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Richterman A, Millien C, Bair EF, Jerome G, Suffrin JCD, Behrman JR, Thirumurthy H. The effects of cash transfers on adult and child mortality in low- and middle-income countries. Nature 2023:10.1038/s41586-023-06116-2. [PMID: 37258664 DOI: 10.1038/s41586-023-06116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/21/2023] [Indexed: 06/02/2023]
Abstract
Poverty is an important social determinant of health that is associated with increased risk of death1-5. Cash transfer programmes provide non-contributory monetary transfers to individuals or households, with or without behavioural conditions such as children's school attendance6,7. Over recent decades, cash transfer programmes have emerged as central components of poverty reduction strategies of many governments in low- and middle-income countries6,7. The effects of these programmes on adult and child mortality rates remains an important gap in the literature, however, with existing evidence limited to a few specific conditional cash transfer programmes, primarily in Latin America8-14. Here we evaluated the effects of large-scale, government-led cash transfer programmes on all-cause adult and child mortality using individual-level longitudinal mortality datasets from many low- and middle-income countries. We found that cash transfer programmes were associated with significant reductions in mortality among children under five years of age and women. Secondary heterogeneity analyses suggested similar effects for conditional and unconditional programmes, and larger effects for programmes that covered a larger share of the population and provided larger transfer amounts, and in countries with lower health expenditures, lower baseline life expectancy, and higher perceived regulatory quality. Our findings support the use of anti-poverty programmes such as cash transfers, which many countries have introduced or expanded during the COVID-19 pandemic, to improve population health.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Elizabeth F Bair
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jere R Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
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2
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Rose AL, Fenelon DL, Fils-Aimé JR, Dubuisson W, Singer SFC, Smith SL, Jerome G, Eustache E, Raviola G. Development of an Innovative Digital Data Collection System for Routine Mental Health Care Delivery in Rural Haiti. Glob Health Sci Pract 2021; 9:990-999. [PMID: 34933992 PMCID: PMC8691881 DOI: 10.9745/ghsp-d-20-00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Mental health information systems in low-resource settings are scarce worldwide. Data collection was accurate, yet sustainable staffing was a challenge when using task-shared clinical providers for data collection in health centers in rural Haiti. Integrating mental health data collection within existing data collection systems would help close this key gap. Introduction: Effective digital health management information systems (HMIS) support health data validity, which enables health care teams to make programmatic decisions and country-level decision making in support of international development targets. In 2015, mental health was included within the Sustainable Development Goals, yet there are few applications of HMIS of any type in the practice of mental health care in resource-limited settings. Zanmi Lasante (ZL), one of the largest providers of mental health care in Haiti, developed a digital data collection system for mental health across 11 public rural health facilities. Program Intervention: We describe the development, implementation, and evaluation of the digital system for mental health data collection at ZL. To evaluate system reliability, we assessed the number of missing monthly reports. To evaluate data validity, we calculated concordance between the digital system and paper charts at 2 facilities. To evaluate the system's ability to inform decision making, we specified and then calculated 4 priority indicators. Results: The digital system was missing 5 of 143 monthly reports across all facilities and had 74.3% (55/74) and 98% (49/50) concordance with paper charts. It was possible to calculate all 4 indicators, which led to programmatic changes in 2 cases. In response to implementation challenges, it was necessary to use strategies to increase provider buy-in and ultimately to introduce dedicated data clerks to keep pace with data collection and protect time for clinical work. Lessons Learned: While demonstrating the potential of collecting mental health data digitally in a low-resource rural setting, we found that it was necessary to consider the ongoing roles of paper records alongside digital data collection. We also identified the challenge of balancing clinical and data collection responsibilities among a limited staff. Ongoing work is needed to develop truly sustainable and scalable models for mental health data collection in resource-limited settings.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA.
- Partners In Health, Boston, MA, USA
| | | | | | | | | | - Stephanie L Smith
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Giuseppe Raviola
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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3
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Raymondville M, Rodriguez CA, Richterman A, Jerome G, Katz A, Gilbert H, Anderson G, Joseph JP, Franke MF, Ivers LC. Barriers and facilitators influencing facility-based childbirth in rural Haiti: a mixed method study with a convergent design. BMJ Glob Health 2021; 5:bmjgh-2020-002526. [PMID: 32830129 PMCID: PMC7445336 DOI: 10.1136/bmjgh-2020-002526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Haiti has the highest maternal mortality rate in the Western Hemisphere. Facility-based childbirth is promoted as the standard of care for reducing maternal and neonatal mortality. We conducted a convergent, mixed methods study to assess barriers and facilitators to facility-based childbirth at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais, Haiti. Methods We conducted secondary analyses of a prospective cohort of pregnant women seeking antenatal care at HUM and quantitatively assessed predictors of not having a facility-based childbirth at HUM. We prospectively enrolled 30 pregnant women and interviewed them about their experiences delivering at home or at HUM. Results Of 1105 pregnant women seeking antenatal care at the hospital between May and December 2017, 773 (70%) returned to the hospital for facility-based childbirth. In multivariable analyses, living farther from the hospital (adjusted OR (AOR)=0.73; 95% CI 0.56 to 0.96), poverty (AOR=0.93; 95% CI 0.88 to 0.99) and household hunger (AOR=0.45; 95% CI 0.26 to 0.79) were associated with not having a facility-based childbirth. Primigravid women were more likely to have a facility-based childbirth (AOR=1.34, 95% CI 1.02 to 1.76). Qualitative data provided insight into the value women place on traditional birth attendants (‘matrons’) during home-based childbirths. While women perceived facility-based childbirths as better equipped to handle birth complications, barriers such as distance, costs of transportation and supplies, discomfort of facility birthing practices and mistreatment by medical staff resulted in negative perceptions of facility-based childbirths. Conclusion Pregnant women in rural Haiti must overcome substantial structural barriers and forfeit valued support from traditional birth attendants when they pursue facility-based childbirths. If traditional birth attendants could be involved in care alongside midwives at facilities, women may be more inclined to deliver there. While complex structural barriers remain, the inclusion of matrons at facilities may increase uptake of facility-based childbirths, and ultimately improve maternal and neonatal outcomes.
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Affiliation(s)
- Maxi Raymondville
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA .,Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Carly A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Richterman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Jerome
- Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Arlene Katz
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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4
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Richterman A, Raymonville M, Hossain A, Millien C, Joseph JP, Jerome G, Franke MF, Ivers LC. Food insecurity as a risk factor for preterm birth: a prospective facility-based cohort study in rural Haiti. BMJ Glob Health 2020; 5:e002341. [PMID: 32611679 PMCID: PMC7332182 DOI: 10.1136/bmjgh-2020-002341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Haiti has an estimated neonatal mortality rate of 32/1000 live births, the highest in the Western Hemisphere. Preterm birth and being born small for gestational age (SGA) are major causes of adverse neonatal outcomes worldwide. To reduce preterm birth and infants born SGA, it is important to understand which women are most at risk and how risk varies within countries. There are few studies estimating the prevalence and risk factors for these conditions in Haiti, particularly in rural regions. METHODS We conducted a prospective cohort study of pregnant women at a rural tertiary care centre in Haiti from May to December 2017. We collected data during interviews and from the medical record. We built multivariable models to identify risk factors for preterm birth and being born SGA among women who had a facility-based delivery. RESULTS 1089 pregnant women delivered at the hospital and were included in this analysis. Median gestational age at delivery was 38 weeks (IQR 36-40). In multivariable analyses, risk factors for preterm birth included maternal age <20 years (adjusted OR (AOR) 1.76, 95% CI 1.14 to 2.72) and >34 years (AOR 1.46, 95% CI 1.01 to 2.11) and severe hunger in the household (AOR 1.57, 95% CI 1.09 to 2.26). Risk factors for SGA were age >34 years (AOR 1.76, 95% CI 1.18 to 2.59), twin pregnancy (AOR 3.28, 95% CI 1.20 to 8.95) and first pregnancy (AOR 1.57, 95% CI 1.12 to 2.23). Number of prior abortions was associated with reduced risk for SGA (AOR 0.41, 95% CI 0.17 to 0.97). CONCLUSIONS Food insecurity as a risk factor for preterm birth stands out as an important addition to the understanding of the risk of neonatal morbidity and mortality. This association highlights a potentially important intervention target to improve birth outcomes and suggests that food support has an important role to play for pregnant women who are food insecure in low-income settings.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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5
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Mukherjee JS, Mugunga JC, Shah A, Leta A, Birru E, Oswald C, Jerome G, Almazor CP, Satti H, Yates R, Atun R, Rhatigan J, Gottlieb G, Farmer PE. A practical approach to universal health coverage. Lancet Glob Health 2020; 7:e410-e411. [PMID: 30879502 DOI: 10.1016/s2214-109x(19)30035-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Joia S Mukherjee
- Partners In Health, Boston, MA 02199, USA; Harvard Medical School, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA.
| | | | | | - Abera Leta
- Partners In Health-Lesotho, Maseru, Lesotho
| | | | | | | | | | - Hind Satti
- Partners In Health, Boston, MA 02199, USA; Brigham & Women's Hospital, Boston, MA, USA
| | | | - Rifat Atun
- Harvard Chan School of Public Health, Boston, MA, USA
| | - Joseph Rhatigan
- Harvard Medical School, Boston, MA, USA; Harvard Chan School of Public Health, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA
| | - Gary Gottlieb
- Partners In Health, Boston, MA 02199, USA; Harvard Medical School, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA
| | - Paul E Farmer
- Partners In Health, Boston, MA 02199, USA; Harvard Medical School, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA
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6
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Ly CV, Koenig L, Christensen J, Gordon B, Beaumont H, Dahiya S, Chen J, Su Y, Nelson B, Jockel-Balsarotti J, Drain C, Jerome G, Morris JC, Fagan AM, Harms MB, Benzinger TLS, Miller TM, Ances BM. Tau positron emission tomography imaging in C9orf72 repeat expansion carriers. Eur J Neurol 2019; 26:1235-1239. [PMID: 30790403 PMCID: PMC6684398 DOI: 10.1111/ene.13940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/21/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE AV-1451 (18 F-AV-1451, flortaucipir) positron emission tomography was performed in C9orf72 expansion carriers to assess tau accumulation and disease manifestation. METHODS Nine clinically characterized C9orf72 expansion carriers and 18 age- and gender- matched cognitively normal individuals were psychometrically evaluated and underwent tau positron emission tomography imaging. The regional AV-1451 standard uptake value ratios from multiple brain regions were analyzed. Spearman correlation was performed to relate the AV-1451 standard uptake value ratio to clinical, psychometric and cerebrospinal fluid measures. RESULTS C9orf72 expansion carriers had increased AV-1451 binding in the entorhinal cortex compared to controls. Primary age-related tauopathy was observed postmortem in one patient. AV-1451 uptake did not correlate with clinical severity, disease duration, psychometric performance or cerebrospinal fluid markers. CONCLUSION C9orf72 expansion carriers exhibited increased AV-1451 uptake in entorhinal cortex compared to cognitively normal controls, suggesting a propensity for primary age-related tauopathy. However, AV-1451 accumulation was not associated with psychometric performance in our cohort.
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Affiliation(s)
- C V Ly
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - L Koenig
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - J Christensen
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - B Gordon
- Department of Radiology, Washington University, Saint Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, Saint Louis, MO, USA
| | - H Beaumont
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - S Dahiya
- Department of Pathology and Immunology, Washington University, Saint Louis, MO, USA
| | - J Chen
- Department of Pathology and Immunology, Washington University, Saint Louis, MO, USA
| | - Y Su
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - B Nelson
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | | | - C Drain
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - G Jerome
- Department of Neurology, Washington University, Saint Louis, MO, USA
| | - J C Morris
- Department of Neurology, Washington University, Saint Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, Saint Louis, MO, USA
| | - A M Fagan
- Department of Neurology, Washington University, Saint Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, Saint Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University, Saint Louis, MO, USA
| | - M B Harms
- Department of Neurology, Columbia University, New York, NY, USA
| | - T L S Benzinger
- Department of Radiology, Washington University, Saint Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, Saint Louis, MO, USA
- Department of Neurosurgery, Washington University, Saint Louis, MO, USA
| | - T M Miller
- Department of Neurology, Washington University, Saint Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University, Saint Louis, MO, USA
| | - B M Ances
- Department of Neurology, Washington University, Saint Louis, MO, USA
- Department of Radiology, Washington University, Saint Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, Saint Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University, Saint Louis, MO, USA
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7
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Richterman A, Franke MF, Constant G, Jerome G, Ternier R, Ivers LC. Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey. PLoS Negl Trop Dis 2019; 13:e0007134. [PMID: 30699107 PMCID: PMC6370226 DOI: 10.1371/journal.pntd.0007134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/11/2019] [Accepted: 01/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Both cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been well-characterized. Methods We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food security (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera (among households reporting at least one case). We performed a complete case analysis because there were <1% missing data for all variables. Results There were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. After adjustment for potential confounders, both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.51, 95% Confidence Interval (CI) 1.30–1.76; p <.0001] and severe hunger in the household (AOR 1.73, 95% CI 1.45–2.08; p <.0001) were significantly associated with reported history of cholera in the household. Severe hunger in the household (AOR 1.85, 95% CI 1.05–3.26; p = 0.03), but not moderate hunger in the household, was independently associated with reported death from cholera in households with at least one case of cholera. Conclusions In this study we identified an independent relationship between household food insecurity and both reported history of cholera and death from cholera in a general population. The directionality of this relationship is uncertain and should be further explored in future prospective research. In this study, we identified an independent relationship between household food insecurity, defined as a persistent lack of access to food in adequate quantity or quality and measured using the Household Hunger Scale, and reported history of cholera and death from cholera in a general population. We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey (DHS) in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. The 2012 survey was conducted during the height of the cholera epidemic, with 453,536 suspected cases and 3,835 deaths in Haiti from 2011–2012. We used multivariable logistic regression to control for measured confounders. The underlying mechanisms and directionality of the association between food insecurity and reported history of cholera are uncertain and should be explored in future prospective research. A better understanding of the relationship between food insecurity and cholera could inform both future cholera outbreak prediction and response, particularly in settings where poor food access and cholera risk factors are known to co-exist.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Louise C. Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Center for Global Health, Boston, Massachusetts, United States of America
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8
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Richterman A, Cheung HC, Meiselbach MK, Jerome G, Ternier R, Ivers LC. Risk Factors for Self-Reported Cholera Within HIV-Affected Households in Rural Haiti. Open Forum Infect Dis 2018; 5:ofy127. [PMID: 29942825 PMCID: PMC6007289 DOI: 10.1093/ofid/ofy127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/30/2018] [Indexed: 11/12/2022] Open
Abstract
Background Cholera continues to be a major cause of morbidity and mortality worldwide and is now endemic in Haiti since first being introduced in 2010. Cholera and HIV have significant geographic overlap globally, but little is known about the clinical features and risk of cholera among HIV-infected people and their households. Methods We assessed HIV-affected households originally recruited for a randomized controlled trial of food supplements. We assessed for correlation between household and individual factors and reported history of cholera since 2010 using univariable and multivariable analyses. Results There were 352 HIV-infected household members, 32 with reported history of medically attended cholera, and 1968 other household members, 55 with reported history of medically attended cholera. Among HIV-infected individuals in this study, no variables correlated with reported history of cholera in univariable analyses. Among all household members, known HIV infection (adjusted odds ratio [AOR], 3.75; 95% CI, 2.43–5.79; P < .0001), source of income in the household (AOR, 1.82; 95% CI, 1.05–3.15; P = .034), time required to fetch water (AOR, 1.07 per 5-minute increase; 95% CI, 1.01–1.12; P = .015), and severe household food insecurity (AOR, 3.23; 95% CI, 1.25–8.34; P = .016) were correlated with reported history of cholera in a multivariable analysis. Conclusions Known HIV infection, source of household income, time required to fetch water, and severe household food insecurity were independently associated with reported history of medically attended cholera in HIV-affected households in rural Haiti. Further research is required to better understand the interactions between HIV and cholera.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | | | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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9
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McBain RK, Jerome G, Leandre F, Browning M, Warsh J, Shah M, Mistry B, Faure PAI, Pierre C, Fang AP, Mugunga JC, Gottlieb G, Rhatigan J, Kaplan R. Activity-based costing of health-care delivery, Haiti. Bull World Health Organ 2018; 96:10-17. [PMID: 29403096 PMCID: PMC5791872 DOI: 10.2471/blt.17.198663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Findings Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Conclusion Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.
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Affiliation(s)
- Ryan K McBain
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | | | | | - Micaela Browning
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | | | | | | | | | - Claire Pierre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | - Jean Claude Mugunga
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | - Gary Gottlieb
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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10
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McBain RK, Jerome G, Warsh J, Browning M, Mistry B, Faure PAI, Pierre C, Fang AP, Mugunga JC, Rhatigan J, Leandre F, Kaplan R. Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing. BMJ Glob Health 2016; 1:e000134. [PMID: 28588971 PMCID: PMC5321372 DOI: 10.1136/bmjgh-2016-000134] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 01/26/2023] Open
Abstract
Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.
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Affiliation(s)
| | | | | | | | - Bipin Mistry
- Harvard Business School, Boston, Massachusetts, USA
| | | | - Claire Pierre
- Zanmi Lasante, Port-au-Prince, Haiti
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anna P Fang
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Joseph Rhatigan
- Harvard Medical School, Boston, Massachusetts, USA
- Dept of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mukherjee J, Satti E, Mugunga J, Almazor C, Jerome G. Toward the implementation of universal health coverage: Introducing the
partners in health's-universal health coverage matrix. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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McBain RK, Jerome G, Warsh J, Browning M, Mistry B, Faure PAI, Pierre C, Fang AP, Mugunga JC, Rhatigan J, Leandre F, Kaplan R. Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing. BMJ Glob Health 2016; 1:e000134. [PMID: 28588971 DOI: 10.1136/bmjgh-2018-000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 05/22/2023] Open
Abstract
Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.
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Affiliation(s)
| | | | | | | | - Bipin Mistry
- Harvard Business School, Boston, Massachusetts, USA
| | | | - Claire Pierre
- Zanmi Lasante, Port-au-Prince, Haiti
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anna P Fang
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Joseph Rhatigan
- Harvard Medical School, Boston, Massachusetts, USA
- Dept of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Jean-Briach B, Clement G, Jerome G, Cyrille D, Eric B, Laetitia DM, Pascale G. 206 An example of collaboration between a regional network and a cancer registry. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moormann AE, Metz S, Toth MV, Moore WM, Jerome G, Kornmeier C, Manning P, Hansen DW, Pitzele BS, Webber RK. Selective heterocyclic amidine inhibitors of human inducible nitric oxide synthase. Bioorg Med Chem Lett 2001; 11:2651-3. [PMID: 11551770 DOI: 10.1016/s0960-894x(01)00523-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The potency and selectivity of a series of 5-hetero-2-iminohexahydroazepines were examined as inhibitors of the three human NOS isoforms. The effect of ring substitution of the 5-carbon for a heteroatom is presented. Potencies (IC(50)'s) for these inhibitors are in the low micromolar range for hi-NOS with some examples exhibiting a 500x selectivity versus hec-NOS.
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Affiliation(s)
- A E Moormann
- Pharmacia, 700 Chesterfield Parkway North, St. Louis, MO 63198, USA.
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Fretland DJ, Widomski DL, Anglin CP, Moore W, Jerome G, Kornmeier C, Connor J, Branson L, Wyatt P, Manning P, Toth M, Webber RK, Hansen D, Hallinan EA, Hagen T, Bergmanis A, Pitzele B, Currie MG. Specific inhibitors of inducible nitric oxide synthase: efficacy in a rodent model of sepsis. Inflamm Res 1999; 48 Suppl 2:S107-8. [PMID: 10667837 DOI: 10.1007/s000110050540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- D J Fretland
- Searle Research and Development, Skokie, IL 60077, USA.
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