Cost of behavior change communication channels of Manoshi

November 25, 2013 · 0 comments

Cost of behavior change communication channels of Manoshi -a maternal, neonatal and child health (MNCH) program in urban slums of Dhaka, Bangladesh. Cost Eff Resour Alloc. 2013 Nov 14;11(1):28.

Sarker BK, et al

BACKGROUND: The cost of behavior change communication (BCC) interventions has not been rigorously studied in Bangladesh. This study was conducted to assess the implementation costs of a BCC intervention in a maternal, neonatal and child health program (Manoshi) run by BRAC, which has been operating in the urban slums of Dhaka since 2007. The study estimates the costs of BCC tools per exposure among the different types of BCC channels: face-to-face, group counseling, and mass media.

METHODS: The study was conducted from November 2010 to April 2011 in the Dhaka urban slum area. A micro-costing approach was applied using primary and secondary data sources to estimate the cost of BCC tools. Primary data were collected through interviews with service-providers and managers from the Manoshi program, observations of group counseling, and mass media events.

RESULTS: Per exposure, the cost of face-to-face counseling was found to be 3.08 BDT during pregnancy detection, 3.11 BDT during pregnancy confirmation, 12.42 BDT during antenatal care, 18.96 BDT during delivery care and 22.65 BDT during post-natal care. The cost per exposure of group counseling was 22.71 BDT (95 % CI 21.30-24.87) for Expected Date of Delivery (EDD) meetings, 14.25 BDT (95% CI 12.37-16.12) for Women Support Group meetings, 17.83 BDT (95% CI 14.90-20.77) for MNCH committee meetings and 6.62 BDT (95% CI 5.99-7.26) for spouse forum meetings. We found the cost per exposure for mass media interventions was 9.54 BDT (95% CI 7.30-12.53) for folk songs, 26.39 BDT (95% CI 23.26-32.56) for street dramas, 0.39 BDT for TV-broadcasting and 7.87 BDT for billboards. Considering all components reaching the target audience under each broader type of channel, the total cost per exposure was found to be 60.22 BDT (0.82 USD) for face-to-face counseling, 61.40 BDT (0.82 USD) for group counseling and 44.19 BDT (0.61 USD) for mass media.
CONCLUSIONS: The total cost for group counseling was the highest per exposure, followed by face-to-face counseling and mass media. The cost per exposure varied substantially across BCC channels due to differences in cost drivers such as personnel, materials and refreshments. The cost per exposure can be valuable for planning and resource allocation related to the implementation of BCC interventions in low resource settings.

Pathways of Economic Inequalities in Maternal and Child Health in Urban India

November 20, 2013 · 0 comments

Pathways of Economic Inequalities in Maternal and Child Health in Urban India: A Decomposition Analysis. PLoS One, March 2013.

Srinivas Goli , Riddhi Doshi, Arokiasamy Perianayagam

Background/Objective: Children and women comprise vulnerable populations in terms of health and are gravely affectedby the impact of economic inequalities through multi-dimensional channels. Urban areas are believed to have better socioeconomic and maternal and child health indicators than rural areas. This perception leads to the implementation of health policies ignorant of intra-urban health inequalities. Therefore, the objective of this study is to explain the pathways of economic inequalities in maternal and child health indicators among the urban population of India.

Methods: Using data from the third wave of the National Family Health Survey (NFHS, 2005–06), this study calculated relative contribution of socioeconomic factors to inequalities in key maternal and child health indicators such as antenatal check-ups (ANCs), institutional deliveries, proportion of children with complete immunization, proportion of underweight children, and Infant Mortality Rate (IMR). Along with regular CI estimates, this study applied widely used regression-based Inequality Decomposition model proposed by Wagstaff and colleagues.

Results: The CI estimates show considerable economic inequalities in women with less than 3 ANCs (CI =20.3501),institutional delivery (CI =20.3214), children without fully immunization (CI =20.18340), underweight children (CI=20.19420), and infant deaths (CI =20.15596). Results of the decomposition model reveal that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical factors contributing to economic inequalities in maternal and child health indicators. The residuals in all the decomposition models are very less; this implies that the above mentioned factors explained maximum inequalities in maternal and child health of urban population in India.

Conclusion: Findings suggest that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical pathways through which economic factors operate on inequalities in maternal and child health outcomes in urban India.

Health Inequalities among Urban Children in India

November 20, 2013 · 0 comments

Health Inequalities among Urban Children in India: A Comparative Assessment of Emprowered Action Group (EAG) and South Indian States. Journal of Biosocial Science, March 2013.

P. Arokiasamy, K. Jain, S. Goli, J Pradhan

As India rapidly urbanizes, within urban areas socioeconomic disparities are rising and health inequality among urban children is an emerging challenge. This paper assesses the relative contribution of socioeconomic factors to child health inequalities between the less developed Empowered Action Group (EAG) states and more developed South Indian states in urban India using data from the 2005–06 National Family Health Survey. Focusing on urban health from varying regional and developmental contexts, socioeconomic inequalities in child health are examined first using Concentration Indices (CIs) and then the contributions of socioeconomic factors to the CIs of health variables are derived.

The results reveal, in order of importance, pronounced contributions of household economic status, parent’s illiteracy and caste to urban child health inequalities in the South Indian states. In contrast, parent’s illiteracy, poor economic status, being Muslim and child birth order 3 or more are major contributors to health inequalities among urban children in the EAG states. The results suggest the need to adopt different health policy interventions in accordance with the pattern of varying contributions of socioeconomic factors to child health inequalities between the more developed South Indian states and less developed EAG states.

Living and health conditions of selected cities in India

November 20, 2013 · 0 comments

Living and health conditions of selected cities in India: Setting priorities for the National Urban Health Mission. Cities 28 (2011) 461–469.

Srinivas Goli, P. Arokiasamy, Aparajita Chattopadhayay

The concept of ‘‘healthy city’’ promotes the physical, mental, social, and environmental well-being of people who live and work in urban areas. Fostering sustainably healthy cities is the prime objective of the National Urban Health Mission (NUHM) in India. However, attaining this goal requires establishing priorities, key concerns, strategies and guidelines for action.

This paper aims to assist policymakers by providing critical insights into the health and living conditions in selected major cities in India, with special emphasis on slums. This paper presents evidence that many of India’s major cities face significant deficits in the provision of basic amenities, including shelter, safe drinking water, improved sanitation and electricity.

Demographic and health conditions in these cities lag far behind the goals set forth in national policies almost a decade ago. Despite the apparent proximity of city dwellers to urban health facilities, less than one third of the urbanites in India utilize government health facilities.

Mar 4-7, 2014 – International Conference on Urban Health

October 22, 2013 · 0 comments

ICUH 2014 – Manchester, England, March 4-7, 2014
Registration and abstract submission are now open for the 11th International Conference on Urban Health. The conference will take place in Manchester, United Kingdom, from March 4-7, 2014. Please go to www.icuh2014.com for more information.

The over-arching theme for ICUH2014 is “Crossing Boundaries – Partnerships for Global Urban Health“.

Confirmed speakers include:

  • Professor Sir Michael Marmot (Director, UCL Institute of Health Equity, Marmot Institute)
  • Professor Ilona Kickbusch (Director of the Global Health Programme, Geneva)
  • Professor David Vlahov (Dean, School of Nursing, University of California, San Francisco)
  • Trevor Hancock (Co-founder, Healthy Cities and Communities)
  • Alex Ross (Director of the World Health Organisation, Kobe Centre)
  • Claudia Stein (Director of the Division of Information, Evidence, Research and Innovation at the World Health Organisation Europe Centre)

 

 

KIT – E-learning: Urban Health in Low- and Middle Income Countries

October 22, 2013 · 0 comments

KIT – E-learning: Urban Health in Low- and Middle Income Countries, April-June 2014.

At the end of this course, participants will be able to:
1. Describe demographic trends and prospects worldwide with respect to urbanisation and interpret the health situation of ‘average’ urban populations in developing countries in the light of existing inequalities.
2. Identify and appraise the important factors implicated in health and inequalities in a (poor) urban environment using a framework of social determinants of health.
3. Ascertain the role of (local) health systems in relation to service provision, health practices and in addressing inequalities in determinants, health status, access, financial contributions and/or consequences of ill-health.
4. Critically evaluate the principles of governance, accountability, participation and voice in relation to marginalised communities in urban environments.
5. Advocate with stakeholders for collaborative intersectoral action to promote urban health.
6. Review good practices and critically appraise interventions and own experiences in the context of urban health and formulate program and policy recommendations.

Factors affecting immunization coverage in urban slums of Odisha, India

October 22, 2013 · 0 comments

Factors affecting immunization coverage in urban slums of Odisha, India: implications on urban health policy. Healthcare in Low-Resource Settings, Oct 2013.

Santosh K., et al.

Infectious diseases are major causes of morbidity and mortality among children. One of the most cost-effective interventions for improved child survival is immunization, which has significant urban-rural divides. Slum dwellers constitute about one-third of Indian population, and most children still remain incompletely immunized. The main purpose of this study was to understand the factors behind partial or non-immunization of children aged 12-23 months in slum areas of Cuttack district, India. Session-based audit and a population-based survey were conducted in the urban slums of Cuttack city, April-June 2012. Total 79 children were assessed and their mothers were interviewed about the nature and quality of immunization services provided.

Children fully immunized were 64.6%. Antigen-wise immunization coverage was highest for Bacillus Calmette-Guérin (BCG) (96.2%) and lowest for Measles (65.8%), which indicates high instances of late drop-out. Frequent illnesses of the child, lack of information about the scheduled date of immunization, frequent displacement of the family and lack of knowledge regarding the benefits of immunization were cited as the main factors behind coverage of immunization services.

The study showed that there is an urgent need to revise the immunization strategy, especially for urban slums. District and sub-district officials should reduce instances of early and late dropouts and, in turn, improve complete immunization coverage. Community participation, intersectoral co-ordination and local decision making along with supportive supervision could be critical in addressing issues of drop-outs, supply logistics and community mobilization.

Microbial risks to human health caused by waterborne viruses and bacteria in an urban slum

October 22, 2013 · 0 comments

Quantification of microbial risks to human health caused by waterborne viruses and bacteria in an urban slum. Journal of Applied Microbiology, October 2013.

A.Y. Katukiza, et al.

Aims – To determine the magnitude of microbial risks from waterborne viruses and bacteria in Bwaise III in Kampala (Uganda), a typical slum in Sub-Saharan Africa.

Methods and results – A quantitative microbial risk assessment (QMRA) was carried out to determine the magnitude of microbial risks from waterborne pathogens through various exposure pathways in Bwaise III in Kampala (Uganda). This was based on the concentration of E. coli O157:H7, Salmonella spp., rotavirus (RV) and human adenoviruses F and G (HAdv) in spring water, tap water, surface water, grey water and contaminated soil samples. The total disease burden was 680 disability-adjusted life years (DALYs) per 1000 persons per year. The highest disease burden contribution was caused by exposure to surface water open drainage channels (39%) followed by exposure to grey water in tertiary drains (24%), storage containers (22%), unprotected springs (8%), contaminated soil (7%) and tap water (0.02%). The highest percentage of the mean estimated infections was caused by E. coli O157:H7 (41%) followed by HAdv (32%), RV (20%), and Salmonella spp. (7%). In addition, the highest infection risk was 1 caused by HAdv in surface water at the slum outlet, while the lowest infection risk was 2.71×10-6 caused by E. coli O157:H7 in tap water.

Conclusions – The results show that the slum environment is polluted and the disease burden from each of the exposure routes in Bwaise III slum, with the exception of tap water, was much higher than the WHO reference level of tolerable risk of 1×10-6 DALYs per person per year

Significance and impact of the study – The findings this study provide guidance to governments, local authorities and non-government organisations in making decisions on measures to reduce infection risk and the disease burden by 102 to 105 depending on the source of exposure to achieve the desired health impacts. The infection risk may be reduced by sustainable management of human excreta and grey water, coupled with risk communication during hygiene awareness campaigns at household and community level. The data also provide a basis to make strategic investments to improve sanitary conditions in urban slums.

Oct 2, 2013 – Building Livable Cities and Healthy Communities Policy and Planning Approaches for Resilience and Sustainability

September 25, 2013 · 0 comments

Please join the Comparative Urban Studies Project of the Woodrow Wilson International Center for Scholars for a seminar on:

Building Livable Cities and Healthy Communities: Policy and Planning Approaches for Resilience and Sustainability - (pdf version for printing)

  • Wednesday, October 2, 2013
  • 3:00 – 5:00 pm
  • 5th Floor Conference Room
  • Woodrow Wilson International Center for Scholars

Please RSVP to cusp@wilsoncenter.org;  acceptances only

Featuring presentations by:

  • Robert Ogilvie, Vice President for Strategic Engagement, ChangeLab Solutions
  • Jon L. Gant, Director of Office for Healthy Homes and Lead Hazard Control, US Department of Housing and Urban Development (HUD)
  • Robin Schepper, Senior Advisor, Nutrition and Physical Activity Initiative, Bipartisan Policy Center
  • Victor Barbiero, Adjunct Professor, Department of Global Health, George Washington University

Chronic diseases have surpassed communicable diseases as leading causes of death worldwide. Enviromental and policy conditions that enable unhealthy diets, physical inactivity and high rates of tobacco underly increasing chronic disease rates. This makes good health in many communities with developing economies, difficult – if not impossible – to achieve.

ChangeLab Solutions is pioneering a new approach to public health advocacy by building collaboration between public health officials and other local government agencies. Often called health in all policies or shared governance, this collaborative governance model is garnering attention at the World Health Organization and other nongovernmental organizations dedicated to addressing the social determinants of health and fostering healthy, resilient and sustainable environments in which the healthy choice is the easy choice.

By creating good laws and policies that link housing, education, jobs, and the built environment to healthy outcomes – and by working with communities to implement them – ChangeLab Solutions is helping to create places where people have easy access to affordable and healthy food, safe and easily accessible places to live and play, plenty of opportunities to bike, walk, or take transit, fresh water, and clean air indoors and out. ChangeLab Solutions works with neighborhoods, cities, and states to transform communities with laws and policies that create lasting change. Its unique approach, backed by decades of solid research and proven results, helps the public and private sectors make communities more livable, especially for those who are at highest risk because they have the fewest resources.

A panel of experts will discuss innovative law and policy solutions for creating healthier neighborhoods, cities. Speakers will identify environmental change solutions for diseases like diabetes, obesity, asthma, and lung cancer. This seminar will showcase the latest in research and practice on how best to incorporate legal and policy tools into public health strategies.

Contracting urban primary healthcare services in Bangladesh

September 6, 2013 · 0 comments

Contracting urban primary healthcare services in Bangladesh – effect on use, efficiency, equity and quality of care. Tropical Medicine & International Health, Volume 18, Issue 7, pages 861–870, July 2013.

A Heard, et al.

Objective – To evaluate a large, ongoing effort to improve urban primary health care (PHC) in Bangladesh through expansion of publicly funded urban health facilities and contracting with partner non-governmental organisations (NGOs).

Methods – A part of Chittagong was assigned to a contracted NGO while the other parts of the city were contracted to the local government. Performance was assessed by baseline and follow-on household surveys, an endline health facility survey and routinely collected data.

Results – The results of a health facility survey indicated that overall quality of care was better in the NGO area, and routinely collected data showed that the NGO provided many more services per capita. Based on household survey data, the NGO area of Chittagong was poorer and had lower coverage at baseline. There were significant improvements in both government and NGO-run areas. However, larger improvements were observed on some coverage indicators in the NGO area compared to the government area. Improvements in coverage among the poorest 50% of the population were greater in the NGO-run area. The cost per service delivered was 47% lower in the NGO area.

Conclusions – Investments in urban PHC led to an improvement in the coverage of basic services. Contracting with an NGO had an additional effect in terms of improving coverage, equity, quality of care and efficiency. Increased investments in PHC facilities and contracting with NGOs may be effective in improving urban health services.

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