mentioned practical contributions to the HSS. At the same time, a wider scope addressing political and policy-wise justifications of the form of the overall health system needs to be further discussed with developing countries stakeholders.
Background In recent global health developments, attention has focused on health system strengthening (HSS). Behind this move is the realization that HSS is essential for the development of sustainable and effective health care activities required to meet UN Millennium Development Goals and eradicate poverty. Since the publication of the World Health Report (WHR) 2000, the World Health Organization (WHO) has made intensive efforts to promote HSS. Progress This paper descibes recent global activities for HSS, based on official WHO documents and related issues, along with the following three phases: publication of the WHR 2000, follow up of feedback on the WHR 2000, and global trends for HSS after publication of the WHR 2003. In particular, we shall clarify progress made after the year 2003 with regards to policy, implementation, and scientific methodology. For policy, the principle of Primary Health Care has been introduced to HSS, and the participation of international agencies has been promoted. With regards to practice, training a health care workforce and financial assistance from global funds are addressed. Finally, for scientific methodology, we refer to instances such as the development of the WHO framework for health systems, the promotion of evidence-based health research, and strengthening of health information systems. Conclusion To make vertical health care programmes for acute care, infectious diseases and chronic illnesse etc. more effective, HSS as the lateral foundation is an urgent global health care issue. It is surely necessary that Japan's basic strategy for supporting HSS is clarified as well as attempts to introduce concrete components for HSS into bilateral cooperation and NGO programmes.
Background and objectives Effective hospital management requires utilizing limited medical resources to repeatedly make decisions based on information by hospital administrators, and to achieve the hospital's goals on the mission statement. Therefore, one of the most important duties performed by hospital management experts is to develop an evidence-based information reporting system in a comprehensive manner for decision-making. The following report explains this process to introduce department-based cost accounting to hospitals in Sri Lanka, from the viewpoint of sorting data. Process During the development survey phase II in the “Evidence-based Management for the Health System in Sri Lanka” which was conducted from October 2005 to October 2007, one national hospital (a tertiary care institution) and one district hospital (a secondary care institution) were selected as pilot hospitals in the Northwest Province of Sri Lanka. After conducting a survey on the present situation of medical treatment information and accounting information, a department-based cost accounting system was introduced. Thus, a system to prepare a monthly report was developed. Results During this survey, the process was carried out whilst explaining to personnel of the Ministry of Health and the Ministry of Finance, the necessity of cost accounting in hospital management and its effective utilization in policy-making from the initial stage of the survey. However, not until the information was actually obtained and revealed by cost accounting (conducted at their own hospitals), could the Ministry of Health and the Ministry of Finance understand the importance and necessity of collection and analysis of detailed cost information such as the costs of medical and health care services. Conclusion By introducing a department-based cost accounting system to hospitals as a managerial accounting system, it was found that the information necessary for hospital management (covering accounting and medical treatment of the entire hospital) could be gathered and processed more efficiently. The activities by hospital management experts can be processed to sort and organize hospital data. Therefore, sorting data with the aim of department-based cost accounting is considered extremely useful as a basic duty by hospital management experts.