India – Women in urban areas more prone to breast cancer

October 6, 2010 · 0 comments

New Delhi, Oct 6 (IANS) – Urban women are more prone to breast cancer than their rural counterparts due to changing lifestyle and stress.

So says Galaxy Cancer Institute’s radiation oncology department director Dinesh Singh.

‘Every year, about 3,000 women get breast cancer in Delhi and NCR alone. Nearly 1,000 die of breast cancer every year,’ Singh told IANS.

October has been declared the national breast cancer month to spread awareness about the disease.

‘Breast cancer is one of the commonest malignancies afflicting women. In some parts, it is the most common malignancy,’ Singh said.

According to doctors, it is estimated that one in 14 of all female children born in India will develop breast cancer in their lifetime.

‘Breast cancer risk increases with age. Sixteen percent of women aged 40-60 have breast-related problems. In most, the lumps may carry a breast cancer risk,’ Galaxy Cancer Institute director Arun Kumar Goel said.

‘A family history of breast cancer increases the risk of developing the disease by three to five times,’ he added.

According to a study by London-based NGO working in Punjab ‘Roko Cancer’, while nine to 15 women per lakh in rural areas are affected by the disease, the number is 25-30 women per lakh in urban India.

‘Changing lifestyle and stress are some of the reasons behind the increasing number of cases,’ Goel said.

While agreeing that lack of awareness is one of the critical factors leading to increasing number of deaths, doctors said the disease can be cured if treatment starts at the right time.

‘Cure rate of over 98 percent is expected in the first stage. Many women with stage-I cancer and are getting cured,’ Singh said.

‘Majority of women in stage-I don’t need complete removal of the breast as only the tumour is taken out, giving excellent cure and maintaining normal body shape,’ Goel said.

Nearly 60,000 women die of breast cancer in India every year. Studies say that at the current rate of increase, the disease will overtake cervical cancer cases by 2020.

http://sify.com/news/women-in-urban-areas-more-prone-to-breast-cancer-news-health-kkgoEejhaha.html

Kenya – Innovative health voucher system for urban poor

September 21, 2010 · 2 comments

Innovative cover gives poor mothers a chance to smile

At the recently constructed semi-permanent Canna Medical Centre in Viwandani slums, Nairobi, Grace Nyambonyi and her baby girl Mary, have come for one of their final post-natal visits.

The happy baby plays on her mother’s lap as the latter chats with Penninah Nyamboke, a friend who has accompanied them.

Ms Nyambonyi and Ms Nyamboke are residents of one of the many slums dotting the city, this one being home to approximately 42,000 residents.

Unlike hundreds of other children born in the slums, Mary was not delivered at home under unsafe conditions, thanks to the Safe Motherhood (SMH) voucher that covered the delivery costs at the health centre.

Ms Nyambonyi is one among hundreds of women in Kenya who have benefited from donor supported programs that have successfully boosted health care provision to the poor.

The government is now duplicating such models in developing health financing policy and designing strategies for facilities through performance based funding.

Ms Nyambonyi’s voucher, purchased for Sh200 under the Output Based Approach (OBA) pilot program — a Kenya Government initiative supported by the German Financial Cooperation, Kfw — has given her access to free pre and post-natal clinic visits at a health centre of her choice throughout her pregnancy.

Emergency expenses such as complications and referrals to larger hospitals are also catered for under the program.

The expectant mothers also receive food rations consisting of seven kilograms of corn soya and a litre of cooking oil at each visits courtesy of the World Food Program, to help them at a time when they are not able to work.

“This program has been very helpful because we deliver safely, complications are treated quickly and our babies are healthy” said Ms Nyambonyi.

She was allowed to purchase the voucher after staff hired by the Voucher Management Agency (VMA) – a private firm that manages this program — visited her house and gave her a chance to carry her pregnancy to term and deliver safely under a skilled health official, reducing the risk of complications that sometimes results in a lifetime of infections and even death.

“When mothers deliver at home, screening for HIV cannot be done, use of unsterilized implements leads to infection and birth notification forms are not available” said Mr Joseph Mambo, Director at Canna Medical Centre.

Ms Nyambonyi also has to certify on claim forms that are processed by VMA that she received satisfactory service before payment is made to the health facility — something new in the provision of health services.

Under a Kfw supported pilot project and similar UNICEF supported program in North Eastern Province, the low cost of the vouchers has led to increased health facility deliveries and uptake of family planning methods, an indication that high costs hinder the poor from accessing health care.

There has also been behavioural change with more women choosing to go to hospital for treatment of other ailments.

Source

Management of delivery care in urban slums, Dhaka, Bangladesh

September 21, 2010 · 0 comments

The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh – a mixed method study

BRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi), funded by the Bill &Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs) are commonly assisting home-delivery.

The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka.

Methods: This cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices.

Results: About one-third (32%) of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women.

Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR): 3.46; 95% confidence interval (CI): 1.65-7.25)], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77) to use a UAP. Of women who reported at least one delivery related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3%) received medicine to start or increase labor with only 6% (9 of 149) referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth.

Conclusion: There is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs’practices are contrary to current World Health Organization recommendations and could be harmful. Programs need to develop interventions to address these practices to improve perinatal care outcomes.

Author: Tasnuva WahedAllisyn MoranMohammad Iqbal
Credits/Source: BMC Pregnancy and Childbirth 2010, 10:50

Red Cross: Urban dwellers globally suffer unprecedented risk from disasters

September 21, 2010 · 0 comments

Sept 21, 2010, BEIJING, China — With the majority of people on Earth now living in towns and cities, urban dwellers in middle and low income nations face rising threats from natural disasters, violence and health hazards, a Red Cross report said Tuesday.

Risks are exacerbated by rapid urbanization, poor local governance, population growth and the worsening of natural disasters due to global warming, according to the World Disasters Report compiled by the International Federation of Red Cross and Red Crescent Societies.

“There are now 1 billion urban dwellers living in slums. If the conditions don’t improve, more people will be affected in the case of major disasters like the Haiti earthquake,” Alistair Henley, director of IFRC’s Asia Pacific region, said at a news conference Tuesday.

This year’s report shifted its focus to hazards in cities in part because the development of disaster aid to urban dwellers has not kept up with the rapid pace of urbanization. The number of urban dwellers reached 3.5 billion this year, compared with 3.4 billion rural residents, the report said.

Of all the disasters, seismic activity killed the most people — an average of 50,184 people per year from 2000 to 2008, the report said. In 2009, natural disasters killed 10,551 people, a figure expected to be substantially higher this year with Haiti’s earthquake alone killing as many as 300,000 people.

Technological disasters such as industrial accidents and mine or chemical plant explosions killed 6,707 last year, the report said.

Henley said slum dwellers in Africa, Latin America and Southeast Asia are at increased risk as a result of health hazards and urban violence stemming from government repression and groups fighting for scarce resources such as food and basic necessities.

The report called for heightened disaster preparation and more government funding for health care and security, while also urging the nurturing of community organizations and private sector initiatives.

http://www.google.com/hostednews/canadianpress/article/ALeqM5jF315u79WrfMI_Mj1Dydm9PEx3VQ

Examining the ‘‘Urban Advantage’’ in Maternal Health Care

September 21, 2010 · 1 comment

PLOS Medicine – September 2010 | Volume 7 | Issue 9 | e1000327

Examining the ‘‘Urban Advantage’’ in Maternal Health Care in Developing Countries

Full-text: http://www.plos.org/press/plme-07-09-channon.pdf

Zoe¨ Matthews1, Amos Channon1*, Sarah Neal1, David Osrin2, Nyovani Madise1, William Stones3

1 Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, United Kingdom, 2 UCL Centre for International Health and Development, Institute of Child Health, London, United Kingdom, 3 Aga Khan University, Nairobi, Kenya

Summary Points

  • Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty.
  • Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care.
  • The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services.
  • There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in which most of the population do not have access to services, and (2) urban marginalisation, in which only the poor are excluded. At a country level, these two types of inequality can be further subdivided on the basis of rural access levels.
  • Inequity is not mandatory. Patterns of health inequality differ with context, and there are examples of countries with relatively small degrees of urban inequity.
  • Women and their babies need to have access to care, especially around the time of birth. Different strategies to achieve universal coverage in urban areas are needed according to urban inequality typology, but the evidence for what works is restricted to a few case studies.

India – Centre to launch health mission for urban poor

September 21, 2010 · 3 comments

Sept 16, 2010 – NEW DELHI:  To deal with the emerging challenges of urbanisation and the non-communicable diseases, the Ministry of Health and Family Welfare has initiated the process for launching the National Urban Health Mission (NUHM) on the lines of National Rural Health Mission (NRHM).

According to sources, the NUHM would be launched in 2011. It was after the success of the NRHM, the health mission for cities and towns was conceptualised by the Ministry of Health and Family Welfare. The NUHM would focus on primary health care services for the people, whereas secondary and tertiary care medical needs of the urban poor would be taken care of through a system of health insurance. Preventive, diagnostic and treatment facilities for different diseases would also be integrated into the basic package.

The NUHM is aimed at providing accessible and affordable healthcare to the 22 crore people living in the urban slums in 429 cities. The mission would also forge partnerships with the Ministry of Urban Development which is implementing a flagship programme for improving the basic infrastructure in the urban slums. It would take full advantage of the civic bodies in implementing health programmes.

Since the nationwide launch of the NUHM will take a few more months, the ministry has identified 33 cities with one million population or more for mobile facilities to carry out diagnostic tests for diabetes and hypertension and linking those in need of treatment to hospital facilities for free.

http://expressbuzz.com/nation/centre-to-launch-health-mission-for-urban-poor/207203.html

Uganda – Challenges in Using Mobile Phones for Data Collection

September 9, 2010 · 2 comments

AIDS Behav. 2010 Jun 8.

Challenges in Using Mobile Phones for Collection of Antiretroviral Therapy Adherence Data in a Resource-Limited Setting.

Haberer JE, Kiwanuka J, Nansera D, Wilson IB, Bangsberg DR. Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA, jhaberer@partners.org.

Frequent antiretroviral therapy adherence monitoring could detect incomplete adherence before viral rebound develops and thus potentially prevent treatment failure. Mobile phone technologies make frequent, brief adherence interviews possible in resource-limited settings; however, feasibility and acceptability are unknown. Interactive voice response (IVR) and short message service (SMS) text messaging were used to collect adherence data from 19 caregivers of HIV-infected children in Uganda.

IVR calls or SMS quantifying missed doses were sent in the local language once weekly for 3-4 weeks. Qualitative interviews were conducted to assess participant impressions of the technologies. Participant interest and participation rates were high; however, weekly completion rates for adherence queries were low (0-33%), most commonly due to misunderstanding of personal identification numbers. Despite near ubiquity of mobile phone technology in resource-limited settings, individual level collection of healthcare data presents challenges. Further research is needed for effective training and incentive methods.

Mobile direct observation treatment for tuberculosis patients

September 9, 2010 · 1 comment

Am J Prev Med. 2010 Jul;39(1):78-80.

Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.

Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, Munly K, Igonya EK, Hunt-Glassman J.

Danya International, Ltd., Silver Spring, Maryland, USA.

BACKGROUND: Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.

PURPOSE: This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.

METHODS: Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009.

RESULTS: All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.

CONCLUSIONS: MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.

Mobile phone-based interventions India

September 9, 2010 · 1 comment

AIDS Behav. 2010 Jun;14(3):716-20

Designing a mobile phone-based intervention to promote adherence to antiretroviral therapy in South India.

Shet A, Arumugam K, Rodrigues R, Rajagopalan N, Shubha K, Raj T, D’souza G, De Costa A. Department of Pediatrics, St John’s National Academy of Health Sciences, Bangalore, India.

anitashet@gmail.com

Integration of mobile phone technology into HIV care holds potential, particularly in resource-constrained settings. Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid. Mobile phone ownership was high at 73%; 26% reported shared ownership. A high proportion (66%) reported using phones to call their healthcare provider. There was interest in weekly telephonic automated voice reminders to facilitate adherence. Loss of privacy was not considered a deterrent. The study presents important considerations in the design of a mobile phone-based adherence intervention in India.

Mobile learning for HIV/AIDS healthcare in peri-urban clinics

September 9, 2010 · 2 comments

Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

We present an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment.Twenty physicians used individual Smartphones (Nokia N95 and iPhone), each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation’s HIV patients in need are on treatment.

A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress.

A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module.

Methods: In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction.

It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning.

Results: With a response rate of 90% (18/20 questionnaires returned), the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone.

Conclusions: Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs).

Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones’purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

Author: Maria Zolfo David Iglesias et al.
Credits/Source: AIDS Research and Therapy 2010, 7:35

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