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Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach

ABSTRACTBackground: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a post-conflict era. Very little is known about the effects that these contextual factors can have on maternal mortality.Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia.Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths.Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays.Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.

Determinants of out-of-pocket health expenditure and their welfare implications in a South African context

This study aims to quantify the extent of catastrophic household health expenditures on welfare and determine factors influencing it. A logistic regression model based on the logit link function was used to predict the probability of catastrophic health expenditure occurrence. A comparison between 2008 and 2012 health status of adults shows that there was a sizable improvement of the health status of individuals. The high level of catastrophic health expenditure may be associated with the low share of prepayment in national health expenditure, adequate availability of services and a high level of poverty which for South Africa is 46.2% according to the Statistics South Africa report (2015). Major factors determining the catastrophic expenditure besides poverty were spending on hospitalisation and medical supplies. Thus, reducing catastrophic expenditures requires an increase in financial protection offered to the poor through expanding government-financed benefits for the poor such as implementation of the Social Health Insurance (SHI) scheme, which will cover all poor households.

TUBERCULOSE: ADESÃO AO TRATAMENTO E OS FATORES QUE DESENCADEIAM EM ABANDONO.

Introdução: A tuberculose é uma doença infectocontagiosa, que se caracteriza como uma emergência mundial. O tratamento dessa doença no Brasil é oferecido pelo Sistema Único de Saúde gratuitamente. O abandono do tratamento é um dos aspectos que mais repercutem no aumento dos índices de mortalidade, incidência e aumento da resistência às drogas. Conhecer os fatores de adesão e abandono do tratamento da tuberculose pode guiar práticas de saúde no controle da doença. Objetivo: Descrever fatores de adesão e abandono do tratamento da tuberculose, de acordo com a literatura nacional. Metodologia: Trata-se de revisão bibliográfica sistemática de abordagem qualitativa, descritiva, através de busca online na Biblioteca Virtual de Saúde (BVS), sendo incluídos artigos disponíveis em texto completo, publicados em português, e excluídos os que não abordavam o tema proposto, artigos repetidos nas bases de dados e revisões bibliográficas. Resultados: Os principais fatores de adesão encontrados foram a oferta de medicação, a consulta em menos de 24 horas e a oferta de vale transporte e cesta básica ou vale alimentação. Já os fatores de abandono foram a acessibilidade, o uso de drogas lícitas e ilícitas, a baixa escolaridade, a coinfecção tuberculose/HIV, a baixa classe econômica e os efeitos adversos das medicações. Considerações finais: Para o aumento da adesão e consequentemente, a diminuição do abandono, são necessários profissionais capacitados, disponibilidade dos serviços, medicações e auxílios. Com esses incentivos, espera-se uma efetiva procura do serviço e continuidade do tratamento, levando à cura dos pacientes.

Household catastrophic health expenditure: evidence from Georgia and its policy implications

BackgroundTo quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007.MethodsThe research is based on the nationally representative Health Care Utilization and Expenditure survey conducted during May-June 2007, prior to preparing for new phase of implementation for the health care financing reforms. Households' catastrophic health expenditures were estimated according to the methodology proposed by WHO – Ke Xu [1]. A logistic regression (logit) model was used to predict probability of catastrophic health expenditure occurrence.ResultsIn Georgia between 2000 and 2007 access to care for poor has improved slightly and the share of households facing catastrophic health expenditures have seemingly increased from 2.8% in 1999 to 11.7% in 2007. However, this variance may be associated with the methodological differences of the respective surveys from which the analysis were derived. The high level of the catastrophic health expenditure may be associated with the low share of prepayment in national health expenditure, adequate availability of services and a high level of poverty in the country. Major factors determining the financial catastrophe related to ill health were hospitalization, household members with chronic illness and poverty status of the household. The FFC for Georgia appears to have improved since 2004.ConclusionReducing the prevalence of catastrophic health expenditure is a policy objective of the government, which can be achieved by focusing on increased financial protection offered to poor and expanding government financed benefits for poor and chronically ill by including and expanding inpatient coverage and adding drug benefits. This policy recommendation may also be relevant for other Low and Middle Income countries with similar levels of out of pocket payments and catastrophic health expenditures.

Volume of VA patients with posttraumatic stress disorder in the New York metropolitan area after September 11.

The authors examined data from the Veterans Integrated Service Network of New York and New Jersey to determine whether the number of veterans who were treated for posttraumatic stress disorder (PTSD) increased significantly after the terrorist attacks of September 11, 2001. They analyzed the number of veterans treated for PTSD at Veterans Healthcare Administration facilities in New York and New Jersey from September 1999 through June 2002. The number of veterans treated for PTSD in these facilities after September 11 exceeded projections based on secular trends, and the increase was more pronounced than for other diagnostic groups. The results highlight the need to ensure adequate availability of services in the wake of traumatic events.