-
[show abstract]
[hide abstract]
ABSTRACT: An examination of the economic consequences for older-age parents of losing an adult child to AIDS in Thailand based on quantitative data derived from a key informant study and a direct interview survey with parents yielded the following main findings: (1) parents frequently paid for their children's care and treatment, but government health insurance and to a lesser extent welfare measures helped alleviate these expenses; (2) parental caregiving often disrupted economic activity, although the resulting opportunity costs were limited by the typically short duration of caregiving; (3) parents commonly paid for funeral costs but benefited from funeral society memberships and customary contributions from those attending; (4) only a minority of parents supported AIDS orphans although orphaned grandchildren often ended up with their grandparents; (5) most deceased children had contributed financially to the parental household but only a minority were main providers. Poorer parents, however, were most likely to lose a main provider and experience severe financial hardship; and (6) although poorer parents spent much less on expenses related to the illness and death of their children, they were much more likely than better-off parents to be seriously burdened by these expenses. Programs are needed to address the plight of AIDS parents but should target those who are most susceptible to resulting economic hardship.
esocialsciences.com, Working Papers. 01/2009;
-
[show abstract]
[hide abstract]
ABSTRACT: With its 2006-2011 National Malaria Strategic Plan, Zambia committed to control malaria at a national scale. This scale-up for impact approach was facilitated by sound business planning and financing in 2006 of approximately US$35 million. Compared with surveys in 2001 and 2004, a 2006 national survey of 14,681 persons in 2,999 households at the end of the transmission season showed substantial coverage increases for preventive interventions. Ownership and use rates of insecticide-treated mosquito nets (ITNs) among vulnerable groups doubled, with 44% of households owning ITNs and 23% of children less than five years of age and 24% of pregnant women using them. Roll Back Malaria Abuja targets for intermittent preventive treatment in pregnancy (IPTp) were exceeded, with 62% of pregnant women receiving at least two doses of IPTp. As of 2006, Zambia is demonstrating substantial progress toward the national targets (80% population coverage rates for the interventions) and aspires to show that malaria need not be its leading health problem, and that malaria control is a sound national investment.
The American journal of tropical medicine and hygiene 08/2008; 79(1):45-52. · 2.59 Impact Factor
-
Alexander K Rowe,
Richard W Steketee,
Fred Arnold,
Tessa Wardlaw, Suprotik Basu,
Nathan Bakyaita,
Marcel Lama,
Carla A Winston,
Matthew Lynch,
Richard E Cibulskis,
Kenji Shibuya,
Amy A Ratcliffe,
Bernard L Nahlen
[show abstract]
[hide abstract]
ABSTRACT: To describe an approach for evaluating the impact of malaria control efforts on malaria-associated mortality in sub-Saharan Africa, where disease-specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children.
Methods for evaluating changes in malaria-associated mortality are examined; advantages and disadvantages are presented.
All methods require a plausibility argument-i.e., an assumption that mortality reductions can be attributed to programmatic efforts if improvements are found in steps of the causal pathway between intervention scale-up and mortality trends. As different methods provide complementary information, they can be used together. We recommend following trends in the coverage of malaria control interventions, other factors influencing childhood mortality, malaria-associated morbidity (especially anaemia), and all-cause childhood mortality. This approach reflects decreases in malaria's direct and indirect mortality burden and can be examined in nearly all countries. Adding other information can strengthen the plausibility argument: trends in indicators of malaria transmission, information from demographic surveillance systems and sentinel sites where malaria diagnostics are systematically used, and verbal autopsies linked to representative household surveys. Health facility data on malaria deaths have well-recognized limitations; however, in specific circumstances, they could produce reliable trends. Model-based predictions can help describe changes in malaria-specific burden and assist with program management and advocacy.
Despite challenges, efforts to reduce malaria-associated mortality in Africa can be evaluated with trends in malaria intervention coverage and all-cause childhood mortality. Where there are resources and interest, complementary data on malaria morbidity and malaria-specific mortality could be added.
Tropical Medicine & International Health 01/2008; 12(12):1524-39. · 2.80 Impact Factor
-
Alexander K. Rowe,
Richard W. Steketee,
Fred Arnold,
Tessa Wardlaw, Suprotik Basu,
Nathan Bakyaita,
Marcel Lama,
Carla A. Winston,
Matthew Lynch,
Richard E. Cibulskis,
Kenji Shibuya,
Amy A. Ratcliffe,
Bernard L. Nahlen,
for the Roll Back Malaria Monitoring and Evaluation Reference Group
[show abstract]
[hide abstract]
ABSTRACT: Objective To describe an approach for evaluating the impact of malaria control efforts on malaria-associated mortality in sub-Saharan Africa, where disease-specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children.Methods Methods for evaluating changes in malaria-associated mortality are examined; advantages and disadvantages are presented.Results All methods require a plausibility argument—i.e., an assumption that mortality reductions can be attributed to programmatic efforts if improvements are found in steps of the causal pathway between intervention scale-up and mortality trends. As different methods provide complementary information, they can be used together. We recommend following trends in the coverage of malaria control interventions, other factors influencing childhood mortality, malaria-associated morbidity (especially anaemia), and all-cause childhood mortality. This approach reflects decreases in malaria’s direct and indirect mortality burden and can be examined in nearly all countries. Adding other information can strengthen the plausibility argument: trends in indicators of malaria transmission, information from demographic surveillance systems and sentinel sites where malaria diagnostics are systematically used, and verbal autopsies linked to representative household surveys. Health facility data on malaria deaths have well-recognized limitations; however, in specific circumstances, they could produce reliable trends. Model-based predictions can help describe changes in malaria-specific burden and assist with program management and advocacy.Conclusions Despite challenges, efforts to reduce malaria-associated mortality in Africa can be evaluated with trends in malaria intervention coverage and all-cause childhood mortality. Where there are resources and interest, complementary data on malaria morbidity and malaria-specific mortality could be added.Evaluation de l’impact des efforts de contrôle de la malaria sur la mortalité en Afrique subsaharienneObjectif: Décrire une approche pour évaluer l’impact des efforts du contrôle de la malaria sur la mortalité associée à la malaria en Afrique subsaharienne où les tendances de mortalités spécifiques à des maladies ne peuvent habituellement pas être mesurées directement et la plupart des décès due à la malaria surviennent chez les enfants en bas âge.Méthodes: Les méthodes pour évaluer les variations dans la mortalité associée à la malaria sont examinées. Les avantages et les inconvénients sont présentés.Résultats: Toutes les méthodes exigent un argument plausible i.e. une assomption que des réductions de mortalité peuvent être attribuées aux efforts de programmes si des améliorations sont trouvées dans les étapes de la voie causale entre le déploiement de l’intervention et les tendances de mortalité. Comme différentes méthodes fournissent des informations complémentaires, elles peuvent être employées ensemble. Nous recommandons de suivre les tendances de la couverture des interventions de contrôle de la malaria, d’autres facteurs influençant la mortalité infantile, la morbidité associée à la malaria (l’anémie en particulier) et la mortalité infantile de toute cause. Cette approche reflète des réductions de la charge directe et indirecte de la mortalité de la malaria et peut être examinée dans presque tous les pays. L’ajout d’autres informations peut renforcer l’argument de plausibilité: tendances dans les indicateurs de la transmission de la malaria, informations des systèmes de surveillance démographiques et des sites sentinelles où le diagnostic de la malaria sont systématiquement utilisés, et des autopsies verbales liées à des enquêtes de ménage représentatives. Les données des services de santé sur les décès de malaria ont des limitations bien connues. Cependant, dans des circonstances spécifiques, elles peuvent produire des tendances fiables. Les prévisions basées sur des modèles peuvent aider à décrire des variations de la charge spécifique à la malaria et à assister dans la gestion et les recommandations de programme.Conclusions: Malgré les défis, les efforts pour réduire la mortalité associée à la malaria en Afrique peuvent être évalués avec les tendances dans la couverture de l’intervention contre la malaria et contre toute cause de mortalité infantile. Là où il y a des ressources et de l’intérêt, des données complémentaires sur la morbidité de la malaria et la mortalité spécifique à la malaria pourraient être ajoutées.Evaluando el impacto de los esfuerzos del control de la malaria sobre la mortalidad en África SubsaharianaObjetivos: Describir un acercamiento para evaluar el impacto de los esfuerzos para controlar la malaria sobre la mortalidad asociada a malaria en África Subsahariana, en donde las tendencias de mortalidad enfermedad-específica no pueden medirse de forma directa y donde la mayoría de las muertes por malaria ocurren en niños pequeños.Métodos: Se examinan los métodos para evaluar cambios en la mortalidad asociada a malaria, presentándose ventajas y desventajas.Resultados: Todos los métodos requieren un argumento plausible, es decir, asumir que las reducciones en mortalidad pueden ser atribuidas a esfuerzos programados si las mejoras se encuentran en el camino causal entre escalar una intervención y las tendencias en mortalidad. Puesto que diferentes métodos proveen información complementaria, pueden utilizarse de forma conjunta. Recomendamos seguir las tendencias de la cobertura de intervenciones para el control de la malaria, de otros factores que tienen influencia sobre la mortalidad infantil, de la morbilidad asociada a la malaria (especialmente la anemia), y de todas las causas de mortalidad infantil. Este enfoque refleja la disminución en la carga de mortalidad por malaria, directa e indirecta, y puede aplicarse en casi todos los países. Añadir otra información refuerza el argumento de plausibilidad; tendencias en indicadores de transmisión de malaria, información de los sistemas de seguimiento demográfico y sitios centinela, en donde los diagnósticos de malaria son utilizados de forma sistemática, y las autopsias verbales van unidas a encuestas representativas en los hogares. Los datos de los centros sanitarios sobre muertes por malaria tienen limitaciones reconocidas; sin embargo, en circunstancias específicas, podrían producir tendencias fiables. Las predicciones basadas en modelos pueden ayudar a describir cambios en la carga específica de malaria y ayudar con el manejo de programas y de asistencia.Conclusiones. A pesar de los desafíos, los esfuerzos para reducir la mortalidad asociada a malaria en África pueden evaluarse mediante tendencias en la cobertura de intervenciones para malaria y de todas las causas de mortalidad infantil. Donde hay recursos e interés, los datos complementarios de morbilidad de malaria y de mortalidad específica por malaria podrían añadirse.
Tropical Medicine & International Health 11/2007; 12(12):1524 - 1539. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To review the evidence on the link between malaria and poverty.
Review of the published and grey literature to identify (i) the data available on the socio-economic distribution of malaria incidence and vulnerability, and (ii) the uptake of malaria control interventions.
We found mixed evidence on malaria incidence, with a number of studies identifying no relationship between socio-economic status and incidence, although a larger number of studies do find a link. There is strong evidence that uptake of preventive and treatment interventions is closely related to proxies for socio-economic status. More generally, the quality of the literature examining this issue is highly variable, with many different measures of socio-economic status and often inadequate descriptions of methods of data collection and analysis in relation to socio-economic status.
Important socio-economic differentials exist in access to malaria interventions, increasing the vulnerability of the poorest. More information is needed about how other methods of delivering malaria treatment and prevention can redress these inequalities.
Tropical Medicine & International Health 11/2005; 10(10):1047-59. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Malaria, more than any other disease of major public health importance in developing countries, disproportionately affects poor people, with 58% of malaria cases occurring in the poorest 20% of the world's population. If malaria control interventions are to achieve their desired impact, they must reach the poorest segments of the populations of developing countries. Unfortunately, a growing body of evidence from benefit-incidence analyses has demonstrated that many public health interventions that were designed to aid the poor are not reaching their intended target. For example, the poorest 20% of people in selected developing countries were as much as 2.5 times less likely to receive basic public health services as the least-poor 20%. In the field of malaria control, a small number of studies have begun to shed light on differences by wealth status of malaria burden and of access to treatment and prevention services. These early studies found no clear difference in fever incidence based on wealth status, but did show significant disparities in both the consequences of malaria and in the use of malaria prevention and treatment services. Further study is needed to elucidate the underlying factors that contribute to these disparities, and to examine possible inequities related to gender, social class, or other factors. To achieve impact and overcome such inequities, malaria control efforts must begin to incorporate approaches relevant to equity in program design, implementation, and monitoring and evaluation.
The American journal of tropical medicine and hygiene 09/2004; 71(2 Suppl):174-8. · 2.59 Impact Factor
