This document discusses new strategies for providing hormonal contraception in developing countries. It notes that while access to contraception has increased, many women in developing countries still have unmet family planning needs. There is a focus on increasing access to long-acting hormonal methods like implants and IUDs to better meet demand. Key factors that have impacted availability include supportive policies, evidence-based practices, and diverse delivery strategies that bring services to the community level. Expanding access to a range of hormonal methods can help reduce population growth and empower women to plan their families.
This document summarizes strategies for transforming agri-food systems in Asia and the Pacific to improve human and planetary health. It finds that multiple burdens of malnutrition persist in the region and progress is not on track to meet SDG targets. Reshaping agri-food systems through policies, institutions, technologies, and cross-sector collaboration is crucial. Specific recommendations include reforming subsidies and taxes to incentivize nutritious foods, strengthening women's empowerment and land rights, investing in nutrition-sensitive technologies, and using evidence from projects like one examining food systems in Papua New Guinea to inform policy.
This document summarizes cancer incidence and spending trends globally:
- Cancer incidence rates vary significantly between more and less developed regions, with higher rates of lung and colorectal cancer in more developed areas and higher rates of liver and gastric cancer in less developed areas.
- Oncology drug spending has grown substantially, reaching $91 billion globally in 2013, still dominated by the US and major EU markets.
- The average monthly cost of branded cancer drugs in the US nearly doubled from 2003-2013, with some individual drugs costing over $30,000 per month.
Using mobile phones for nutrition surveillance a review of evidenceDr Lendy Spires
This document reviews evidence on using mobile phones for nutrition surveillance. It identifies 9 studies that assessed the impact of mobile phone-based surveillance systems, mostly in sub-Saharan Africa. The studies evaluated systems for monitoring nutrition, livestock diseases, malaria, influenza and cholera. Most systems used basic phones and SMS to collect and transmit surveillance data from health facilities or communities to central databases. The evidence provides an overview of the technical aspects and data flows involved in mobile phone-based surveillance systems. However, the quality of available evidence is limited as the studies were mostly short pilot projects without rigorous evaluation.
1) The World Health Organization (WHO) report "Health for the world's adolescents" addresses improving health outcomes for the world's one billion adolescents. It highlights both successes, such as declining adolescent pregnancy and maternal mortality rates in some regions, as well as ongoing challenges like HIV mortality among adolescents rising in Africa.
2) Adolescence is a crucial life stage for establishing health behaviors and patterns that affect future adult health. Many major causes of illness and death among adolescents, like road injuries, violence, and mental health issues, have preventable underlying factors.
3) Achieving overall health and development requires a holistic, multisector approach that addresses individual, social, and environmental determinants of adolescent health
Sustainably Feeding the World: The Next 40 YearsShenggen Fan
Global food security is under stress due to population growth, resource constraints from land and water scarcity, and climate change impacts. "Business as unusual" is urgently needed to enhance food security through investing in agriculture and social protection, bringing in new partners from the private sector and philanthropies, adopting country-led approaches, and using evidence from policy experiments. Agricultural science, technology, and policy research are critical to increasing yields sustainably and designing effective policies, but these need to be made more accessible to smallholders.
The Impact of Ethiopia’s Productive Safety Nets Programme: 2006-2012essp2
International Food Policy Research Institute (IFPRI) and Ethiopian Development Research Institute (EDRI). Conference on "Towards what works in Rural Development in Ethiopia: Evidence on the Impact of Investments and Policies". December 13, 2013. Hilton Hotel, Addis Ababa.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
This document summarizes strategies for transforming agri-food systems in Asia and the Pacific to improve human and planetary health. It finds that multiple burdens of malnutrition persist in the region and progress is not on track to meet SDG targets. Reshaping agri-food systems through policies, institutions, technologies, and cross-sector collaboration is crucial. Specific recommendations include reforming subsidies and taxes to incentivize nutritious foods, strengthening women's empowerment and land rights, investing in nutrition-sensitive technologies, and using evidence from projects like one examining food systems in Papua New Guinea to inform policy.
This document summarizes cancer incidence and spending trends globally:
- Cancer incidence rates vary significantly between more and less developed regions, with higher rates of lung and colorectal cancer in more developed areas and higher rates of liver and gastric cancer in less developed areas.
- Oncology drug spending has grown substantially, reaching $91 billion globally in 2013, still dominated by the US and major EU markets.
- The average monthly cost of branded cancer drugs in the US nearly doubled from 2003-2013, with some individual drugs costing over $30,000 per month.
Using mobile phones for nutrition surveillance a review of evidenceDr Lendy Spires
This document reviews evidence on using mobile phones for nutrition surveillance. It identifies 9 studies that assessed the impact of mobile phone-based surveillance systems, mostly in sub-Saharan Africa. The studies evaluated systems for monitoring nutrition, livestock diseases, malaria, influenza and cholera. Most systems used basic phones and SMS to collect and transmit surveillance data from health facilities or communities to central databases. The evidence provides an overview of the technical aspects and data flows involved in mobile phone-based surveillance systems. However, the quality of available evidence is limited as the studies were mostly short pilot projects without rigorous evaluation.
1) The World Health Organization (WHO) report "Health for the world's adolescents" addresses improving health outcomes for the world's one billion adolescents. It highlights both successes, such as declining adolescent pregnancy and maternal mortality rates in some regions, as well as ongoing challenges like HIV mortality among adolescents rising in Africa.
2) Adolescence is a crucial life stage for establishing health behaviors and patterns that affect future adult health. Many major causes of illness and death among adolescents, like road injuries, violence, and mental health issues, have preventable underlying factors.
3) Achieving overall health and development requires a holistic, multisector approach that addresses individual, social, and environmental determinants of adolescent health
Sustainably Feeding the World: The Next 40 YearsShenggen Fan
Global food security is under stress due to population growth, resource constraints from land and water scarcity, and climate change impacts. "Business as unusual" is urgently needed to enhance food security through investing in agriculture and social protection, bringing in new partners from the private sector and philanthropies, adopting country-led approaches, and using evidence from policy experiments. Agricultural science, technology, and policy research are critical to increasing yields sustainably and designing effective policies, but these need to be made more accessible to smallholders.
The Impact of Ethiopia’s Productive Safety Nets Programme: 2006-2012essp2
International Food Policy Research Institute (IFPRI) and Ethiopian Development Research Institute (EDRI). Conference on "Towards what works in Rural Development in Ethiopia: Evidence on the Impact of Investments and Policies". December 13, 2013. Hilton Hotel, Addis Ababa.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
The document discusses research gaps on food security and nutrition under the Comprehensive Africa Agriculture Development Programme (CAADP). It identifies the top research gaps as food access/availability, value chain development, children and women malnutrition, market access, climate change and agroforestry, and post-harvest losses. It also describes the role of the Food Security Portal in providing information to policymakers, enabling information sharing and coordination, and influencing policy to increase food security.
Glob Health Sci Pract-2016-Samuel-S60-72Melaku Samuel
The document summarizes an intervention in Ethiopia that aimed to strengthen postabortion family planning (PAFP) services by expanding contraceptive choice and improving access to long-acting reversible contraceptives (LARCs). The intervention was implemented in 101 public health facilities in Southern Nations, Nationalities, and People’s Region from 2010 to 2014. It significantly improved PAFP uptake and increased the proportion of abortion clients receiving LARCs over the period. Specifically, the share of the method mix for LARCs rose from 2% in 2010 to 55% in 2014, while use of implants increased from 2% to 43% and IUDs from 0.1% to 12%. The broader method mix allowed more clients
This document is a case study of Marie Stopes International's BlueStar social franchise network in Vietnam. It provides context on Vietnam's population, health system, and regulations regarding private healthcare providers. It then describes BlueStar's business model, which franchises family planning and safe abortion services to over 300 private providers. The network aims to increase access to quality sexual and reproductive healthcare in underserved urban and rural areas. The case study discusses BlueStar's operations, challenges, and lessons learned in implementing this social franchise model in Vietnam.
Rising food prices and implications for information needsJohan Lorenzen
Rising global food prices and domestic food security in Uganda require ongoing monitoring and analysis of indicators to understand trends and impacts. Key information needs include:
1) Monitoring domestic food prices, production, consumption and nutrition status to track food security.
2) Analyzing indicators to identify causes of changes, such as whether rising prices stem from global markets, weather, or other factors.
3) Assessing relationships between indicators like how crop failures or price hikes affect households.
4) Evaluating impacts of policies on food security, which requires methods like randomized trials. Balancing data collection costs and accuracy is important for effective policy responses.
The document discusses Afghanistan's experience monitoring basic health services contracts with NGOs in a conflict setting. It outlines Afghanistan's complex monitoring and evaluation (M&E) system involving multiple departments and organizations. Resources for M&E activities are substantial, with a third party responsible for most activities at a cost of $3.2 million per year. The relationship between contract managers and service-providing NGOs aims to improve performance through monitoring reports and meetings, though external factors sometimes interfere.
The document summarizes a presentation on the Millennium Development Goals given by Dr. G. Hari Prakash. It discusses the eight MDGs related to poverty, education, gender equality, child and maternal health, HIV/AIDS and other diseases, environmental sustainability, and global partnerships. It provides updates on India's progress in achieving the health-related targets of reducing poverty, hunger, child mortality, and maternal mortality. While most targets have been achieved or are in progress, some states still face challenges in improving maternal and child health indicators. The key drivers in achieving the targets included economic growth, investment in social sectors, effective implementation of programs, and infrastructure development.
Understanding the Effect of the GAVI Initiative on Reported Vaccination Cover...UWGlobalHealth
This document discusses the critical role of health metrics and evaluation in ensuring accountability, transparency and reducing corruption in global health. It provides two examples: tracking childhood immunization coverage shows investments have increased coverage gradually over 20 years but initiatives can lead to over-reporting; India's conditional cash transfer program for facility births increased coverage and likely reduced mortality, but quality issues remain. Overall, independent monitoring of health indicators and evaluation of programs is needed to show resources are having their intended impact.
Source, Availability and Use of Agricultural Informationby Extension Agents i...paperpublications3
Abstract: Assessment of the agricultural information systems and communication arrangement used by extension workers provided a framework to identify the strength and weaknesses of the current systems and led to recommendations to improve their performance. Structured interviews were used to collect data from a randomly selected twenty eight extension workers of the Sidama zone of SNNPRs. The data analysis was performed using SPSS. The responses indicated that Woreda agricultural office top rated (77.8%), followed by mass media (55.6%), news paper (51.9%) and mobile (37%) by delivering agricultural information regularly. The result of the study shows that all of the respondents (100%) have got agricultural information in the form of training and extension meeting. Similarly, 96.3% have got from local radio program and 88.9% from field visit, manual and national radio program. In addition to this, national television program, leaflets, and regional television program serves as source of agricultural information for 74.1, 74.1, and 70.4% of the respondents respectively whereas reports and websites provide agricultural information for 3.7 and7.4% respectively. Among the respondents, the majority (59.3%) have used notebook to file agricultural information obtained from different sources through different means. However, 3.7 and 29.6% of them have been used farmers training centers (FTC) and kept the original document to file the available agricultural information. Based on the result of the study most (74.04%) of the respondents were highly motivated on their work. However 22.2 and 3.7% of them were low and medium motivated on their work respectively. The study revealed that extension agents in the study area had adequate job autonomy. However the extension workers did not have an appropriate information management system. The finding of this research revealed that the governments need to frame sensitive policies to address the problem of the extension workers loyalty to their organization in order to increase their commitment in which they play vital roles in agricultural development.
Urbanization is increasing globally, with more people living in urban areas. This presents challenges for distributing adult vaccines. The document reviews different strategies used in various settings to increase adult vaccination rates. Hospital/clinic-based interventions like standing orders and reminders showed success. Community-based programs distributing vaccines in non-traditional settings also increased rates. While many focused on the elderly, few targeted high-risk adults or children. A limitation is reaching those not engaged in healthcare.
Effective implementation of national health strategy finalNajibullah Safi
The document outlines key actions for effective implementation of Afghanistan's national health strategy 2016-2020 to achieve universal health coverage. The actions include expanding health services coverage and packages, enhancing financial protection, improving coordination, strengthening accountability, increasing efficiency, and addressing cross-cutting issues such as capacity building and private sector regulation. The overall goal is to ensure all Afghans have access to needed health services without financial hardship.
Public-private delivery of insecticide-treated netsSusan Burns
During a one-year pilot program in Ghana's Volta Region, over 25,000 vouchers were issued to pregnant women attending antenatal clinics to subsidize the purchase of insecticide-treated bed nets. This accounted for about 50% of antenatal registrants during the period. Approximately 67% of the issued vouchers were redeemed by distributors to purchase more nets from suppliers. Interviews found that initially some midwives did not issue vouchers due to their own eligibility criteria, but later it was often due to the women's own decisions or lack of available nets. Factors like existing net ownership and competing delivery programs influenced both voucher issuance and redemption. Monitoring of the program provided useful data on barriers
Do Investments in Agricultural Extension Deliver Positive Benefits to Health,...Premier Publishers
The study provides an overview of the state of Agricultural Extension with the major aim of identifying gaps and areas of advocacy in the laws and policies that govern extension service delivery in Uganda, document the linkages and analytical trends between agricultural extension and performance of Health, Trade and Industry and Water and Environment sectors, as well as establish the value of each shilling or dollar invested in agricultural extension. Using secondary sources of data and Statistical Based Costing methods, the results revealed that the state of agricultural extension services in Uganda is wanting. Adoption of improved technologies was very low and technology misuse was very rampant. In livestock, the quality of veterinary services and their use were particularly very low. Our results showed that the unit cost of providing agricultural extension services that result in increased productivity, better nutrition as well as higher incomes to farmers is UGX 66,290 per visit. The total cost of not providing agricultural extension is extremely high and the country stands to lose greatly due to the multiplier effect and spillover effect of agricultural extension in other productive sectors. There is certainly need to invest in agricultural extension both in crop and livestock sectors.
Presented in a one day policy consultation workshop jointly organized by the A N Sinha Institute of Social Science (ANSISS), and the International Food Policy Research Institute (IFPRI) on ‘‘Food Security Portal Partnership and Policy Dialogue in India Emerging Food Security Issues in Bihar’’ on Saturday, April 25, 2015 in, Patna, Bihar. The main objective of the policy consultative workshop is to deliberate on the options and strategies for making food system efficient and effective in Bihar. Also to get valuable input with regard to other emerging issues in Bihar i.e. water management, nutrition and diversification and markets for food security.
Najibullah Safi, MD, MSc. HPM presented on the history and current state of Afghanistan's health care system. He discussed key progress made in health indicators like immunization coverage and under-five mortality. However, challenges remain such as high stunting rates, poor quality of care in hospitals, and a high maternal mortality ratio. Moving forward, Afghanistan aims to implement an Integrated Package of Essential Health Services to address the triple burden of diseases. Principles of the way forward include prioritizing the poor, increasing community engagement, and raising domestic financing for health.
The EAT Lancet Publication: Implications for Nutrition Health and Planetessp2
The document discusses a publication by the EAT-Lancet Commission that aimed to define global scientific targets for healthy diets from sustainable food systems. It established a reference diet of 2500 calories per day consisting of vegetables, fruits, whole grains, plant proteins, unsaturated fats, and limited red meat and sugar. Current diets vary widely from this target. The commission also set planetary boundaries related to greenhouse gas emissions, land and water use, and nutrient flows to define a safe operating space for food production. Global modeling was used to identify combinations of measures needed to meet dietary targets sustainably by 2050, such as shifting diets, reducing food waste, and improving agricultural practices.
This document discusses challenges faced during the COVID-19 pandemic, including health workforce gaps, limited health system capacity, and lack of access to healthcare facilities and resources. It outlines WHO strategic priorities to promote healthier populations through universal health coverage and addressing health emergencies. Specific priorities include expanding immunization coverage, strengthening health workforces, and protecting populations from disease outbreaks. The challenges of the pandemic, as well as opportunities to build more resilient and equitable health systems, are also summarized.
- South Africa's antiretroviral (ARV) treatment program is the largest in the world, providing treatment to over 1 million people by 2010, though total need is estimated at 5.7 million.
- The program faces challenges of expanding capacity to treat the additional 300,000 people in need each year given constraints of human resources, infrastructure, and drug supply.
- Recent government efforts to address gaps include increasing the health budget, expanding treatment guidelines in line with WHO recommendations, implementing task shifting, and centralized drug purchasing to reduce costs.
This document outlines a protocol for an economic evaluation of using mobile phone text messaging to improve maternal and newborn healthcare services in Cameroon. The study will have two phases: 1) An observational study to measure the effectiveness of an existing mHealth project. 2) A randomized controlled trial to test the impact of SMS messages on healthcare indicators in the Fundong Health District. The goal is to assess the costs and benefits of using FrontlineSMS's mobile platform to promote health behaviors and measure the economic effects on the district. Key outcomes include healthcare utilization, birth outcomes, immunization rates, and behavior changes related to nutrition, smoking, and postpartum depression.
This document provides guidelines for the effective and appropriate use of long-acting reversible contraception (LARC) methods. It was developed by the National Collaborating Centre for Women's and Children's Health and commissioned by the National Institute for Health and Clinical Excellence. The document covers copper intrauterine devices (IUDs), the intrauterine system (IUS), progestogen-only injectable contraceptives, and progestogen-only subdermal implants. It provides recommendations on the use, effectiveness, risks and benefits of these LARC methods.
Most internists' practices include patients who have had or will seek induced abortion. Each year, about 2% of women ages 15-44 have an abortion. Most abortions are performed by vacuum aspiration under local anesthesia in freestanding clinics before 9 weeks of gestation. Medical abortion with mifepristone and misoprostol is a growing nonsurgical alternative for early pregnancy termination. Abortion remains very safe, with a risk of less than 1 death per 100,000 procedures.
The document discusses research gaps on food security and nutrition under the Comprehensive Africa Agriculture Development Programme (CAADP). It identifies the top research gaps as food access/availability, value chain development, children and women malnutrition, market access, climate change and agroforestry, and post-harvest losses. It also describes the role of the Food Security Portal in providing information to policymakers, enabling information sharing and coordination, and influencing policy to increase food security.
Glob Health Sci Pract-2016-Samuel-S60-72Melaku Samuel
The document summarizes an intervention in Ethiopia that aimed to strengthen postabortion family planning (PAFP) services by expanding contraceptive choice and improving access to long-acting reversible contraceptives (LARCs). The intervention was implemented in 101 public health facilities in Southern Nations, Nationalities, and People’s Region from 2010 to 2014. It significantly improved PAFP uptake and increased the proportion of abortion clients receiving LARCs over the period. Specifically, the share of the method mix for LARCs rose from 2% in 2010 to 55% in 2014, while use of implants increased from 2% to 43% and IUDs from 0.1% to 12%. The broader method mix allowed more clients
This document is a case study of Marie Stopes International's BlueStar social franchise network in Vietnam. It provides context on Vietnam's population, health system, and regulations regarding private healthcare providers. It then describes BlueStar's business model, which franchises family planning and safe abortion services to over 300 private providers. The network aims to increase access to quality sexual and reproductive healthcare in underserved urban and rural areas. The case study discusses BlueStar's operations, challenges, and lessons learned in implementing this social franchise model in Vietnam.
Rising food prices and implications for information needsJohan Lorenzen
Rising global food prices and domestic food security in Uganda require ongoing monitoring and analysis of indicators to understand trends and impacts. Key information needs include:
1) Monitoring domestic food prices, production, consumption and nutrition status to track food security.
2) Analyzing indicators to identify causes of changes, such as whether rising prices stem from global markets, weather, or other factors.
3) Assessing relationships between indicators like how crop failures or price hikes affect households.
4) Evaluating impacts of policies on food security, which requires methods like randomized trials. Balancing data collection costs and accuracy is important for effective policy responses.
The document discusses Afghanistan's experience monitoring basic health services contracts with NGOs in a conflict setting. It outlines Afghanistan's complex monitoring and evaluation (M&E) system involving multiple departments and organizations. Resources for M&E activities are substantial, with a third party responsible for most activities at a cost of $3.2 million per year. The relationship between contract managers and service-providing NGOs aims to improve performance through monitoring reports and meetings, though external factors sometimes interfere.
The document summarizes a presentation on the Millennium Development Goals given by Dr. G. Hari Prakash. It discusses the eight MDGs related to poverty, education, gender equality, child and maternal health, HIV/AIDS and other diseases, environmental sustainability, and global partnerships. It provides updates on India's progress in achieving the health-related targets of reducing poverty, hunger, child mortality, and maternal mortality. While most targets have been achieved or are in progress, some states still face challenges in improving maternal and child health indicators. The key drivers in achieving the targets included economic growth, investment in social sectors, effective implementation of programs, and infrastructure development.
Understanding the Effect of the GAVI Initiative on Reported Vaccination Cover...UWGlobalHealth
This document discusses the critical role of health metrics and evaluation in ensuring accountability, transparency and reducing corruption in global health. It provides two examples: tracking childhood immunization coverage shows investments have increased coverage gradually over 20 years but initiatives can lead to over-reporting; India's conditional cash transfer program for facility births increased coverage and likely reduced mortality, but quality issues remain. Overall, independent monitoring of health indicators and evaluation of programs is needed to show resources are having their intended impact.
Source, Availability and Use of Agricultural Informationby Extension Agents i...paperpublications3
Abstract: Assessment of the agricultural information systems and communication arrangement used by extension workers provided a framework to identify the strength and weaknesses of the current systems and led to recommendations to improve their performance. Structured interviews were used to collect data from a randomly selected twenty eight extension workers of the Sidama zone of SNNPRs. The data analysis was performed using SPSS. The responses indicated that Woreda agricultural office top rated (77.8%), followed by mass media (55.6%), news paper (51.9%) and mobile (37%) by delivering agricultural information regularly. The result of the study shows that all of the respondents (100%) have got agricultural information in the form of training and extension meeting. Similarly, 96.3% have got from local radio program and 88.9% from field visit, manual and national radio program. In addition to this, national television program, leaflets, and regional television program serves as source of agricultural information for 74.1, 74.1, and 70.4% of the respondents respectively whereas reports and websites provide agricultural information for 3.7 and7.4% respectively. Among the respondents, the majority (59.3%) have used notebook to file agricultural information obtained from different sources through different means. However, 3.7 and 29.6% of them have been used farmers training centers (FTC) and kept the original document to file the available agricultural information. Based on the result of the study most (74.04%) of the respondents were highly motivated on their work. However 22.2 and 3.7% of them were low and medium motivated on their work respectively. The study revealed that extension agents in the study area had adequate job autonomy. However the extension workers did not have an appropriate information management system. The finding of this research revealed that the governments need to frame sensitive policies to address the problem of the extension workers loyalty to their organization in order to increase their commitment in which they play vital roles in agricultural development.
Urbanization is increasing globally, with more people living in urban areas. This presents challenges for distributing adult vaccines. The document reviews different strategies used in various settings to increase adult vaccination rates. Hospital/clinic-based interventions like standing orders and reminders showed success. Community-based programs distributing vaccines in non-traditional settings also increased rates. While many focused on the elderly, few targeted high-risk adults or children. A limitation is reaching those not engaged in healthcare.
Effective implementation of national health strategy finalNajibullah Safi
The document outlines key actions for effective implementation of Afghanistan's national health strategy 2016-2020 to achieve universal health coverage. The actions include expanding health services coverage and packages, enhancing financial protection, improving coordination, strengthening accountability, increasing efficiency, and addressing cross-cutting issues such as capacity building and private sector regulation. The overall goal is to ensure all Afghans have access to needed health services without financial hardship.
Public-private delivery of insecticide-treated netsSusan Burns
During a one-year pilot program in Ghana's Volta Region, over 25,000 vouchers were issued to pregnant women attending antenatal clinics to subsidize the purchase of insecticide-treated bed nets. This accounted for about 50% of antenatal registrants during the period. Approximately 67% of the issued vouchers were redeemed by distributors to purchase more nets from suppliers. Interviews found that initially some midwives did not issue vouchers due to their own eligibility criteria, but later it was often due to the women's own decisions or lack of available nets. Factors like existing net ownership and competing delivery programs influenced both voucher issuance and redemption. Monitoring of the program provided useful data on barriers
Do Investments in Agricultural Extension Deliver Positive Benefits to Health,...Premier Publishers
The study provides an overview of the state of Agricultural Extension with the major aim of identifying gaps and areas of advocacy in the laws and policies that govern extension service delivery in Uganda, document the linkages and analytical trends between agricultural extension and performance of Health, Trade and Industry and Water and Environment sectors, as well as establish the value of each shilling or dollar invested in agricultural extension. Using secondary sources of data and Statistical Based Costing methods, the results revealed that the state of agricultural extension services in Uganda is wanting. Adoption of improved technologies was very low and technology misuse was very rampant. In livestock, the quality of veterinary services and their use were particularly very low. Our results showed that the unit cost of providing agricultural extension services that result in increased productivity, better nutrition as well as higher incomes to farmers is UGX 66,290 per visit. The total cost of not providing agricultural extension is extremely high and the country stands to lose greatly due to the multiplier effect and spillover effect of agricultural extension in other productive sectors. There is certainly need to invest in agricultural extension both in crop and livestock sectors.
Presented in a one day policy consultation workshop jointly organized by the A N Sinha Institute of Social Science (ANSISS), and the International Food Policy Research Institute (IFPRI) on ‘‘Food Security Portal Partnership and Policy Dialogue in India Emerging Food Security Issues in Bihar’’ on Saturday, April 25, 2015 in, Patna, Bihar. The main objective of the policy consultative workshop is to deliberate on the options and strategies for making food system efficient and effective in Bihar. Also to get valuable input with regard to other emerging issues in Bihar i.e. water management, nutrition and diversification and markets for food security.
Najibullah Safi, MD, MSc. HPM presented on the history and current state of Afghanistan's health care system. He discussed key progress made in health indicators like immunization coverage and under-five mortality. However, challenges remain such as high stunting rates, poor quality of care in hospitals, and a high maternal mortality ratio. Moving forward, Afghanistan aims to implement an Integrated Package of Essential Health Services to address the triple burden of diseases. Principles of the way forward include prioritizing the poor, increasing community engagement, and raising domestic financing for health.
The EAT Lancet Publication: Implications for Nutrition Health and Planetessp2
The document discusses a publication by the EAT-Lancet Commission that aimed to define global scientific targets for healthy diets from sustainable food systems. It established a reference diet of 2500 calories per day consisting of vegetables, fruits, whole grains, plant proteins, unsaturated fats, and limited red meat and sugar. Current diets vary widely from this target. The commission also set planetary boundaries related to greenhouse gas emissions, land and water use, and nutrient flows to define a safe operating space for food production. Global modeling was used to identify combinations of measures needed to meet dietary targets sustainably by 2050, such as shifting diets, reducing food waste, and improving agricultural practices.
This document discusses challenges faced during the COVID-19 pandemic, including health workforce gaps, limited health system capacity, and lack of access to healthcare facilities and resources. It outlines WHO strategic priorities to promote healthier populations through universal health coverage and addressing health emergencies. Specific priorities include expanding immunization coverage, strengthening health workforces, and protecting populations from disease outbreaks. The challenges of the pandemic, as well as opportunities to build more resilient and equitable health systems, are also summarized.
- South Africa's antiretroviral (ARV) treatment program is the largest in the world, providing treatment to over 1 million people by 2010, though total need is estimated at 5.7 million.
- The program faces challenges of expanding capacity to treat the additional 300,000 people in need each year given constraints of human resources, infrastructure, and drug supply.
- Recent government efforts to address gaps include increasing the health budget, expanding treatment guidelines in line with WHO recommendations, implementing task shifting, and centralized drug purchasing to reduce costs.
This document outlines a protocol for an economic evaluation of using mobile phone text messaging to improve maternal and newborn healthcare services in Cameroon. The study will have two phases: 1) An observational study to measure the effectiveness of an existing mHealth project. 2) A randomized controlled trial to test the impact of SMS messages on healthcare indicators in the Fundong Health District. The goal is to assess the costs and benefits of using FrontlineSMS's mobile platform to promote health behaviors and measure the economic effects on the district. Key outcomes include healthcare utilization, birth outcomes, immunization rates, and behavior changes related to nutrition, smoking, and postpartum depression.
This document provides guidelines for the effective and appropriate use of long-acting reversible contraception (LARC) methods. It was developed by the National Collaborating Centre for Women's and Children's Health and commissioned by the National Institute for Health and Clinical Excellence. The document covers copper intrauterine devices (IUDs), the intrauterine system (IUS), progestogen-only injectable contraceptives, and progestogen-only subdermal implants. It provides recommendations on the use, effectiveness, risks and benefits of these LARC methods.
Most internists' practices include patients who have had or will seek induced abortion. Each year, about 2% of women ages 15-44 have an abortion. Most abortions are performed by vacuum aspiration under local anesthesia in freestanding clinics before 9 weeks of gestation. Medical abortion with mifepristone and misoprostol is a growing nonsurgical alternative for early pregnancy termination. Abortion remains very safe, with a risk of less than 1 death per 100,000 procedures.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
El documento describe el proceso de pensamiento reflexivo según John Dewey. Explica que el pensamiento real difiere de la forma lógica y depende de los hábitos de un individuo. Describe las cinco fases del pensamiento reflexivo: sugerencias, intelectualización, idea conductora, razonamiento y comprobación de hipótesis. También discute el papel del juicio en la actividad reflexiva, incluyendo la selección de hechos y principios, y la formación de conclusiones.
Este documento discute diferentes aspectos del pensamiento. Explica que el pensamiento reflexivo implica resolver problemas mediante la investigación de nuevos hechos. También analiza las condiciones escolares que pueden fomentar o limitar el desarrollo del pensamiento, como la naturaleza de las asignaturas y los objetivos de la enseñanza.
Este documento discute varios temas relacionados con el aprendizaje y el desarrollo cognitivo. Argumenta que aunque los niños aprenden de forma intuitiva su lengua materna, experimentan dificultades cuando empiezan la escuela formal. También señala que los estudiantes exitosos a menudo no comprenden profundamente los conceptos que estudian. Finalmente, presenta las teorías de Piaget sobre el desarrollo cognitivo en etapas y la perspectiva de Chomsky sobre el lenguaje como una capacidad innata.
Este documento descreve as funções de um avaliador externo no processo de reconhecimento, validação e certificação de competências de adultos. O avaliador externo analisa os dossiês dos candidatos, interpreta as evidências de acordo com os referenciais, coopera com outros membros do júri na decisão final e apoia o candidato no seu projeto pessoal.
Este documento presenta información sobre el desarrollo del pensamiento y lenguaje en la infancia. Incluye secciones sobre lenguaje oral, lenguaje escrito, y las etapas evolutivas del lenguaje en niños de 3 a 6 años. También cubre tres unidades de estudio sobre las relaciones entre pensamiento y lenguaje, las fases de la adquisición del lenguaje, y el lenguaje como herramienta para la comunicación.
Ute los emprendimientos sociales y la cultura organizacional.CHELITA29
Este documento trata sobre la estrategia de los emprendimientos sociales y la cultura organizacional de los emprendimientos sociales. Fue escrito por Janina Elizabeth Solano Jaramillo para su carrera de Ciencias de la Educación en la Universidad Tecnológica Equinoccial, Sede Loja, bajo la tutoría del Dr. Manuel Gonzalo Remache Bunci durante el período de septiembre a febrero del 2014.
El documento ofrece soluciones sustentables para mejorar el entorno a través de productos y servicios ecológicos de limpieza, desinfección y mantenimiento. Se ofrecen equipos y productos de última generación que utilizan vapor seco, ozono, rayos UVC y son biodegradables. También se proveen servicios de capacitación, mantenimiento de sistemas de refrigeración y asesoría en buenas prácticas ambientales.
Este documento fornece 13 regras importantes sobre o uso seguro e responsável do email. Algumas dessas regras incluem: 1) encaminhar apenas a mensagem real em vez de toda a cadeia de encaminhamentos; 2) usar CCO ao enviar para múltiplos destinatários; 3) remover prefixos como "Re:" do assunto; e 4) nunca abrir anexos .exe ou encaminhar alertas de vírus sem confirmação. O documento também alerta sobre boatos comuns e encoraja a verificar os fatos antes de encaminhar.
Este documento presenta los detalles de un proyecto llamado "Noche de Leyendas" organizado por estudiantes de la Licenciatura en Educación Preescolar del Centro Regional de Educación Normal "Dr. Gonzalo Aguirre Beltrán" en Túxpam, Veracruz. Incluye la misión, visión, objetivos y plan de trabajo del evento, el cual consiste en un recorrido nocturno por las instalaciones donde se compartirán breves relatos y leyendas tradicionales de la región. También presenta información sobre un
El documento discute varias tendencias pedagógicas que influyen en la enseñanza, incluyendo el aprendizaje basado en proyectos, el aprendizaje vivencial y el aprendizaje invertido. Estas tendencias enfatizan que los estudiantes construyan el conocimiento a través de proyectos y experiencias del mundo real, y que los docentes usen herramientas digitales como videos para hacer la enseñanza menos tediosa.
1) O documento resume o livro "Jogos de Escala: a experiência da microanálise", que discute a abordagem da micro-história na pesquisa histórica francesa.
2) A micro-história surgiu como uma crítica à perspectiva macro-histórica dominante que buscava explicações nos níveis estruturais.
3) A micro-história valoriza a escala local e os sujeitos históricos, questionando noções rígidas de racionalidade e causalidade históricas.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
mHealth for Family Planning_Lairmore_finalKate Lairmore
Mobile health (mHealth) tools show promise in increasing access to family planning services and education by leveraging the widespread availability of mobile phones. However, while mHealth applications are growing rapidly, evidence of their effectiveness remains limited. This paper examines the potential uses of mHealth strategies in family planning programs and presents examples to address unmet needs for information and services. The goal is to provide an overview of how adding mobile phone tools could help reduce high unmet need levels.
2010 trends in immunization completion health reform bmcRoger Zapata
This document analyzes trends in immunization completion rates and disparities in Tanzania using data from Demographic and Health Surveys conducted in 1990, 1996, and 2004/05. The key findings are:
1) The percentage of children completing vaccinations was similar across the three time periods at around 70-72%, however disparities emerged over time.
2) In 2004/05, immunization completion declined significantly among the poor while increasing among the least poor, indicating a disparity associated with wealth.
3) Children from households with low levels of parental education were less likely to complete immunization across all three time periods.
4) While national immunization coverage did not change much, sub-
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
The document discusses alternative sustainable financing options for primary health care services in Kenya. It notes that while the Kenyan government is committed to providing quality primary health care, budgetary allocations to health care have declined and out-of-pocket spending is high. User fees intended to increase cost recovery have negatively impacted access to care. The study examines alternative financing mechanisms that could help mitigate these trends, such as pooling funds to protect the poor from catastrophic costs, establishing taxes specifically for health care, and issuing bonds for health infrastructure. However, identifying the poor and providing safety nets like waivers will be important for the success of any new mechanisms.
Overview of the Decade of Vaccines Collaboration including background, structure and vision for creation of the Global Vaccines Action Plan.
www.dovcollaboration.org
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
Abortion is a common health intervention that is safe when performed by trained professionals using WHO-recommended methods appropriate for the duration of pregnancy. However, 45% of all induced abortions are unsafe, and 97% of unsafe abortions occur in developing countries. Unsafe abortion is a major cause of maternal death and illness. Expanding access to safe, affordable, timely abortion care is critical for public health and human rights. Multiple actions are needed to establish supportive legal frameworks, increase availability of information, and strengthen health systems to ensure universal access to comprehensive abortion services.
Using Demographic Data to Forecast Contraceptive Implant Demand Underestimate...JSI
This poster was presented by Laila Akhlaghi at the International Conference on Family Planning (ICFP) in Kigali, Rwanda in November 2018.
The Family Planning 2020 (FP2020) Initiative was launched in 2012 to address high unmet need for contraception, especially in low and middle income countries. Increasing access to long acting hormonal contraceptives (LARCs), and specifically hormonal contraceptive implants is an important strategy for achieving increases in modern contraceptive prevalence rates (mCPR).
Increasing access to contraceptive implants and ensuring demand is being met begins with accurate forecasting. This step precedes the process of supply planning, procurement, and distribution of these goods to service delivery points (SDPs) that make them available as a choice for women.
Several methods can be used in forecasting demand for contraceptives. How closely does contraceptive implant demand estimated from survey and demographics data align with actual data on insertions collected from service delivery points through eLMIS, LMIS, or DHIS II data?
The findings indicate that demographic estimates underestimate actual consumption for long-term methods. This has implications for the use of survey and demographic data (including CYPs), for forecasting demand for contraceptive implants.
The results also emphasize the importance of establishing and strengthening eLMIS systems that collect supply chain data and the use of this data for operational and management decisions to improve performance. Understanding true demand at the last mile of the supply chain, is an essential data element for managing supply chains. Without this information, supply chain managers have limited ability to increase performance and efficiency of their systems.
The document discusses maternal health and efforts to reduce maternal mortality. It notes that Millennium Development Goal 5 aimed to reduce maternal mortality by 75% by 2015 but progress has been slow. It provides facts about the high rate of maternal deaths worldwide, especially in developing countries, and discusses causes as well as strategies that have been shown effective in increasing skilled care during childbirth such as professionalizing midwifery, ensuring funding and supplies for skilled care at births, and strengthening community support and referral systems.
Day 2 session 3 financing and governance v24_october2016 (1)mapc88812
The document discusses various aspects of financing for universal health coverage including:
1) Population coverage, health service coverage, and cost coverage are key dimensions of reforms for UHC.
2) In many low and middle income countries, high out-of-pocket expenditures negatively impact equity, access, and use of health services.
3) Reducing out-of-pocket costs requires addressing factors like irrational drug use and insufficient private sector regulation that contribute to cost escalation.
Family planning, Poverty and Economic developmentShikha Basnet
The document discusses family planning and its relationship to poverty reduction and economic development. It provides definitions of family planning and outlines its benefits, including improved health outcomes for mothers and children as well as empowerment of women. Family planning is characterized as a cost-effective intervention. The document then discusses global trends in contraceptive use and unmet need for family planning. It also provides regional overviews of family planning for South and Southeast Asia as well as scenarios specifically for Nepal. Major family planning activities and challenges to uptake are outlined. Poverty is then defined and its multidimensional causes and measurement approaches are briefly explained, followed by the global scenario of poverty.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
Future of health - An initial perspective - Devi ShettyFuture Agenda
1) The healthcare industry currently only addresses 30% of the world's population, with 70% having little to no access to decent healthcare services. A revolution is needed to serve the entire market.
2) While healthcare technologies and some treatments have advanced over the past century, they remain unaffordable for 90% of the world's population. New approaches are required that focus on process innovation to make healthcare accessible to all.
3) Models like those in India that focus on efficiency and large volumes have reduced the costs of certain surgeries and procedures to a small fraction of prices elsewhere. These principles of process innovation could be applied globally to make high quality healthcare universally affordable.
The U.S. Government’s Global Health Initiativejehill3
The document summarizes the US Global Health Initiative (GHI), which aims to invest $63 billion over six years to strengthen health systems and improve health outcomes in partner countries, with a focus on women, newborns and children. The GHI will work through coordination, integration, country ownership and health systems strengthening. It establishes targets to reduce mortality and prevalence of diseases like HIV/AIDS, tuberculosis, malaria and malnutrition by 2015. The GHI operational plan includes assessing country health plans, focusing US investments, and designating some countries for additional technical and financial support.
This document summarizes a study on contraceptive use dynamics using data from 60 Demographic and Health Surveys conducted between 1990-2009 in 25 countries. It analyzes 422,478 episodes of contraceptive use reported by women who were married or in unions. Key indicators presented include discontinuation rates by reason and method, duration of use by method, switching after discontinuation, and reproductive outcomes after discontinuation or failure. Discontinuation is high, ranging from 13% for IUD to 50% for condoms at 12 months. Method-related reasons are the main cause of discontinuation. Consequences can be serious, with 5-20% of accidental pregnancies ending in miscarriage, stillbirth or abortion. The results stress the need
This document discusses strategies for improving women's reproductive health through expanding access to key health technologies. It outlines several approaches needed for successful introduction of new reproductive health products, including demonstrating pilot project success, health systems strengthening, and stakeholder engagement. The document then summarizes the burden of women's reproductive health issues and several underutilized technologies, such as microbicides, female barriers, emergency contraception, and cervical cancer prevention strategies. For each technology, it discusses research efforts, potential public health impacts, challenges to wider adoption, and strategies to increase impact and access.
This document provides background information on a study exploring the implementation challenges of Ghana's Free Maternal Health Care policy at the St. Dominic Hospital in Akwatia. The policy was introduced to improve maternal health and reduce mortality. However, the hospital has seen a decline in supervised deliveries and an increase in maternal deaths among women aged 25-29. The study aims to identify policy-related, external, and internal factors challenging the policy's implementation and make recommendations to address these challenges.
Similar to 2011 townsend newstrategiesforp_727 (20)
This document discusses urinary tract injuries that can occur during laparoscopic gynecological surgery. It notes that bladder injury is the most common major complication. Prevention strategies include catheterization before trocar insertion, using the lowest effective power for electrosurgery, and identifying bladder boundaries. Injuries may be recognized intraoperatively through direct visualization, cystoscopy, or instilling dye. Postoperative recognition involves symptoms like pain and hematuria. Management often involves laparoscopic repair by a gynecologist or urologist to avoid additional morbidity of laparotomy.
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
This document summarizes recent advances in endocrine therapy for breast cancer. Key findings from clinical trials show that aromatase inhibitors are superior to tamoxifen for postmenopausal women, 10 years of tamoxifen is better than 5 years for premenopausal women, and combining mTOR inhibitors like everolimus with hormonal therapies improves outcomes. New trials also found fulvestrant works as well as aromatase inhibitors for first-line metastatic disease. Combining fulvestrant and exemestane was more effective than single agents. Exemestane was also found to reduce invasive breast cancers in prevention settings.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
This study examined the effects of mechanical cervical dilation using laminaria tents for women with premature rupture of membranes (PROM) at term. The study compared outcomes between women who received laminaria tent insertion for unfavorable cervical ripening prior to 2010 (group 1) and women managed without laminaria tents after 2010 (group 2). The results found no significant differences between the groups in maternal and neonatal outcomes such as infection rates, time to delivery, Apgar scores, or umbilical cord pH levels. Mechanical cervical dilation did not increase infection risks or improve perinatal prognosis, providing no clear benefits for women with PROM at term.
This document discusses selective progesterone receptor modulators (SPRM) and their uses in gynecology. It provides background on the initial development of mifepristone as a progesterone receptor antagonist in the 1980s. More recently, ulipristal acetate, a SPRM, has been licensed for emergency contraception and as a preoperative treatment for uterine fibroids. The document outlines the mechanism of action of SPRMs as having mixed agonist and antagonist effects on progesterone receptors. It also summarizes recent clinical trials showing ulipristal acetate to be an effective alternative to gonadotropin-releasing hormone analogues for preoperative treatment of uterine fibroids, with reduced side effect profiles compared to analogues.
This study assessed satisfaction in 89 women who underwent concurrent pelvic organ prolapse (POP) repair and midurethral sling placement to treat stress urinary incontinence (SUI). At the 1-year follow-up, 72% of patients had complete cure of both POP and SUI, while 17% and 10% had persistent SUI or POP respectively. Overall, 88% reported being satisfied. Patients who achieved complete cure of both conditions had a 95% satisfaction rate, while 40% were dissatisfied if SUI was not cured and 22% if POP was not cured. The only outcome measure correlated with satisfaction was improvement in vaginal bulge symptoms. The study highlights the complex relationship between surgical outcomes and patient
1) The document discusses retinoids, which are known to be teratogenic when used during pregnancy. Isotretinoin in particular is used to treat severe acne but has significant risks of causing fetal malformations.
2) When isotretinoin is prescribed to women of childbearing age, a pregnancy prevention programme is implemented to prevent exposure during treatment and for at least one month after. However, pregnancies still occasionally occur despite these measures.
3) The main teratogenic effects of isotretinoin exposure during pregnancy include craniofacial, central nervous system, cardiovascular and thymic abnormalities in the developing fetus. Management of pregnancies with recent isotretinoin exposure involves counseling and potential
This study assessed resilience, depressed mood, and menopausal symptoms in 169 postmenopausal women aged 48-68 years. 45% of women had depressed mood and 35% had severe menopausal symptoms. Women with less resilience had higher depressed mood scores and more severe menopausal symptoms. Multiple regression identified two models: 1) Resilience scores correlated inversely with depressed mood and positively with regular exercise. 2) Depressed mood scores correlated positively with somatic and psychological menopausal symptom scores and inversely with resilience. This study suggests depressed mood and menopausal symptoms are associated with lower resilience in postmenopausal women, while exercise is linked to higher resilience.
This document discusses risk factors for early childhood obesity from a prenatal care perspective. It identifies several risk factors that occur before or immediately after birth, including maternal obesity, excessive weight gain during pregnancy, smoking during pregnancy, and bottle feeding rather than breastfeeding. The document provides evidence from multiple studies on how each of these factors increases the risk of a child being overweight or obese. It emphasizes that prenatal care provides an opportunity for healthcare providers to educate mothers on these risks and support behaviors like maintaining a healthy weight, smoking cessation, limiting weight gain during pregnancy, and breastfeeding to help decrease the likelihood of early childhood obesity.
Nerve injuries are a common complication of gynaecological surgery, occurring in 1.1-1.9% of cases. The femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, iliohypogastric and genitofemoral nerves are most commonly injured during surgery due to patient mal-positioning, incorrect retractor placement, haematoma formation, or direct nerve entrapment or transection. While most neuropathies resolve with conservative management, selective serotonin reuptake inhibitors or other medications may help manage painful neuropathies.
This document discusses progress towards Millennium Development Goal 4 (MDG4) of reducing child mortality. While overall progress has been made, neonatal mortality rates have declined more slowly. Simple, low-cost interventions like kangaroo mother care, neonatal resuscitation, and breastfeeding can significantly reduce neonatal deaths. However, implementation faces barriers like lack of healthcare workers, cultural practices, financial barriers to care, and poor quality of services. Political will is needed to fully achieve MDG4 targets through strengthened health systems and addressing inequities between regions.
This document discusses litigation in the field of gynaecology. It begins by noting that obstetrics and gynaecology has a reputation as a highly litigious specialty. It then discusses some of the common reasons why doctors are sued, including accountability, the need for explanation, concern over standards of care, and compensation. The document outlines the typical stages of a medical claim and summarizes several important legal cases that have influenced medico-legal rulings. It also discusses factors that commonly lead to claims in gynaecology, such as issues with consent, sterilization procedures, and laparoscopic surgeries.
This study examined the effects of adding estradiol valerate (EV) to clomiphene citrate (CC)-stimulated cycles on endometrial thickness. Thirty women received CC for ovulation induction in two treatment cycles, with one group also receiving a placebo and the other group receiving additional EV. While CC alone slightly reduced endometrial thickness, the addition of EV significantly increased thickness compared to CC with placebo. EV especially improved endometrial thickness in women where CC caused thinning, but had little effect where thickness was normal with CC alone. Other measures of folliculogenesis and ovulation were unaffected by EV. The study concluded EV prevents CC-induced endometrial thinning without disrupting the ovulation process.
This document reviews studies that have assessed the biomechanical properties of the uterine cervix during pregnancy using various quantitative methods. It discusses how elastography techniques have been applied to measure cervical deformability but have not demonstrated an ability to predict delivery timing. Measurement of maximum cervical deformability (cervical consistency index) provided more meaningful results, showing increased compliance with gestational age. Aspiration measurements also found a progressive decrease in cervical stiffness along gestation. Cervical consistency index and aspiration measurements are promising for quantitative assessment of changing cervical biomechanics during pregnancy.
This document discusses how functional echocardiography can assess cardiac function in fetuses with non-cardiac diseases or conditions that impact the fetus. It provides details on:
1) How ultrasound can evaluate various aspects of fetal cardiac function like cardiac output, size, contractility, and diastolic function.
2) Examples of conditions that can alter fetal hemodynamics like intrauterine growth restriction (IUGR), tumors, twin-twin transfusion syndrome, and maternal diabetes. In IUGR, changes in the umbilical artery and ductus venosus occur as placental function declines.
3) Insights from evaluating these conditions, such as how IUGR fetuses develop a dominant left
This document summarizes a presentation on whether incidental findings from prenatal testing should always be reported to patients. It discusses the case for reporting all incidental findings by defining what incidental findings are and outlining the purpose and goals of prenatal diagnosis. It then applies principles of medical ethics including autonomy, beneficence, non-maleficence, and justice to argue that incidental findings of known clinical significance that are actionable should be reported. It acknowledges the difficulty of incidental findings of unknown significance but still argues they should be shared with parents so they can make informed decisions. Finally, it addresses concerns about discovering late-onset untreatable diseases and risks of anxiety, but concludes that an ethical approach is to
This document discusses the potential for noninvasive prenatal DNA testing (NIDT) to become the standard screening test for Down syndrome in all pregnant women. It presents perspectives both for and against this proposition. Those in favor argue that NIDT has higher accuracy and lower risk than current invasive screening tests, so it respects patient autonomy and informed choice better. However, others are more cautious and want more data on costs and outcomes before widely implementing NIDT as the standard of care for all pregnancies. Overall the debate centers on whether NIDT should replace current screening paradigms or be offered as an additional option based on its advantages over existing tests.
This cross-sectional study examined gestational weight gain and perinatal outcomes in 1462 pregnant women in southern India. The study found that 37.41% of women gained less than the recommended weight based on IOM guidelines, while 21.41% gained more. Less than optimal weight gain was associated with a higher risk of preterm delivery (adjusted odds ratio 3.58). However, gestational weight gain was not significantly associated with other maternal or neonatal outcomes. This suggests the IOM guidelines may not be an appropriate standard for monitoring gestational weight gain in this population.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. 406
J.W. Townsend et al. / Contraception 83 (2011) 405–409
users), while Malawi and Ethiopia are experiencing high
demand for injectables (about 60% of users) [4]. Hormonal
products come in a range of presentations, are useful for
both spacing and limiting, can be used by clients as well as
being provider dependent and are generally quite effective
(more than 90%) [5,6].
Due to its early introduction in many developing
countries, increased access and high unmet need in many
countries have led to rapid uptake as both providers and
users become familiar with OCs as one of the first methods
used by women in developing countries. As a result, the OCs
have the widest geographic distribution of any contraceptive
method, with 9% of married women aged 15 to 49 years
reporting use. Pill prevalence is relatively high, ranging from
20% to 55%, in four countries in Africa, four in Asia, 11 in
Latin America and the Caribbean [4], with highest
developing country prevalence in Morocco and Zimbabwe
(both over 40%).
Given the cumulative nature of protection provided by
sterilization and the long-term efficacy of the IUD, these two
methods are the most widely used in developing countries.
However, in terms of the share of hormonal contraceptives in
overall contraceptive use, there are more countries where at
least 30% of contraceptive users rely on OCs than there are
countries where a similar share is accounted for by either
female sterilization or the intrauterine device (IUD). Other
modern hormonal contraceptive methods are also popular in
selected regions. In East and Southern Africa, for instance,
injectables and implants are the most popular methods,
accounting for over 40% of overall contraceptive use [4].
The cost of commodities is a critical element for both
donors and countries planning procurement. According to
the UNFPA [7], contraceptive commodities required for
reproductive health in developing countries cost about US
$840 million per year in 2005 and will increase to about US
$984.5 million by 2015 (including non-hormonal methods).
The cost of contraceptive commodities will grow faster than
the number of users because of the changing method mix:
given the young age structure of new users, pill use and
injectable use in parts of Africa should increase the fastest.
The result will be that pills, costing about $3.60 per year of
protection, will play a more substantial role in procurement
budgets than female sterilization or the IUD, which have
lower annual costs of protection but are more appropriate for
users who desire longer spacing or have completed their
desired family size.
Between 2000 and 2015, the use of all methods, but
particularly OCs, will increase by 37% (from a base of
998.2 million cycles) and so will the use of injectables by
31% (from a base of 123.1 million per unit) [7]. Increases in
contraceptive users will be seen in all regions, although the
absolute numbers and the method mix will differ significantly, e.g., 51 million new users in India between 2000 and
2015. To meet this demand, some regions such as Africa
may have to build new networks and scale up existing
services, while others such as South Asia may see their
greatest concern in commodity support. Procurements of
hormonal contraceptive methods from major international
donors increased dramatically for combined OC (60 to
200 million cycles per year) and injectables (from about
10 to 60 million units) from 2000 to 2008, but remained low
and stable for emergency contraceptives (EC) and implants
(both under 10 million units). Moreover, the combined value
of these shipments of hormonal contraceptives during 2008
alone was about $120.4 million [8].
To address the need for contraceptive protection over a
longer period of time with lower discontinuation, there is a
renewed focus on longer acting methods of which many are
hormonal based. Innovations are seen in the increasing
availability of methods with either greater ease of use or
provision (e.g., the use of paramedical personnel for the
provision of implants Jadelle®, Implanon® and SinoImplants®) and in the use of depot medroxyprogesterone
acetate (DMPA) in Uniject®, facilitating the safer provision
of injectables at the community level.
2. Major processes
Beyond demographic trends and the increasing demand
for products, there are a number of processes which have
profoundly affected the procurement and use of hormonal
contraceptives in developing countries in the past 50 years,
namely, a supportive policy environment, the adoption of
evidence-based practices and increasing diversity of service
delivery strategies.
2.1. Policy environment
The improved policy environment in support of reproductive health and rights has contributed greatly to the
availability and access to all contraceptive methods (including hormonal methods). In 2007, 92% of countries supported
contraceptive provision, either directly through public
services (74%) or indirectly through non-government service
outlets (18%) [9]. This favorable policy environment, often
linking contraception with maternal and child health
programs, not only facilitates procurement through international donations and national purchases, but also enhances
access through a supportive public information environment.
The policy environment was reinforced by the International
Conference on Population and Development (ICPD), Plan of
Action and is now reinforced by the MDG of improved
maternal health through universal access to reproductive
health services, including contraception. The challenge
implicit in this supportive environment is the trend toward
the decentralization of both health policy and product
procurement to municipalities, health districts and states,
making commodity decisions more complex. This changing
environment is also evident in the evolving relationships
between the public and private sectors, with both state
and donors interested in exploring new ways of operation,
from outsourcing, updating regulations, licensing and
3. J.W. Townsend et al. / Contraception 83 (2011) 405–409
accreditation to social insurance (see Abt Associates PSPOne project for practical examples of these interventions)
[10]. The private sector is also looking for opportunities for
local manufacturing and distribution of products, and
supporting networks of providers where they can both
make a profit and serve the public interest.
Of the 1.76 billion persons who will be added to the
world's 6.8 billion population by 2024, about 86% will be in
urban areas of developing countries [11]. As the population
becomes increasingly urban, potential contraceptive users
have access to a greater array of products, providers and a
community with a different ideation about the benefits of
contraceptive use. Although urban slums, accounting for
about 43% of urban residents in developing countries (even
higher in South Asia and sub-Saharan Africa), are perhaps
the exception to this process, the increasing concentration of
a growing population in urban areas will undoubtedly be
reflected in greater demand for hormonal contraceptives.
One of the most significant contributions to the change in
availability and access to hormonal contraception is the
development of new and diverse service delivery strategies
that respond to the need for meeting clients' needs within
diverse market conditions. One responds to the need for
consensus among providers about what is appropriate care
for an individual client, while others focus on alternative
approaches to increasing access and reducing the costs of
services to all clients. Each of these strategies has profoundly
influenced the way in which hormonal contraceptives are
understood by the community and how they are provided.
Innovative strategies contributing to the diversification of
service delivery systems are expanded upon below.
2.2. Evidence-based practices
The first of these strategies is developing a better
understanding of the evidence base on client eligibility and
health risk of use. Moving beyond the clinical experience
of individuals, efforts like WHO's the Medical Eligibility
Criteria for Contraceptive Use [12] and systematic reviews
[13] provide globally relevant evidence-based recommendations on whether an individual can safely use a
particular contraceptive method, including the full range
of hormonal methods. This guideline was intended for use
by policy-makers, program managers and the scientific
community in the preparation of national family planning
and reproductive health programs for the delivery of contraceptives. The importance of this development is its
critical review of available evidence as an alternative to
traditional forms of clinical reference and inevitable conflict among “expert opinions” without reference to globally
relevant safety data. While this review is global in scope,
it is intended to serve as guidance for national service
delivery guidelines.
Medical eligibility criteria also facilitate a better understanding of safety issues at the intersection of two fields of
care. For example, while hormonal methods provide no
407
protection against infections such as HIV for women in the
general population, hormonal methods do not increase the
risk of becoming infected with HIV. Moreover, commonly
used antiretroviral regimens do not significantly affect
hormone levels in DMPA users and therefore are not likely
to decrease its contraceptive effect [5]. Despite this lack of
infection protection, relatively few women actually report
the use of hormonal contraception with other forms of
infection prevention such as male or female condoms in
stable relationships [14]. The consensus on safety and
appropriate screening offer greater confidence in the practice
of using trained staff at many levels in the provision of a
range of family planning services.
As a response to the estimated shortage of 4.3 million
health workers in developing countries and the need to
improve access to critical health services, many governments
have sought to train more health workers, particularly for
Africa [15], while at the same time allowing other health
workers and community members to take on tasks that are
critical for health, known as task sharing and task shifting.
The World Health Organization [6] describes task shifting as
the rational redistribution of tasks among health workforce
teams in order to maximize the efficient use of health
workforce resources. The main cadres of workers among
whom tasks can be shifted are medical doctors, nonphysician clinicians, nurses and community health worker,
all with appropriate training.
Forty years ago, Rosenfield et al. [16] documented that
paraprofessionals could provide OCs with an equivalent
level of quality as physicians, when indeed physicians are
not available, as was the case in Thailand and certainly still
true to much of sub-Saharan Africa and South Asia. More
recently, WHO conducted a consultation and systematic
review of data on the practice of providing injectable
contraception at the community level and concluded that the
provision of progestin-only injectable contraceptives (specifically DMPA) by appropriately trained community health
workers is safe, effective and acceptable to users [17].
2.3. New array of service delivery vehicles
The general trend to greater public acceptance of family
planning concepts and an acknowledgment of the right to
decide has led to an increased range of delivery systems
involved in the provision of hormonal contraception.
Beyond hospitals, public clinics and private physicians,
there are now a full range of delivery systems, including
pharmacies, medical sellers, social marketing and, more
recently, social franchises (SFs). There seems to be renewed
interest in a modified community-based distribution model
for the 10 low prevalence countries in sub-Saharan Africa,
with total fertility rates of more than 5, where access is
challenging, private sector is weak and community support is
required for acceptability of family planning [18].
Social marketing programs followed shortly thereafter.
These used pharmaceutical manufacturer's models of
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J.W. Townsend et al. / Contraception 83 (2011) 405–409
distribution to pharmacies and other medical outlets with a
branded product, but with a subsidy for prices in exchange
for promotion through diverse social communication and
marketing strategies. In this sense, social marketing
programs are designed to complement commercial
approaches, in that their educational campaigns and
distribution strategies focus on areas where commercial
suppliers show little interest. For example, Population
Services International and DKT International provide
hormonal contraception (and more recently bed nets and
oral rehydration therapy) to poor population segments in
more than 25 African countries. The goal of all these
strategies is increase access to services, particularly among
the poor, and their programs are designed to reduce
inequities of wealth and ability to pay.
As a further development of commercial models for
serving the market for hormonal contraception, SFs have
been functioning in many developing countries including
PROSALUD in Bolivia, Gold Star Network in Kenya and
Greenstar in Pakistan. Like its commercial counterpart, SF
systems have identifiable key elements of operation [19].
SFs have become particularly popular in large markets with
the need for brand identity and range of providers. The
desired result of these network strategies is to sustain the
presence of qualified providers in rural and peri-urban areas,
build local capacity to improve the quality of care and offer
services at a more affordable cost to poorer clients than in
the commercial and fully private markets.
The emergence of these new service models has led to
new partnership arrangements with producers, procurers and
providers of hormonal contraception. For example, as part
of a public–private partnership with the United States
Agency for International Development (USAID) during the
next 5 years, Bayer Schering Pharma will deliver up to
50 million cycles per year of Microgynon® and Microlut®
for public markets, and up to 60 million cycles per year for
social marketing programs in more than 50 supported
programs globally [20]. More recently, demand side
financing strategies such as vouchers for family planning
have been adopted by Kreditanstalt für Wiederaufbau
(KfW), the Gates Foundation and others as a way of giving
more decision-making power to poor clients. These
alternative financing schemes offer client-controlled vouchers for selected reproductive products and services at a
subsidized price at qualified outlets. The innovation lies in
the focus on clients' choice and financial decision making as
a way of stimulating improved services in qualified service
outlets, rather than financing these services through the
health systems directly. These systems have been functioning in Bangladesh, Cambodia, Kenya, Uganda and elsewhere, providing prenatal care, skilled attendance at birth
and a range of contraceptive services. The use of
accreditation systems and cost analyses within these
schemes ensures that providers meet required standards (of
infrastructure and quality of care) and are willing to provide
services at the established price.
In terms of long-acting hormonal methods, there are two
specific service provision developments. The International
Contraceptive Access (ICA) Foundation of Turku, Finland, a
partnership between the Population Council and Bayer
Schering Pharma, provides service-delivery organizations
with the levonorgestrel-releasing intrauterine system (LNG
IUS) on a not-for-profit basis to serve the reproductive needs
of women and families in developing countries. To date, they
have made over 31,000 donations to 13 countries [21]. At the
same time, Family Health International is facilitating the
introduction of Sino-implant (II) in several developing
countries. Sino-Implant (II) is a low-cost subdermal
contraceptive implant biosimilar to Jadelle®, containing
two rods (each with 75 mg levonorgestrel) labeled for 4 years
of use and manufactured in China by Shanghai Dahua
Pharmaceutical Co., Ltd. [22]. To date, Sino-implant (II) is
approved by drug regulatory authorities in Kenya and Sierra
Leone and will be distributed by Pharm Access Africa
Limited (PAAL). PAAL is seeking approval of the implant
in nine African countries, while Marie Stopes International
(MSI), DKT International, Progyne and Profamilia are
moving forward with registrations in other countries. Sinoimplant (II) costs about 70% less than implants currently on
the market and, as a result, can be offered to women on a
much broader scale. This use of market segmentation
strategies to provide a range of products to different clients
with the ability to pay a range of prices is pursued with the
hope of expanding the total market in the long run.
Price and proximity of source are two main determinants
of access, with safety and efficacy the most sensitive
determinants of client use. As a consequence, there is
increasing interest in the use of generics and second-tier
pricing strategies to ensure that, for hormonal contraception,
the lowest prices are available to users. Once new products
are off patent, generic producers seek to develop market
share with the provision of lower priced products, often in
national and emerging regional markets. With the demand
for hormonal contraceptives increasing in many markets by
up to 5% per year, there is enough profit even for low-priced
products to keep generic producers engaging in this market,
albeit with only modest confidence. With nearly half the
world's population (and nearly two-thirds of the population
in sub-Saharan Africa) living on less than $2 per day, finding
the right market niche for hormonal products is certainly a
challenge [2].
Nevertheless, the Reproductive Health Supplies Coalition
members, including the Deliver Project of John Snow, Inc.
(JSI), work with donors, procurement agencies, manufacturers and other organizations concerned with commodity
security continue to support the development of sustainable
contraceptive markets, the use of good manufacturing
practice, improving procurement capacity and strengthening
logistic management systems [8]. In addition, it hosts a site
to share information about the sources, shipments and costs
of contraceptive products. Specifically, the RHInterchange
(www.rhsupplies.org/resources-tools/rhinterchange.html)
5. J.W. Townsend et al. / Contraception 83 (2011) 405–409
provides access to up-to-date, harmonized data on more than
$1 billion worth of shipments of contraceptive supplies for
more than 140 countries around the world.
3. Conclusions
Hormonal contraception is often the first method of
exposure for young women in many developing countries,
even when it does not provide protection against unwanted
sexually transmitted infections as would barrier methods such
as the male and female condoms. The choices from EC to the
LNG IUS make hormonal methods appropriate for an array of
lifestyles and needs. The clinical and non-clinical nature of the
products imply that different types of training, standards of
quality and diverse levels of providers must be included in the
analysis of the role of hormonal contraception.
Given the expected growth in both users and the costs of
contraception, the issue of contraceptive security must be on
the policy agenda of most developing countries. New service
strategies including the use of trained paramedical health
providers, community-based service providers, social marketing, social franchising and insurance schemes will help
make products more accessible, even in countries with
current low contraceptive use. This will be particularly true
in urban areas where the developing world will see the
largest growth in population and in the demand for quality
contraceptive services.
The promise of the use of hormonal methods for men is still
a long way off, but we suspect that with the growing interest in
the role of men in reproductive health programs, we will see
progress in the coming years. In the long run, however, the
field will likely see more investment in user-controlled longacting delivery systems, non-hormonal options and dualprotection methods that protect against unwanted infections as
well as unwanted pregnancy. In the interim, with the number of
contraceptive users in developing countries increasing significantly in the future, the demands for hormonal contraception
and its providers will only increase.
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