Increasing the utilization of cost-effective health services through changes in demand.
(9/1561)
Attaining efficiency in a health care system with a budget constraint involves increasing the utilization of the most cost-effective services. This can be achieved by adjustments to prices, cost curves, or demand curves. In this paper, the potential for demand curve adjustments is examined by selecting two apparently cost-effective services (prenatal care and childhood immunization against tuberculosis), and analyzing the factors explaining their utilization. Data from recent household surveys in Burkina Faso and Niger are used. A multivariate analysis of utilization employs income, price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price variable. Members of certain ethnic groups tend to use the services less, other things being equal. The importance of demand-side factors like ethnicity points to certain kinds of policy interventions like information, education and communication activities which could increase the utilization of cost-effective services. (+info)
Factors affecting acceptance of immunization among children in rural Bangladesh.
(10/1561)
This paper uses the Bangladesh Fertility Survey 1989 data to identify the factors affecting acceptance of immunization among children in rural Bangladesh. Acceptance of DPT, measles and BCG vaccinations were the dependent variables. The independent variables included proximity to health facilities, frequency of visit by health worker, respondent's mobility, media exposure, education, age, economic status of household, region of residence, and gender of child. Logistic regression analysis was performed to assess the net effects of the variables in addition to univariate analysis. Among the independent variables, proximity to health facility, frequency of health worker's visit, mother's mobility, education, age, gender of child, ownership of radio, economic condition of household, and region of residence showed statistically significant association with acceptance of immunization. The effect of frequency of health worker's visit was dependent on region of residence, possession of radio, and mother's education. The effect of mother's ability to visit health centre alone was also dependent on ownership of radio, economic condition of household, and mother's education. (+info)
Immunization determinants in the eastern region of Ghana.
(11/1561)
A study of the immunization determinants of children aged 12 to 18 months was conducted in 1991 in the Eastern Region of Ghana, using structured interviews of mothers and fathers. The completion of immunization schedules by one year, among the 294 children, was positively associated (P < 0.005) with the town of residence of the child and mother, the ability of the mother to speak English, the target child having been treated for illness at the local hospital, the child's mother having given birth to less than 5 children, the possession of a sewing machine by the mother, and the birth of the child in the current town of residence. Significantly higher immunization coverage levels were achieved where the Under Fives' Clinic was an affordable and acceptable service, integrating preventive and curative care, and where measures were implemented by the community to increase attendance levels at the Clinic. This was achieved among a target group who were otherwise at a relatively high risk of failing to complete immunization schedules on-time. (+info)
Parental perceptions of barriers to childhood immunization: results of focus groups conducted in an urban population.
(12/1561)
The current US immunization rates for 2 year olds are approximately half of the goal set for the year 2000. Research studies have focused primarily on the perception of health care providers in the identification of barriers and benefits to childhood immunization. While health care providers are an important part of the immunization delivery process, the perceptions of parents are also important. In this study, qualitative methods were used to explore perceived parental barriers to childhood immunization delivery. Twelve focus groups comprising White, African-American, Hispanic, urban and non-urban people were conducted at a variety of sites, including clinics, churches, schools and work sites. The results indicated that time off from work, access to well-child care and difficulty understanding the complexity of the immunization schedule were seen as barriers to adhering to an immunization schedule. Participants emphasized problems in taking time off from work to get immunizations, sometimes without pay, and expressed fears that doing so would jeopardize promotions and raises. While some of the parental perceptions were similar to those identified in studies of health care providers in the literature, many were not. This study emphasizes the importance of gathering information from parents as well as from health care providers. (+info)
Impact of national immunization days on polio-related knowledge and practice of urban women in Bangladesh.
(13/1561)
Bangladesh began to hold National Immunization Days (NIDs) from 1995 as part of the country's goal to eradicate poliomyelitis by the turn of the century. The NIDs brought together government agencies, the media, voluntary organisations and individual volunteers in social mobilization and service delivery activities. This paper assesses the impact of the first two polio NIDs in terms of the immunization coverage and change in knowledge about the disease among women living in Dhaka city, the capital of the country. Data were collected through pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. Knowledge data were collected from 525 women with at least one child aged less than five years. The oral polio vaccine (OPV) coverage during NIDs was obtained from 720 children. Knowledge of polio as a vaccine preventable disease increased after NIDs among both slum and non-slum women. The knowledge gap between the two groups was significantly reduced. Field workers, who regularly visit women at their homes to promote health and family planning services, were the main source of information for the slum women while television was cited as the most important source of information by non-slum women. The study revealed that 88% of children under five years received at least one dose of oral polio vaccine (OPV) during NIDs, and 67% received two stipulated doses with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. The study suggests that strategies like NID can be effectively used to tap into community resources and to generate political commitments for health programmes. (+info)
The quality of immunization data from routine primary health care reports: a case from Nepal.
(14/1561)
Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage. (+info)
The census-based, impact-oriented approach: its effectiveness in promoting child health in Bolivia.
(15/1561)
This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, including child survival service coverage, mortality impact, and the level of resources required to attain these results. As a result of first identifying the entire programme population through visits at least biannually to all homes and then targeting selected high-impact services to those at highest risk of death, the mortality levels of children under five years of age in the established programme areas was one-third to one-half of mortality levels in comparison areas. Card-documented coverage for the complete series of all the standard six childhood immunizations among children 12-23 months of age was 78%, and card-documented coverage for three nutritional monitorings during the previous 12 months among the same group of children was 80%. Coverage rates in comparison areas for similar services was less than 21%. The local annual recurring cost of this approach was US $8.57 for each person (of all ages) in the programme population. This cost includes the provision of primary care services for all age groups as well as targeted child survival services. This cost is well within the affordable range for many, if not most, developing countries. Manpower costs for field staff in Bolivia are relatively high, so in countries with lower salary scales, the overall recurring cost could be substantially less. An Expert Review Panel reviewed the CBIO approach and found it to be worthy of replication, particularly if stronger community involvement and greater reliance on volunteer or minimally paid staff could be attained. The results of this approach are sufficiently promising to merit implementation and evaluation in other sites, including sites beyond Bolivia. (+info)
The progress of the Polio Eradication Initiative: what prospects for eradicating measles?
(16/1561)
Although various attempts have been made to eradicate infectious diseases, only smallpox has been eradicated to date. Polio is targeted for eradication in 2000 and already planning has begun for the eradication of measles. However, before we commit to a measles eradication effort, we must examine the lessons to be learned from polio eradication. Of particular importance is the debate over whether resources should be invested in 'horizontal' or 'vertical' programmes. The outcome of these debates will have a very deep and lasting impact on global health development in years to come. Collaboration between targeted programmes and the primary health care sector through polio and measles eradication efforts will help bring about the necessary balance between goal-oriented programmes, which are subject to quality control and can be evaluated by measurable outcomes, and broader efforts to build up sustainable health infrastructure. (+info)