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Floridia M, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Giuliano M. Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth. Nutrients 2023; 15:3282. [PMID: 37513701 PMCID: PMC10386663 DOI: 10.3390/nu15143282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Department of Medicine, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
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Fonzo M, Zuanna TD, Amoruso I, Resti C, Tsegaye A, Azzimonti G, Sgorbissa B, Centomo M, Ferretti S, Manenti F, Putoto G, Baldovin T, Bertoncello C. The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia. Int J Gynaecol Obstet 2023. [PMID: 36815783 DOI: 10.1002/ijgo.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/02/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.
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Affiliation(s)
- M Fonzo
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - T D Zuanna
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - I Amoruso
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - C Resti
- Doctors with Africa CUAMM, Addis Ababa, Ethiopia
| | - A Tsegaye
- Doctors with Africa CUAMM, Addis Ababa, Ethiopia
| | | | - B Sgorbissa
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - M Centomo
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - S Ferretti
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - F Manenti
- Doctors with Africa CUAMM, Padova, Italy
| | - G Putoto
- Doctors with Africa CUAMM, Padova, Italy
| | - T Baldovin
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - C Bertoncello
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
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Quality and Integrated Service Delivery: A Cross-Sectional Study of the Effects of Malaria and Antenatal Service Quality on Malaria Intervention Use in Sub-Saharan Africa. Trop Med Infect Dis 2022; 7:tropicalmed7110363. [DOI: 10.3390/tropicalmed7110363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Using regionally linked facility and household surveys, we measured the quality of integrated antenatal care and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania. We examined country heterogeneities for the association of integrated antenatal and malaria service quality scores with insecticide-treated bed net (ITN) use in pregnant women and children under-five and intermittent preventive treatment in pregnancy (IPTp-2) uptake. Malaria in pregnancy service quality was low overall. Our findings suggest modest, positive associations between malaria in pregnancy quality and ITN use and IPTp-2 uptake across pooled models and for most studied countries, with evidence of heterogeneity in the strength of associations and relevant confounding factors. Antenatal care quality generally was not associated with the study outcomes, although a positive interaction with malaria in pregnancy quality was present for pooled ITN use models. The improved quality of malaria services delivered during formal antenatal care can help address low coverage and usage rates of preventive malaria interventions in pregnancy and childhood. Study findings may be used to target quality improvement efforts at the sub-national level. Study methods may be adapted to identify low-performing facilities for intervention and adaption to other areas of care, such as HIV/AIDS, child immunizations, and postnatal care.
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Kujawski SA. Maternal Health Infrastructure and Interpersonal Quality of Care During Childbirth: An Examination of Facility Delivery in Malawi. Matern Child Health J 2020; 25:460-470. [PMID: 33201451 DOI: 10.1007/s10995-020-03081-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The maternal health field has recently focused on the importance of interpersonal quality of care and continues to cite structural deficits as a contributor to poor interpersonal treatment. This hypothesis is supported by qualitative evidence. This study quantitatively tested the effect of maternal health structural inputs on interpersonal quality of care during childbirth. METHODS Analyses were conducted using data from the 2013 to 2014 Malawi Service Provision Assessment, which documented the availability and quality of health facility services and included the observation of laboring and delivering women. Maternal health structural inputs were measured using 26 facility infrastructure variables. The outcome, interpersonal quality of care, was measured as a sum score of 12 items collected during the observations. Crude and adjusted associations between maternal health structural inputs on interpersonal quality of care were assessed using linear regression with cluster robust standard errors. RESULTS 345 Observations of delivering women in 174 health facilities were included in the analysis. 19.1% of women delivered in a facility with high maternal health structural inputs, and the mean interpersonal quality of care score was 8.9/12. Maternal health structural inputs had a small, non-meaningful association with interpersonal quality of care during childbirth (adjusted β - 0.19, 95% CI - 0.85, 0.47). CONCLUSIONS FOR PRACTICE These findings do not verify the quality of care frameworks or qualitative evidence that support the relationship between structure and interpersonal quality of care. While structural inputs are important for health system performance, the results suggest that they might not be necessary for a respectful childbirth experience.
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Affiliation(s)
- Stephanie A Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168 Street, New York, NY, 10032, USA.
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Arsenault C, English M, Gathara D, Malata A, Mandala W, Kruk ME. Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys. Trop Med Int Health 2020; 25:442-453. [PMID: 31828923 PMCID: PMC7217001 DOI: 10.1111/tmi.13361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor‐quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care. Methods We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random‐intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient‐, provider‐ and facility‐level and subnational divisions). Results Only 61–66% of basic elements of competent and respectful care were performed. In adjusted models, better‐staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV‐positive women received higher‐quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage‐point gap between Nairobi and the Coast region. Quality was also higher in higher‐volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient‐level characteristics in Malawi. Conclusions Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher‐volume facilities – along with promotion of respectful care in these facilities – should be considered in sub‐Saharan Africa to improve outcomes for mothers and newborns.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan school of Public Health, Boston, MA, USA
| | - Mike English
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Gathara
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Address Malata
- The Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Wilson Mandala
- The Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan school of Public Health, Boston, MA, USA
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The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda. PLoS One 2019; 14:e0223426. [PMID: 31596884 PMCID: PMC6785126 DOI: 10.1371/journal.pone.0223426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/20/2019] [Indexed: 12/03/2022] Open
Abstract
Background Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda’s HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017. Methods We conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013–December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period. Results There were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, p<0.001) and to report declines in HIV care access (43.5% vs. 3.1%, p<0.001) and quality (35.6% vs. 0%, p<0.001). However, transition facilities did not differ in their trends in HIV service volume relative to maintenance facilities. Conclusions Transition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents’ perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.
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Kanyangarara M, Sakyi K, Laar A. Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys. Reprod Health 2019; 16:60. [PMID: 31138242 PMCID: PMC6538552 DOI: 10.1186/s12978-019-0713-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this study, we assessed the availability of integrated FP services and the associated factors in HIV care and support sites across sub-Saharan Africa. Methods We conducted a secondary analysis of nationally representative facility-level data from Service Availability and Readiness Assessments (SARA) and Service Provision Assessments (SPA) conducted in 10 sub-Saharan African countries between 2012 and 2015. We used six indicators that reflect the structure and process of care essential for FP service delivery in HIV care and support facilities to define the outcome of interest - onsite availability of integrated FP services. Multivariate logistic regression was used to explore facility-level characteristics associated with the outcome. Results Among the 3161 health facilities offering HIV care and support services, most reported also offering FP services at the same location. The availability of three FP methods was higher than the availability of FP guidelines and trained staff. Onsite availability of integrated FP services ranged from 10 to 61%. Results of multivariate logistic regression indicated that the odds of having onsite integrated FP services available was higher in HIV care and support sites that were operated by the government, classified as a tertiary level care facility, and provided services for PMTCT, antenatal care and basic surgery. Conclusions Our findings indicate critical shortcomings in the preparedness of HIV care and support sites to deliver onsite integrated FP services. Renewed efforts are needed to address these supply-side barriers and ensure that integrated FP and HIV services meet the unique needs of HIV clients. Electronic supplementary material The online version of this article (10.1186/s12978-019-0713-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mufaro Kanyangarara
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Kwame Sakyi
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Amos Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Larson E, Vail D, Mbaruku GM, Mbatia R, Kruk ME. Beyond utilization: measuring effective coverage of obstetric care along the quality cascade. Int J Qual Health Care 2017; 29:104-110. [PMID: 27920246 DOI: 10.1093/intqhc/mzw141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/16/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To determine the effective coverage of obstetric care in a rural Tanzanian region and to assess differences in effective coverage by wealth. Design Cross-sectional structured interviews. Setting Pwani Region, Tanzania. Participants The study includes 24 rural, government-managed, primary healthcare clinics and their catchment populations. From January-April 2016, we conducted a household survey of a census of women with recent deliveries, health worker knowledge surveys and facility audits. Main Outcome Measures We explored the proportion of women receiving quality care through the cascade and conducted an equity analysis by wealth. Results In total, 2,910 of 3,564 women (81.6%) reported delivering their most recent child in a health facility, 1,096 of whom delivered in a study facility. Using a minimum threshold of quality, the effective coverage of obstetric care was 25%. Quality was lowest in the emergency care dimensions, with the average score on the provider knowledge tests at 47% and the average provision of basic emergency obstetric services below 50%. The wealthiest 20% of women were 4.1 times as likely to deliver in facilities offering at least the minimum threshold of quality care through the cascade compared to the poorest 80% of women (95% confidence interval: 1.5-11.3). Conclusions Effective coverage of delivery care is very low, particularly among poorer women. Health worker knowledge caused the sharpest decline in effective coverage. Measures of effective coverage are a better performance measure of under-resourced health systems than utilization. Equity analyses can further identify important discrepancies in quality across socio-economic levels. Trial Registration ISRCTN 17107760.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Bldg 1, 11th floor, Boston, MA 02115, USA
| | - Daniel Vail
- Stanford University School of Medicine, 291 Campus Drive, Palo Alto, CA 94305, USA
| | - Godfrey M Mbaruku
- Ifakara Health Institute, P.O. Box 78373, Plot 463, Kiko Avenue, Mikocheni A, Mwai Kibaki Road, Dar es salaam, United Republic of Tanzania
| | - Redempta Mbatia
- Tanzania Health Promotion Support, 3rd Floor, Coco Plaza Bldg, Plot 254, Masaki Dar es Salaam, United Republic of Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Bldg 1, 11th floor, Boston, MA 02115, USA
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The US President's Malaria Initiative and under-5 child mortality in sub-Saharan Africa: A difference-in-differences analysis. PLoS Med 2017; 14:e1002319. [PMID: 28609442 PMCID: PMC5469567 DOI: 10.1371/journal.pmed.1002319] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/09/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Despite substantial financial contributions by the United States President's Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA). METHODS AND FINDINGS We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74-0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78-0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86-15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79-12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI -0.07-7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal. CONCLUSIONS PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality.
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Lohman N, Hagopian A, Luboga SA, Stover B, Lim T, Makumbi F, Kiwanuka N, Lubega F, Ndizihiwe A, Mukooyo E, Barnhart S, Pfeiffer J. District Health Officer Perceptions of PEPFAR's Influence on the Health System in Uganda, 2005-2011. Int J Health Policy Manag 2017; 6:83-95. [PMID: 28812783 PMCID: PMC5287933 DOI: 10.15171/ijhpm.2016.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/18/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including the President's Emergency Plan for AIDS Relief (PEPFAR), have successfully contributed to reducing HIV/AIDS related morbidity and mortality. However, there is still debate about whether these disease-specific programs have improved or harmed health systems overall, especially with respect to non-HIV health needs. METHODS As part of a larger evaluation of PEPFAR's effects on the health system between 2005-2011, we collected qualitative and quantitative data through semi-structured interviews with District Health Officers (DHOs) from all 112 districts in Uganda. We asked DHOs to share their perceptions about the ways in which HIV programs (largely PEPFAR in the Ugandan context) had helped and harmed the health system. We then identified key themes among their responses using qualitative content analysis. RESULTS Ugandan DHOs said PEPFAR had generally helped the health system by improving training, integrating HIV and non-HIV care, and directly providing resources. To a lesser extent, DHOs said PEPFAR caused the health system to focus too narrowly on HIV/AIDS, increased workload for already overburdened staff, and encouraged doctors to leave public sector jobs for higher-paid positions with HIV/AIDS programs. CONCLUSION Health system leaders in Uganda at the district level were appreciative of resources aimed at HIV they could often apply for broader purposes. As HIV infection becomes a chronic disease requiring strong health systems to manage sustained patient care over time, Uganda's weak health systems will require broad infrastructure improvements inconsistent with narrow vertical health programming.
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Affiliation(s)
- Nathaniel Lohman
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | | | - Bert Stover
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Travis Lim
- Division of Global HIV and Tuberculosis, Atlanta, GA, USA
| | | | - Noah Kiwanuka
- Faculty of Health Sciences, Makerere University, Kampala, Uganda
| | - Flavia Lubega
- Faculty of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Eddie Mukooyo
- Resource Center for the Uganda Ministry of Health, Uganda Ministry of Health, Nakasero, Uganda
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. LANCET GLOBAL HEALTH 2016; 4:e845-e855. [DOI: 10.1016/s2214-109x(16)30180-2] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/23/2016] [Accepted: 07/20/2016] [Indexed: 01/22/2023]
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