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JSI staff publish their research and results from work in peer-reviewed journals on a regular basis. This section provides a brief abstract with a link to the journal where you can read more and either order or download the article, depending on the journal in question.
October 2011
Researching routine immunization—do we know what we don't know? in Vaccine, Volume 29, Issue 47
A conference report has been published in the journal, Vaccine, co-written by JSI's Immunization Senior Advisor, Robert Steinglass, among others, which maps out the recommendations and implications of a 2009 U.S. Centers for Disease Control and Prevention (CDC) expert panel. The panel reviewed and identified areas of research required to strengthen routine Expanded Programme on Immunization (EPI) service delivery in developing countries. Launched in 1974, EPI includes strategies and practices to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases.
The CDC panel showed that there is an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research, will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies. C. John Clements, Margaret Watkins, Ciro de Quadros, Robin Biellik, James Hadler, Deborah McFarland, Robert Steinglass, Elizabeth Luman, Karen Hennessey, Vance Dietz.
Read the abstract and download the report on researching routine immunization in Vaccine.
Sexual orientation differences in asthma correlates in a population-based sample of adults in American Journal of Public Health
Most research on the health of the lesbian, gay, and bisexual (LGB) populations has focused on HIV & AIDS, sexual health, and substance use. Recent studies, however, have documented elevated rates of chronic disease risk factors among LGB people relative to heterosexuals. In particular, LGB populations may be at increased risk for asthma.
This is the first population-based study to explore correlates of asthma in a large sample of LGB adults and to compare them with correlates for heterosexuals. This study assesses how education, urbanicity, weight status, smoking, access to primary care, anxiety, and depression may correlate with asthma diagnoses in the LGB population. The study identified two correlates of history of an asthma diagnosis among LGB individuals: current or former cigarette smoking and obesity. These correlates were also observed among heterosexuals, in addition to underweight, overweight, and current symptoms of depression.
With increasing data on risk factors and disease prevalence among LGB individuals, disparities in chronic diseases are emerging as significant areas for further research. Identifying differences in risk factors between LGB individuals and their heterosexual counterparts can help public health practitioners develop effective interventions to reduce or prevent development of chronic diseases such as asthma in the LGB population. Stewart J. Landers, Matthew J. Mimiaga, and Kerith J. Conron.
Read the abstract on sexual orientation differences in asthma correlates in American Journal of Public Health. Published online ahead of print October 20, 2011.
August 2011
Massachusetts' Health Care Reform Increased Access to Care for Hispanics, But Disparities Remain in Health Affairs, Vol. 30, No. 8
Massachusetts' health care reform has greatly expanded the proportion of the state's population with health insurance and the rate of coverage among Hispanics increased more dramatically than for non-Hispanic whites. Despite these gains, however, important disparities persist. In 2009, 79 percent of Hispanics had coverage, versus 96 percent of non-Hispanic whites.
This paper evaluates the extent to which health reforms in Massachusetts have reduced racial and ethnic disparities in insurance coverage and access to health care. JSI found that language and other cultural factors remained significant barriers to get coverage: only 67 percent of Hispanics with limited proficiency in English were insured after health reform in 2009. Difficulty finding a personal provider and cost also represented barriers to receiving care. One-third of Spanish-speaking Hispanics still did not have a personal provider in 2009, and 27 percent reported not seeing a doctor because of cost, up from 19 percent in 2005.
The research suggests strategies to further reduce disparities such as simplified health insurance enrollment and reenrollment processes and help finding a provider, and navigating an unfamiliar care system. The study has major implications for implementing the Affordable Care Act as many other states have larger Hispanic populations.
Read the abstract on Increased Access to Care for Hispanics under Health Reform, but Disparities Remain in Health Affairs.
June 2011
Determinants of delayed initiation of breastfeeding in rural Ethiopia: Programmatic implications in Food and Nutrition Bulletin, Vol. 32, No. 2, pp. 94-10
A number of studies have examined the possible adverse impact of services
offered by health workers and community members on postpartum infant feeding
practices. The objective of this study was to determine the most significant
factors for delayed initiation of breastfeeding in rural Ethiopia. Using
data from two child health and nutrition project baseline surveys, this analysis
explored factors associated with delayed initiation of more than one hour
after birth. Four key determinants were identified, including the existing
health system, socioeconomic status, newborn status, and maternal status.
Results indicated that inadequate breastfeeding information
in the health system and attendance at delivery by health
workers are associated with delay. In addition, births attended
by trained traditional attendants and family members are
associated with better practices, and targeting health workers,
community members, families, and women to promote optimal
infant feeding practices is likely to hold much potential
to increase the adoption of early initiation of breastfeeding. Naoko Horii, Agnès B. Guyon, and Victoria J. Quinn.
Read the abstract on Determinants of delayed initiation of breastfeeding in rural Ethiopia: Programmatic implications in Food and Nutrition Bulletin.
May 2011
Prevalence and Correlates of Lifetime HIV Testing in a Population-Based Sample of Men Who Have Sex with Men in Massachusetts in AIDS Patient Care and STDs, Volume: 25 Issue 6: May 25, 2011
"Nearly 30 years into the epidemic, HIV/AIDS continues to greatly impact the U.S. population, with men who have sex with men (MSM) accounting for nearly half of the more than 1 million people living with HIV and the group at greatest risk for HIV infection," write the authors in this letter to the Editor of AIDS Patient Care and STDs. This letter looks at HIV testing as a critical part of prevention and education strategies, with a focus on Massachusetts. The authors examine demographic data and potential correlates for lifetime HIV testing for Massachusetts adult MSM residents. Findings reveal that the majority of MSM in MA have had a lifetime HIV test and the authors make recommendations for looking at factors associated with decision's not to test to reduce HIV-transmission rates to at-risk MSM in Massachusetts. Matthew J. Mimiaga, Stewart J. Landers, and Kerith J. Conron.
Read the article on Prevalence and Correlates of Lifetime HIV Testing in a Population-Based Sample of Men Who Have Sex with Men in Massachusetts in AIDS Patient Care and STDs.
Psychosocial Processes and Sexual Initiation among Ghanaian Youth in Health Education and Behavior
In recent years, African youth have been exposed to a range of sexual risk reduction interventions, and various models have been used to conceptualize the behavior change processes within the interventions. This study aims to examine how reproductive knowledge and social cognitive factors jointly affect the choice to initiate sex.
The study models primary abstinence and age at first sex in a cross-sectional sample of Ghanaian youth aged 17 to 22 years. Among males, the authors find that reproductive knowledge is negatively associated with abstinence. Its negative association, however, is moderated by the extent of adult support a respondent receives. Among females, reproductive knowledge is positively associated with abstinence. Its positive association is moderated by the extent of household sex communication.
Though causal direction cannot be established, the results suggest that cognition affects sexual initiation both directly and through complex social mechanisms. The evidence provides theoretical support for comprehensive adolescent sexual and reproductive health interventions that promote abstinence and other safe sex behaviors through social as well as individual pathways. Michael McQuestion, PhD, Clement Ahiadeke, PhD, Jessica Posner, MPH and Timothy Williams, PhD.
Read the abstract on Psychosocial Processes and Sexual Initiation among Ghanaian Youth in Health Education and Behavior.
April 2011
Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System in Health Services Research
The health care system in Liberia was obliterated by 14 years of civil war. Maternal mortality—a measure of the safety of pregnancy and childbirth and therefore an indicator of the effectiveness of the health system—is among the highest in the world at 994 per 100,000 live births.
The Rebuilding Basic Health Services (RBHS) program, funded by USAID and implemented by JSI, aims to reconstruct and equip more than 100 of the 330 health clinics in Liberia. This study was designed by RBHS to quantify the influence of health system attributes, particularly the quality of care, on preferences for health clinics in Liberia. The study found that participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Rose Macauley, Margaret E. Kruk, Peter C. Rockers, and S. Tornorlah Varpilah.
Read the abstract on Liberia's Health System in Health Services Research.
February 2011
Community Perspectives on Developing a Sexual Health Agenda for Gay and Bisexual Men in AIDS & Behaviors, Vol. 15, Supplement 1
Community mobilization around gay rights in the late 1960s and 1970s led to the first efforts to improve the health of gay and bisexual men. In the 1980s the deadly AIDS epidemic was confronted with fierce organizing and community activism, primarily led by gay men.
Today, community involvement is crucial to many advocacy and organizing efforts for the health of gay and bisexual men. The purpose of this article is to demonstrate some of the ways that community mobilization has worked to improve gay men's health, to propose a national advocacy plan for promoting gay men's health in the near future, and to discuss the challenges and opportunities that lie ahead. The article begins with the roots of this history and then describes how they are reflected in a number of key health initiatives for this community. The path forward outlines the next steps for advocacy for gay men's health, in particular that of gay and bisexual men of color, emphasizing cultural viability, development of new leaders, and strategic alliances. Stewart Landers, Jim Pickett, Leo Rennie and Steve Wakefield.
Read the abstract on Developing a Sexual Health Agenda for Gay and Bisexual Men in AIDS & Behavior.
Health-care worker engagement in HIV-related quality improvement in Dar es Salaam, Tanzania in International Journal for Quality in Health Care
As countries strive toward the goal of universal HIV care and treatment, measuring and improving quality is necessary to ensure the efficacy and sustainability of care. Engaging health care workers (HCWs) in efforts to measure and improve the quality of care has been prioritized by national programs, donor agencies, and programs intended to scale-up HIV care and treatment.
This study was designed to assess HCW awareness, interest, and engagement in quality improvement in HIV care sites in Tanzania. The study found that HCWs can facilitate quality care and can be effectively engaged in quality improvement activities. They can also provide important insights into barriers to care. The research highlights the need to increase opportunities for HCWs to actively and more formally engage in quality improvement activities as interventions, such as ARV treatment, are scaled up. Lisa R. Hirschhorn, Maria E. Garcia, Michelle S. Li, Hellen Siril, Claudia Hawkins, Sylvia Kaaya, Shabbir Ismail, Guerino Chalamilla and Sarah Geoffrey Mdingi.
Read the abstract on health-care worker engagement in Tanzania in International Journal for Quality in Health Care.
December 2010
Assessing the knowledge and behavior towards HIV/AIDS among youth in Northern Uganda: a cross-sectional survey in Giornale Italiano Di Medicina Tropicale (Vol. 15, 1-4, 2010, pp. 29-34).
Young people are particularly vulnerable to HIV infection and they represent a crucial target group for preventive activities. Attaining accurate knowledge about HIV among youth is a vital objective of HIV prevention activities. In Uganda, 30% of young women and 35% of young men have comprehensive knowledge of HIV. The numbers are lower in the Northern region which has been affected by conflict for 20 years.
The Northern Uganda Malaria AIDS/HIV and TB (NUMAT) Program engages youth with multifaceted prevention activities. This article presents the results of a survey conducted to assess the knowledge and attitudes of youth in Northern Uganda toward HIV. Assessing the level of knowledge about HIV and the attitudes and practices toward HIV services among youth is an imperative endeavor for monitoring the progress of HIV prevention programs, identifying information gaps and factors related, and refocusing the planning and implementation of preventive activities. Luigi Cicciò, Diana Sera.
Read "Assessing the knowledge and behavior towards HIV/AIDS among youth in Northern Uganda" in Giornale Italiano Di Medicina Tropicale
July 2010
Maternal and newborn health subject of a special issue of The Ethiopian Journal of Health Development (Volume 24, Special Issue, 2010, 87-129)
The Bill & Melinda Gates Foundation-funded Last 10 Kilometers (L10K) project is working to extend the reach of the Ethiopian government's health extension program (HEP), which trains Health Extension Workers (HEW) to spread health messages and practices to families around the country. The articles in a special issue of the Ethiopian Journal of Health Development are based on presentations and proceedings of the "Workshop to Address Community Maternal and Neonatal Health in Ethiopia," which was conducted by L10K in partnership with the Federal Ministry of Health and the Ethiopian Society of Obstetricians & Gynecologists in Addis Ababa from May 12-14, 2009. L10K sponsored the workshop to bring maternal and newborn health into the national spotlight. Articles were written by faculty of the Addis Ababa University, a representative of the Population Council, L10K project staff, and others.
Recently, maternal and newborn health has gained increased prominence in the Ethiopian public health arena. The Gates Foundation has funded the Maternal and Newborn Health Project in Ethiopia, and the Ministry of Health launched a national campaign focusing on maternal health. In addition, the main theme of the 2010 Ethiopian Public Health Conference will be maternal and newborn health.
Articles published include:
- Programmatic correlates of maternal healthcare seeking behaviors in Ethiopia. By Ali Mehryar Karim, Wuleta Betemariam, Samuel Yalew, Hibret Alemu, Mary Carnell, Yared Mekonnen
- Responding to the maternal health care challenge: The Ethiopian Health Extension Program. By Marge Koblinsky, Frances Tain, Asheber Gaym, Ali Karim, Mary Carnell, Solomon Tesfaye
- Care of the newborn: Community perceptions and health seeking behavior. By Charlotte Warren
- Utilization of post-abortion care services in three regional states of Ethiopia. By Yilma Melkamu, Mulugeta Betre, Solomon Tesfaye
Read the articles on maternal and newborn health in the Ethiopian Journal of Health Development
Rhode Island Child Death Review: Sudden Infant Death and Sudden Unexpected Infant Deaths, 2008-2009 in Medicine & Health Rhode Island (Vol. 93, 7)
This article examines the risk factors leading to sudden unexpected infant deaths (SUID) in Rhode Island. Sudden infant death syndrome (SIDS) is the third leading cause of death for children under the age of one in the U.S., and the second leading cause in Rhode Island. With many causes undetermined following postmortem examination, the term SUID was introduced to recognize this trend.
Research for this article was conducted by the Rhode Island Child Death Review Team (RICDRT) during 2008-2009, and looked at cases reported to the Office of the State Medical Examiner (OSME). In-depth analysis of data from all OSME infant death cases during that period showed that co-sleeping with an adult, prone position sleeping, and sleeping on structures not designed for infant use were the biggest risk factors for SUID. It was also determined that the age of the child and the socioeconomic status of the family can increase risk of SUID. The research concluded that risk factor screening prior to discharge from the hospital, support and information from primary care providers, caregiver training and outreach, and the availability of safe sleeping structures for infants can significantly reduce and prevent sudden infant death in Rhode Island. Stephen C. Meersman, and Monica J. Schaberg.
Read "Rhode Island Child Death Review" in Medicine & Health Rhode Island
Availability of Essential Health Services in Post-Conflict Liberia in Bulletin of the World Health Organization 2010 (Vol. 88, 7, pp. 527-534)
In response to the post-civil war health challenges in Liberia, the Ministry of Health and Social Welfare, with assistance from donors and international NGOs, embarked on rebuilding the health system. This paper describes the availability of essential health services in rural Liberia five years after the end of the civil war. The services examined—integrated management of childhood illness, basic emergency obstetric care, artemisinin-based combination therapy (ACT) for malaria, HIV counseling and testing and mental health care—are part of the basic package of health services and address priority health conditions in Liberia.
The study uses a combination of population- and facility-level data to describe the availability of clinic inputs (infrastructure equipment and human resources) and scope of services available to villagers at their nearest health care facility. The research further maps the provision of each service and proposes potential reasons for asymmetries in distribution. Liberia's experience may be instructive for other countries emerging from conflict. Margaret E Kruk, Peter C Rockers, Elizabeth H Williams, S Tornorlah Varpilah, Rose Macauley, Geetor Saydee, and Sandro Galea.
Read "Availability of Essential Health Services in Post-Conflict Liberia" in the Bulletin of the World Health Organization
June 2010
The Open Door Project: A Qualitative Study on LGBT Aging in the Journal of Gay & Lesbian Social Services, (22:316-336, 2010)
This paper reports on JSI's evaluation and development of measures for the Open Door Program (ODP), a unique program created by the Lesbian, Gay, Bisexual and Transgender (LGBT) Aging Project. ODP is a collaboration of 14 Aging Service Access Points (ASAPs) in Massachusetts that support training activities that increase their cultural competence in meeting the needs of LGBT seniors.
JSI staff worked closely with ODP to develop and implement a research plan to ascertain its strengths and challenges to allow for further refinement and improvement of the program. On a broader scale, this qualitative research was conducted with the goal of advocating for aging LGBT communities across the country. Findings revealed that agencies took significant steps to make structural changes, including changing diversity and personnel policies and intake forms to be LGBT inclusive; implementing ongoing staff training initiatives on LGBT issues; and actively involving leadership to create and sustain organizational change.
The study found that ODP is an effective model to increase cultural competence in work with aging LGBT communities. It is hoped that the assessment will contribute to the development of measures for a new type of program that does not have standard indicators with which to measure progress.
Read the abstract on "The Open Door Project" in Journal of Gay & Lesbian Social Services.
Process Evaluation of a Community-Based Intervention Promoting Multiple Maternal and Neonatal Care Practices in Rural Nepal in BMC Pregnancy and Childbirth 2010
The challenge of delivering multiple, complex messages to promote maternal and newborn health in the Terai region of Nepal was addressed through training Female Community Health Volunteers (FCHV) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients.
This study examined the use of the booklet and factors affecting adoption of practices through semi-structured interviews with district and community-level government health personnel, staff from JSI's Nepal Family Health Program, FCHVs, recently delivered women and their husbands and mothers-in-law.
The study concluded that interpersonal peer communication through trusted community-level volunteers is an acceptable primary strategy in Nepal for promotion of household-level behaviors. Robert A. McPherson, Jyotsna Tamang, Stephen Hodgins, Laxmi R. Pathak, Ram C. Silwal, Abdullah H. Baqui, and Peter J. Winch.
Read the abstract in the BMC Pregnancy and Childbirth
Prevalence of and Factors Associated with Extramarital Sex among Nigerian Men in American Journal of Men's Health (Vol. 4, 2, pp. 124-134)
This study examines the prevalence of and factors associated with extramarital sex among men in Nigeria. The study shows that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence.
Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners.
The study concluded that the promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. Kola Oyediran, Uche C. Isiugo-Abanihe, Bamikale J. Feyisetan, and Gbenga P. Ishola.
Read the abstract in Journal of Men's Health
A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health in the American Journal of Public Health
As Healthy People 2020 has been established, information about sexual orientation differences across a spectrum of health issues and geographic regions is needed. This study extends the literature by providing estimates of several leading U.S. adult health indicators by sexual orientation identity and gender.
The study reported that compared with heterosexuals, sexual minorities were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on Pap tests, mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease than their heterosexual counterparts. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. Kerith J. Conron, Matthew J. Mimiaga, Stewart J. Landers.
Read the abstract in the American Journal of Public Health
The female community health volunteer program in Nepal: decision makers' perceptions of volunteerism, payment and other incentives in Social Science & Medicine (Vol. 70, issue 12, pp. 1920-1927)
The Female Community Health Volunteer (FCHV) Program in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programs are widely thought to be characterized by high attrition levels, the FCHV Program loses fewer than 5% of its volunteers annually.
The degree to which decisionmakers understand community health worker motivations and match these with appropriate incentives is likely to influence program sustainability. This study explored the views of stakeholders who have participated in the design and implementation of the FCHV regarding volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of volunteers.
This article presents the results from the study and suggests recommendations to improve community health worker program sustainability. Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S, Shrestha V.
Read the article in Social Science & Medicine
May 2010
Communication for Polio Eradication: Improving the Quality of Communication Programming Through Real-Time Monitoring & Evaluation in Journal of Health Communication, 15:9-24, 2010
Communication is a critical component in assuring that children are fully immunized and that simultaneous immunity is attained and maintained across large geographic areas for disease eradication and control initiatives. If service delivery is of good quality and outreach to the population is active, effective communication—through advocacy, social mobilization, and program communication (including behavior change activities and interpersonal communication)—will assist in raising awareness, creating and sustaining demand, preventing or dispelling misinformation and doubts, encouraging acceptance of and participation in vaccination services, more rapid reporting of disease cases and outbreaks, and mobilizing financial resources to support immunization efforts. There is evidence of 12% to 20% or more increases in the absolute level of immunization coverage and 33% to 100% increases in relative coverage compared to baselines when communication is included as a key component of immunization strengthening. This article utilizes evidence from Afghanistan, India, Pakistan, and Nigeria to examine how the Global Polio Eradication Initiative has utilized monitoring and evaluation data to focus and improve the quality and impact of communication activities.
Read the article in the Journal of Health Communication
Using Data to Guide Action in Polio Health Communications: Experience From the Polio Eradication Initiative (PEI) in Journal of Health Communication, 15:48-65, 2010
Health communication is increasingly recognized as a priority in changing health behaviors. But a prevailing focus in health communication on information, education, awareness, and knowledge—and their assumed relation to changing behavior among individuals or households—can underestimate the complexity of wider ecological conditions that influence and limit individual, household, and even community choices and capacity to choose. This study in the Journal of Health Communication looks at experience from the Polio Eradication Initiative (PEI), drawing on evidence from the India and Nigeria country programs, and provides insights into how health communication interventions can be strengthened by adopting a more holistic ecological model of people and their health-related behaviors. In particular, polio eradication health communication offers useful lessons in the importance of generating and using quality data to enable a more ecological analysis, combining and measuring specific communication inputs and epidemiological "outputs."
Read the article in the Journal of Health Communication
April 2010
Care seeking at time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh in Bulletin of the World Health Organization (Vol. 88, pp. 289-296)
The study examines the nature of the relationship between the use of skilled attendance around the time of delivery and maternal and perinatal mortality. The study was based on health and demographic surveillance system data collected between 1987 and 2005 by the International Centre for Diarrhoeal Disease Research, Bangladesh in Matlab, Bangladesh.
The study established that more than half (57.8%) of the women who died and one-third (33.7%) of those who experienced a perinatal death had sought skilled attendance. Maternal mortality was low among women who did not seek skilled care (160 per 100 000 pregnancies) and was nearly 32 times higher among women who came into contact with comprehensive emergency obstetric care. Perinatal death rates were also higher for those who sought skilled care than for those who did not.
Given the high maternal mortality ratio and perinatal mortality rate among women who sought obstetric care, more work is needed to ensure that women and their neonates receive timely and effective obstetric care. Reductions in perinatal mortality will require strategies such as early detection and management of health problems during pregnancy. Carine Ronsmans, Mahbub Elahi Chowdhury, Marge Koblinsky, and Anisuddin Ahmed.
Read the article in Bulletin of the World Health Organization
February 2010
Successful implementation of evidence-based routines in Ukrainian maternities, in Acta Obstetricia et Gynecologica Scandinavica
Eastern European countries typically have worse maternal health outcomes than Western European countries due to the poor health conditions of women, inadequate health training for specialists, and inefficiency in the health-care system. Maternity facilities also lack the basic equipment for neonatal care and delivery.
The article Successful implementation of evidence-based routines in Ukrainian maternities describes the process of change and assesses compliance and effect on maternal and infant outcomes when the WHO package of Effective Perinatal Care (EPC) was implemented at maternity hospitals in Ukraine. The article focuses on three of the 20 maternities that participated in JSI's Mother and Infant Health Project, in which the goal of improving practice and interventions in hospitals by introducing evidence-based routines for perinatal care was met. Helene Lefevre-Cholay, Anna Berglund, Alberta Bacci, Anna Blyumina and Gunilla Lindmark.
Read the article in in Acta Obstetricia et Gynecologica Scandinavica
December 2009
Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal, in International Journal of Gynecology & Obstetrics
The article 'Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal' looks at the feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services. The research was implemented in one district in Nepal.
The research concluded that community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged. Rajbhandari S, Hodgins S, Sanghvi H, McPherson R, Pradhan Y, Baqui AH.
Read the article in International Journal of Gynecology & Obstetrics
The Impact of the African Youth Alliance Program on the Sexual Behavior of Young People in Uganda in the Studies in Family Planning
The article The Impact of the African Youth Alliance Program
on the Sexual Behavior of Young People in Uganda looks at
the impact of the African Youth Alliance (AYA)
program on the sexual behavior of young people aged 17-22
in Uganda. The importance of protecting the health of young
people and encouraging and promoting safe sexual behaviors
is particularly great in sub-Saharan Africa. About one-third
of the population in sub-Sahara Africa is in the 15-24 age
group, and about half of all new infections occur within
that age group.
Between 2000 and 2005, the comprehensive multicomponent AYA program
implemented behavior-change communication and youth-friendly
clinical services, and it coordinated policy and advocacy.
The program provided institutional capacity building and
established coordination mechanisms between agencies that
implemented programs for young people. Ali Mehryar Karim,
Timothy Williams, Leslie Patykewich, Disha Ali, Charlotte
E. Colvin, Jessica Posner, and Gideon Rutaremwa.
Read the abstract in the Studies in Family Planning
November 2009
Has routine immunization in Africa become endangered? in The Lancet Infectious Diseases, November 2009
Many advances have been made in immunization in Africa in the past decade; there has been a large drop in mortality due to measles and the three-dose regimen of DPT3 provides coverage of at least 80% in all districts. Yet, the coverage goals of the Global Immunization Vision & Strategy remain elusive, and many children continue to be unimmunized. This article from in The Lancet Infectious Diseases looks at this issue in more depth and recommends that Africa needs to accelerate and sustain efforts to improve routine immunization services, with a focus on unimmunized children. The authors maintain that routine immunization is an integral part of all eradication activities, and greater emphasis beyond lip service needs to be placed on strengthening it. Routine immunization should not be considered simply as an end strategy once campaigns have halted transmission. Yermaine Berhane, John C. Clements, Jean Michael Ndiaye, and Patricia Taylor.
Read the article in the The Lancet Infectious Diseases
October 2009
Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal in the Journal of Perinatology
The aim of the study was to determine the feasibility of improved maternal neonatal care-seeking and household practices using an approach scalable under Nepal's primary health-care services. The intervention consisted primarily of community-based antenatal counseling and dispensing and an early postnatal home visit; most activities were carried out by community-based health volunteers. There were notable improvements in most household practice and service utilization indicators, although results regarding care-seeking for danger signs were mixed.
The study concluded that it is feasible in Nepal to significantly improve utilization of maternal neonatal services and household practices, using the resources available under the government primary health-care system. This has the potential to significantly reduce neonatal mortality. Hodgins S, McPherson R, Suvedi BK, Shrestha RB, Silwal RC, Ban B, Neupane S, Baqui AH.
Read the abstract in the Journal of Perinatology
Using Small-Area Estimation to Describe County-Level Disparities in Mammography in Preventing Chronic Disease Journal
Breast cancer control in the United States is a research area that could benefit
from estimating prevalence at the substate level. Most of
the data available on the use of preventive services, like
mammography, are national and state data, and studies have
identified correlates of cancer screening on these geographic
levels by using national health survey data.
Research is needed on subpopulations defined by geographic
units smaller than the state because findings from the national
or even state level often do not translate to the contextual
experience of women on the county or neighborhood level.
Substate variation in mammography prevalence has been found
for metropolitan statistical areas and counties with adequate
sample size (>= 50). Geographic gaps exist in mammography interventions;
certain areas disproportionately receive funds and outreach.
Women who are not screened may be concentrated in locations
with particular screening barriers.
The purpose of this study, "Using Small-Area Estimation
to Describe County-Level Disparities in Mammography," was
to determine the extent to which geographic disparities exist
in mammography and the extent to which the magnitude and
distribution of geographic disparities vary by race and age.
Karen Schneider, PhD, Kate L. Lapane, PhD, Melissa A Clark,
PhD, and William Rakowski, PhD.
Read the abstract in Preventing Chronic Disease.
September 2009
Implementing an integrated nutrition package at large scale in Madagascar: the Essential Nutrition Actions framework in Food & Nutrition Bulletin
Madagascar has some of the highest rates of child stunting, maternal malnutrition, and infant mortality in sub-Saharan Africa. The implementation of the Essential Nutrition Actions (ENA) framework in Madagascar aimed to improve infant and young child feeding practices, increase uptake of micronutrient supplements, and improve women's dietary practices.
This paper shows that nutritional practices can significantly improve when providing consistent messages through existing health systems. Changes in practices were assessed through a comparison of data for children under 2 from representative cross-sectional household surveys collected at baseline in 2000 and at the end of program implementation in 2005. The surveys were conducted in six districts with a population of 1.4 million.
As detailed in the paper, the implementation of ENA in Madagascar dramatically improved breastfeeding rates, iron-folic acid supplementation during pregnancy and postpartum vitamin A supplementation. Guyon AB, Quinn VJ, Hainsworth M, Ravonimanantsoa P, Ravel Joana V, Rambeloson Z, Martin L
Read the abstract in PubMed (a service of the U.S. National Library of Medicine)
June 2009
Reaching Every District (RED) Approach to Strengthen Routine Immunization Services: Evaluation in the African Region, 2005 in The Journal of Public Health
This evaluation of the RED implementation process provided evidence of improvement and challenges in delivery of routine immunization services. In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners visited sites at national, district and health facility levels using standardized qualitative questionnaires. The findings showed that RED was implemented in a similar manner in all five countries and that all five RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside of fixed immunization locations), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used. The evaluation concluded that the RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions. T. Ryman, R. Macauley, D. Nshimirimana, P. Taylor, L. Shimp, K. Wilkins.
Read the abstract in The Journal of Public Health
Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention in the Journal of Health, Population and Nutrition
Early recognition can reduce maternal disability and death due to postpartum hemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Data obtained through interviews with 149 participants living in Matlab, Bangladesh—including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs)—were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normal amount of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captured variation in theories with specificity and representativeness necessary to inform community health intervention. Lynn M. Sibley, Daniel Hruschka, Nahid Kalim, Jasmin Khan, Moni Paul, Joyce K. Edmonds, Marjorie A. Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
May 2009
Reported care quality in federal Ryan White HIV/AIDS Program supported networks of HIV/AIDS care in AIDS Care
This paper is based upon the EQITI project (Evaluation of Quality Improvement in Title I Programs) conducted by JSI in collaboration with Harvard Medical School. The Ryan White Program supports networks of care which include medical care providers and support services for people living with HIV and AIDS (PLWHA) in 51 Eligible Metropolitan Areas (EMAs). In the 2000 reauthorization of the Ryan White Program, quality management programs were required for all sites receiving funding.
To facilitate quality management and improvement activities in EMAs, a set of surveys was developed to measure characteristics of care networks and the quality, accessibility, and coordination of services from the perspectives of case management and medical providers, administrators and consumers. The surveys measured the entire network's quality management and support activities and reported on the quality of services at individual care sites. The article summarizes the findings of these surveys. Lisa R. Hirschhorn, Stewart Landers, D. Keith McInnes, Faye Malitz, Lin Ding, Rebecca Joyce, Paul D. Cleary.
Read the abstract in AIDS Care
April 2009
Safe Motherhood Case Studies: Learning with Stakeholders in South Asia—An Introduction in the Journal of Health, Population and Nutrition
The international community resolved in 1987 to reduce maternal mortality around the world. This resolution was strengthened in 2001 when 189 countries signed the Millennium Declaration, committing themselves to Millennium Development Goal (MDG) 5 towards improvement of maternal health. To accelerate national progress towards achieving MDG 5, a deeper understanding of what works at scale is needed. This article introduces a series of case studies that initiated a response to the growing call for evidence to support improved local implementation, gathering lessons from practice within and across more and less successful areas of South Asian countries. The aim is to build a body of knowledge by looking at patterns of problems and solutions to improve safe motherhood implementation at the national and subcountry levels. Highlighted within these case studies are lessons for the implementation of safe motherhood programs, stakeholders' dialogue, programmatic elements of successful safe motherhood programs, and selected context-specific innovations highlighted by national leadership in regional meetings of stakeholders.
Read the article in the Journal of Health, Population and Nutrition
Improving Maternal Survival in South Asia—What Can We Learn from Case Studies? in the Journal of Health, Population and Nutrition
Technical interventions for maternal healthcare are implemented through a dynamic social process, and peoples' behaviors influence the outcomes. Given the complexity inherent in these processes, a cause-and-effect relationship in one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers, and multiple technical interventions—without the ability to measure significant change in the outcome, the maternal mortality ratio.
This case study observes the implementation of maternal health programs across five states in India, Pakistan, and Bangladesh. Patterns that stand out and seem to apply throughout are discussed, as well as others that require more data to understand the observed patterns. Results from this study can provide guidance to program managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies; and to governments as to the factors shaping dynamic responses that might themselves warrant intervention. Barbara McPake, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Causes of Maternal Mortality Decline in Matlab, Bangladesh in the Journal of Health, Population and Nutrition
Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR), despite the lack of skilled care at delivery. This study investigates the possible causes of the maternal mortality decline in one rural area of Bangladesh—Matlab—where maternal mortality data has been available since the mid-1970s. Findings from this study show that improved comprehensive emergency obstetric care, stronger family-planning services, and expanded education for women are essential for maternal mortality decline. Mahbub Elahi Chowdhury, Anisuddin Ahmed, Nahid Kalim, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Public-sector Maternal Health Programmes and Services for Rural Bangladesh in the Journal of Health, Population and Nutrition
This paper assesses the development of public sector maternal health services and policies since independence in 1971, with primary focus on rural areas where 3/4 of the population of Bangladesh reside. Since 1971, the health infrastructure has developed, though not in a uniform pattern, despite policy shifts. Indicators are substantially lower for those in poorer areas, and a wide variation exists in the availability of comprehensive essential obstetric care (EOC) facilities in the public sector among Bangladesh's six divisions. The WHO 2005 recommendation (1 comprehensive EOC for 3,500 births) suggests that there is a need for significantly more comprehensive EOC facilities. This study provides recommended actions for the Government of Bangladesh, based on the WHO recommendation. Malay Kanti Mridha, Iqbal Anwar, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh in the Journal of Health, Population and Nutrition
This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in the rural areas of Khulna and Sylhet divisions—relatively high and low-performing areas of Bangladesh respectively. Areas examined include the distribution of functional EOC facilities throughout the districts, human resource constraints as a barrier to maternal health, sanctioned posts for nurses, unavailability of blood, lack of evidence-based techniques, and literacy and sociocultural barriers as they pertain to context of care. This study also suggests ways these facilities and constraints can be improved to further develop maternal healthcare in these divisions. Iqbal Anwar, Nahid Kalim, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Postpartum Hemorrhage and Eclampsia: Differences in Knowledge and Care-seeking Behaviour in Two Districts of Bangladesh in the Journal of Health, Population and Nutrition
Hemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. This study, conducted from July 2006 to December 2007, examines the differences in perceived knowledge and care-seeking behaviors of women in relation to these problems, in both high and low-performing districts of Bangladesh. Results show differences in care-seeking practices among women in the two different areas, which may reflect sociocultural differences, disparities in economic and educational opportunities, and discrimination in the availability of care. This gap could contribute to the high rate of maternal deaths associated with these conditions. Nahid Kalim, Iqbal Anwar, Jasmin Khan, Lauren S. Blum, Allisyn C. Moran, Roslin Botlero, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Verbal Autopsy of Maternal Deaths in Two Districts of Pakistan—Filling Information Gaps in the Journal of Health, Population and Nutrition
In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio (MMR) are limited. This study was conducted from 2005 to 2007 to collect information from various sources on maternal deaths, identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. Risk factors identified were low socioeconomic status, illiteracy, low-earning jobs, parity, and poor obstetric history. The study identified gaps in reporting of maternal deaths, and also provided profiles of the dead women, and their causes of death. Sadiqua N. Jafarey, Talat Rizvi, Marge Koblinsky, Nazo Kureshy.
Read the article in the Journal of Health, Population and Nutrition
March 2009
Communicating Hospital Infection Data to the Public: A Study of Consumer Responses and Preferences in the American Journal of Medical Quality
The study evaluated different approaches for reporting hospital-level comparative data on hospital-associated infections (HAIs) and the extent to which such data might influence hospital choice. Findings suggest that public reporting of comparative data on HAIs could influence hospital choice, but other factors including prior experience, reputation, physicians recommendations, and insurance coverage are also influential. Kathleen M. Mazor, EdD, Katherine S. Dodd, BS, Laureen Kunches, ANP, PhD.
Read the abstract in the American Journal of Medical Quality
Use of Computer Modeling for Emergency Preparedness Functions by Local and State Health Officials: A Needs Assessment in the Journal of Public Health Management and Practice
The article presents the methodology, results, and lessons learned from a multistate needs assessment of local and state public health and safety officials regarding their familiarity and use of formal computer modeling for preparedness activities. The study was undertaken to provide information to the newly formed Preparedness Modeling Unit within the Centers for Disease Control and Prevention.
Use of preparedness modeling would enhance the planning for vulnerable and at-risk populations, all-hazard emergencies and infectious disease containment strategies, as well as for response functions including evacuation, sheltering, quarantine, and distribution of medications and supplies. Rosenfeld, Lisa A.; Fox, Claude Earl; Kerr, Debora; Marziale, Erin; Cullum, Amy; Lota, Kanchan; Stewart, Jonathan; Thompson, Mary Zack
Read the abstract in the Journal of Public Health Management and Practice
February 2009
Female Community Volunteers Save Children from Pneumonia Deaths in Nepal in Global Health magazine
Pneumonia is a leading cause of mortality in children under-five in Nepal. In 1991, the Ministry of Health estimated the proportion of deaths due to pneumonia was between 30 to 40 percent. Today there are over 54,000 Female Community Health Volunteers (FCHVs) who have been trained to recognize key health issues and provide life-saving treatments, including providing Vitamin A, treating diarrhea with oral rehydration solution (ORS) and zinc, and recognizing and referring seriously ill children to health facilities.
JSI worked with the Nepal government to develop a community-based pneumonia treatment training package that FCHVs, many of whom are illiterate, could understand and implement in their communities. The results of this approach have been dramatic. Community-based pneumonia treatment has doubled the total number of cases treated as compared to districts with facility-based treatment only. Penny Dawson.
Read the article in Global Health
2009
Improving the capacity of the health workforce through pre-service medical education reform in the World Health Organization's (WHO) European Magazine for Sexual and Reproductive Health 'Entre Nous'
The article 'Improving the capacity of the health workforce through pre-service medical education reform' focuses on the need to ensure stronger pre-service education and in-service training systems in order to develop a well-performing health workforce and meet the increasing need for quality services.
In October 2008, the Europe and Eurasia Regional Family Planning Activity (EERFPA), funded by the U.S. Agency for International Development (USAID) and implemented by JSI, launched the initiative to address the scarcity of family planning topics in the curricula of medical and nursing schools in the region. EERFPA worked to reform medical and nursing school curricula by increasing evidence-based family planning teaching in pre-service medical education curricula and working within the systems that govern curriculum content. Berdzuli N.
December 2008
Cost of Hospital-Associated Infections in Massachusetts in the American Journal of Infection Control
The Massachusetts Department of Public Health appointed an expert panel to assess the problem of hospital-associated infections (HAI) in the state and make recommendations regarding mandatory reporting. At the panel's request, a cost-of-illness study was conducted using available data sources. In Massachusetts, the excess hospital costs attributed to HAIs were estimated at approximately $233 to $275 million in 2006. Patricia W. Stone, PhD, MPH, RN; Laureen Kunches, ANP, PhD; Lisa Hirschhorn, MD, MPH.
Read the abstract in the American Journal of Infection Control
Research Priorities to Reduce Global Mortality from Newborn Infections by 2015 in Pediatric Infectious Disease Journal
The article, "Research Priorities to Reduce Global Mortality From Newborn Infections by 2015," examines the types of questions researchers pose—and the responses they get in return—as a critical way to close the gap in delivering services in developing countries.
Given the lack of progress in improving newborn survival despite the existence of effective interventions, it is not surprising that of the top ranked research priorities in this article the majority are in the domain of health systems and policy research. The article urges funding agencies and investigators to invest in key research priorities to accelerate reduction of neonatal deaths, particularly those due to infections. Co-authored by Dr. Nabeela Ali, JSI Chief of Party in Pakistan
Read the abstract in the Pediatric Infectious Disease Journal
October 2008
Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature in Clinical Infectious Diseases
JSI senior staff, Laurie Kunches and Lisa Hirschhorn, have co-authored "Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature," an article in the October issue of Clinical Infectious Diseases (2008; 47:937-44). The article is part of the evidence review that the JSI team has done for the Massachusetts Department of Public Health's Healthcare Associated Infection project. The efforts are focused on eliminating preventable infections through application of clinical 'best practices' and other incentives across Massachusetts hospitals.
Read the abstract in Clinical Infectious Diseases
June 2008
Sexual and Gender Minority Health: What We Know and What Needs to be Done in the American Journal of Public Health
JSI Health Services Senior Consultant Stewart Landers co-authored an article in the American Journal of Public Health. The article is both a primer on sexual and gender minorities and their particular health care needs, and an outline on how health care practitioners can better serve these special populations by helping to meet those needs.
Read the abstract in the American Journal of Public Health
May 2008
From research to national expansion: 20 years' experience of community-based management of childhood pneumonia in Nepal in WHO Bulletin
Pneumonia is a leading cause of mortality of children aged under five in Nepal. Research conducted by JSI in the 1980s determined that pneumonia case management by community-based workers decreased under-five mortality by 28%.
The paper highlights the use of female community health volunteers to manage childhood pneumonia at community level using oral antibiotics.
The paper was written by JSI's Penny Dawson in collaboration with YV Pradhan, the Director of the Child Health Division, MOHP/Nepal, Robin Houston an independent consultant, Sushil Karki, Dilip Poudel, and Steve Hodgins, Chief of Party of the Nepal Family Health Project.
Learn more about JSI's work in Nepal
Read the abstract in the Bulletin of the World Health Organization, Volume 86, Number 5, May 2008.
April 2008
Improving the Management of Hypertension in Kazakhstan: Implications for improving clinical practice, patient behaviours and health outcomes in Global Public Health Journal
The article presents findings from the assessment of a strategy aimed at improving case-finding and management of hypertension patients. It was written by staff from the ZdravPlus Project, including Gita Pillai, the JSI Regional Director of Maternal and Child Health, and Deputy Chief of Party of the ZdravPlus Project, in collaboration with staff from Abt Associates and the Kazakhstan Association of Family Physicians and Family Medicine, Department of Almaty Postgraduate Institute for Physicians, Almaty, Kazakhstan.
Read the abstract in the Global Public Health Journal
October 2007
An On-going Burden: Chlamydial Infections among Young American Indian Women in the Maternal Child Health Journal
Yvonne Hamby, JSI Project Director of the Region VIII Infertility Prevention Project (IPP), collaborated with Centers for Disease Control and Prevention (CDC) and Indian Health Service (IHS) to contribute to the article, "An On-going Burden: Chlamydial Infections among Young American Indian Women," for the Maternal Child Health Journal (2008) 12:S25-29. The purpose of the study was to determine the chlamydia positivity and risk factors for chlamydia among women screened in Indian Health Service clinics participating in the Region VIII IPP in 2003.
Read the abstract in the Maternal Child Health Journal
Rural Community Members' Perceptions of Harm from Medical Mistakes: A High Plains Research Network (HPRN) Study in the American Board of Family Medicine
Over the past fiv years, there has been a push to improve patient safety. The aim of this study was to learn about community members' definitions and types of harm from medical mistakes.
The researchers used a mixed-methods study using community-based participatory research. Reported types of harm included emotional, financial, and physical harm. Reports suggest that perceived clinician indifference to unanticipated outcomes may lead to patients' loss of trust and belief that the unexpected outcome was a result of an error. By Rebecca F. Van Vorst, MSPH; Rodrigo Araya-Guerra, BA; Maret Felzien, MA; Douglas Fernald, MA; Nancy Elder, MD, MSPH; Christine Duclos, PhD, MPH and John M. Westfall, MD, MPH.
Read the article in the American Board of Family Medicine
August 2007
Promoting Unity of Purpose in District Health Service Delivery in Uganda through Partnerships, Trust Building and Evidence-based Decisionmaking in Education for Health
This paper examines how evidence-based decisionmaking and partnership-oriented implementation led to programmatic results and institutional behavior change in Ugandan districts through synergetic relationships between local governments and civil society organizations. Profiling the work of the Uganda Program for Human and Holistic Development (UPHOLD), this paper focuses on how the program addressed fragmentation to improve service delivery in the health sector.
The pillars of 'evidence-based decisionmaking' and 'partnerships,' together with approaches which strengthen existing synergies, produced more results, faster. Programs designed to work with fragmented settings should consider using the same pillars and blocks to ultimately make a difference in the lives of program beneficiaries. Authors: Orobaton N, Nsabagasani X, Ekochu E, Oki J, Kironde S, Lippeveld T.
Read the abstract in Education for Health
June 2007
An evaluation of infant immunization in Africa: is a transformation in progress? in the Bulletin of the World Health Organization
This article presents the findings from a review of data from
national infant immunization programs in the 46 countries
of WHO's African Region, to assess the progress made towards
meeting the goals of the African Regional Strategic Plan
of the Expanded Programme on Immunization between 2001 and
2005.
The authors found that rates of immunization coverage are
improving dramatically in the WHO African Region, though
countries did fall short of the target for 80% of countries
to achieve at least 80% immunization coverage by 2005. The
huge increases in spending on immunization and the related
improvements in program performance are linked predominantly
to increases in donor funding. L Arevshatian, CJ Clements,
SK Lwanga, AO Misore, P Ndumbe, JF Seward, P Taylor.
Read the abstract in Bulletin of the World Health Organization
January 2007
Alcohol Consumption Among Older Adults in Primary Care in the Journal of General Internal Medicine
This study explored alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. The cross-sectional analysis of more than 24,000 patients from multiple sites and looked at the quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety.
The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health. Authors: Joann E Kirchner, Cynthia Zubritsky, Marisue Cody, Eugenie Coakley, Hongtu Chen, James H Ware, David W Oslin, Herman A Sanchez, U Nalla B Durai, Keith M Miles, Maria D Llorente, Giuseppe Costantino, Sue Levkoff
Read the abstract in the Journal of General Internal Medicine
May 2005
Market Watch: Are California's Large Employers Moving to Catastrophic Health Insurance Coverage in Health Affairs
Large employers in California are experimenting with new health benefit and insurance options as premium rates continue to escalate. This study examines the offer and penetration rates of catastrophic coverage insurance products, including high-deductible PPO and consumer-driven health plans, among large CA employers before the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was passed. Only a few employers offered these plans, and they did not provide adequate incentives for their workers to accept. CA employers, like the rest of the nation, implemented these plans as alternatives rather than replacements to their current plan choices. James Maxwell, Peter Temin, Saminaz Zaman, Tanaz Petigara. Health Affairs/Project HOPE—The People-to-People Health Foundation, Inc. 2005. Health Affairs web exclusive.
March/April 2004
Private Health Purchasing Practices In The Public Sector: A Comparison of State Employers And The Fortune 500 in Health Affairs
State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs. James Maxwell, Peter Temin and Tanaz Petigara. Health Affairs, March/April 2004.
2003
Corporate Management of Quality in Employee Health Plans in Health Care Management Review
As large companies move their employees into managed care, they must concern themselves with the quality and price of their employees' health care. Based on a survey of Fortune 500 companies, this report shows that most Fortune 500 companies are integrating several aspects of quality into their purchasing and contracting decisions by focusing on three dimensions of quality—customer service, network composition, and clinical quality. James Maxwell, Peter Temin. Lippincott Williams & Wilkins, Inc. Health Care Management Review, Series volume 2003, vol. 28 (1), pages 29-42.
Read the article (PDF, 153 KB)
2002
The Benefits Divide: Health Care Purchasing in Retail Versus Other Sectors in Health Affairs
This study compares health care purchasing in the retail versus other sectors of the Fortune 500. Employing millions of low-wage workers, the retail sector is the largest employer of uninsured workers in the economy. This study found that retail companies are using the same competitive bidding process that other companies use to obtain a given level of coverage for the lowest possible cost. They are more price-oriented, however, than other Fortune 500 companies. The most striking disparity lies in the nearly fivefold difference in offer rates for health care coverage. James Maxwell, Saminaz Zaman, Peter Temin. Project Hope—The People-to-People Health Foundation, Inc. Health Affairs. Volume 21, Number 5, September-October 2002.