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1.

Measurement of Health Program Equity Made Easier: Validation of a Simplified Asset Index Using Program Data From Honduras and Senegal.

Ergo, Alex; Ritter, Julie; Gwatkin, Davidson R; Binkin, Nancy
| Idioma(s): Inglés
Equitable access to programs and health services is essential to achieving national and international health goals, but it is rarely assessed because of perceived measurement challenges. One of these challenges concerns the complexities of collecting the data needed to construct asset or wealth indices, which can involve asking as many as 40 survey questions, many with multiple responses. To determine whether the number of variables and questions could be reduced to a level low enough for more routine inclusion in evaluations and research without compromising programmatic conclusions, we used data from a program evaluation in Honduras that compared a pro-poor intervention with government clinic performance as well as data from a results-based financing project in Senegal. In both, the full Demographic and Health Survey (DHS) asset questionnaires had been used as part of the evaluations. Using the full DHS results as the "gold standard," we examined the effect of retaining successively smaller numbers of variables on the classification of the program clients in wealth quintiles. Principal components analysis was used to identify those variables in each country that demonstrated minimal absolute factor loading values for 8 different thresholds, ranging from 0.05 to 0.70. Cohen's kappa statistic was used to assess correlation. We found that the 111 asset variables and 41 questions in the Honduras DHS could be reduced to 9 variables, captured by only 8 survey questions (kappa statistic, 0.634), without substantially altering the wealth quintile distributions for either the pro-poor program or the government clinics or changing the resulting policy conclusions. In Senegal, the 103 asset variables and 36 questions could be reduced to 32 variables and 20 questions (kappa statistic, 0.882) while maintaining a consistent mix of users in each of the 2 lowest quintiles. Less than 60% of the asset variables in the 2 countries' full DHS asset indices overlapped, and in none of the 8 simplified asset index iterations did this proportion exceed 50%. We conclude that substantially reducing the number of variables and questions used to assess equity is feasible, producing valid results and providing a less burdensome way for program implementers or researchers to evaluate whether their interventions are pro-poor. Developing a standardized, simplified asset questionnaire that could be used across countries may prove difficult, however, given that the variables that contribute the most to the asset index are largely country-specific.
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2.

Social network targeting to maximise population behaviour change: a cluster randomised controlled trial.

Kim, David A; Hwong, Alison R; Stafford, Derek; Hughes, D Alex; O'Malley, A James; Fowler, James H; Christakis, Nicholas A
| Idioma(s): Inglés
BACKGROUND: Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change. METHODS: In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580. FINDINGS: Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting. INTERPRETATION: Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health. FUNDING: National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.
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3.

Características de colecistectomía laparoscópica ambulatoria y hospitalaria, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 2012-2013/ Characteristics of outpatient and hospital laparoscopic cholecystectomy, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 2012-2013

Blanco Raudales, Ericka; Sierra, Rafael; Alger, Jackeline
| Idioma(s): Español
Antecedentes: Colecistectomía Laparoscópica Ambulatoria (CLA) es el procedimiento donde el tiempo entre ingreso y egreso del paciente es <12 horas. En el Hospital de Especialidades (HE) del Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, se implementó desde 2007. Objetivo: Determinar las características de CLA y de Colecistectomía Laparoscópica Hospitalaria (CLH), IHSS, 2012-2013. Métodos: Estudio descriptivo transversal en pacientes atendidos en Unidad de Cirugía Ambulatoria y HE IHSS, enero 2012­Enero 2013. Se identificaron características sociodemográficas y clínicas a partir de expedientes seleccionados aleatoriamente. Se estimó costo-beneficio en base a costo/intervención quirúrgica y días de hospitalización e incapacidad. Resultados se presentan como frecuencia y porcentaje, razones de disparidad (OR), intervalo de confianza 95% y valor de p<0.05. Resultados: Se analizaron 100 pacientes en cada grupo. Se asociaron a CLA edad ≤50 (3.8, 2.1
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4.

Tailored nutrition education and food assistance improve adherence to HIV antiretroviral therapy: evidence from Honduras.

Martinez, Homero; Palar, Kartika; Linnemayr, Sebastian; Smith, Alexandria; Derose, Kathryn Pitkin; Ramírez, Blanca; Farías, Hugo; Wagner, Glenn
| Idioma(s): Inglés
Food insecurity and malnutrition negatively affect adherence to antiretroviral therapy (ART) and are associated with poor HIV clinical outcomes. We examined the effect of providing household food assistance and nutrition education on ART adherence. A 12-month prospective clinical trial compared the effect of a monthly household food basket (FB) plus nutrition education (NE) versus NE alone on ART adherence on 400 HIV patients at four clinics in Honduras. Participants had been receiving ART for an average of 3.7 years and were selected because they had suboptimal adherence. Primary outcome measures were missed clinic appointments, delayed prescription refills, and self-reported missed doses of ART. These three adherence measures improved for both groups over 12 months (p < 0.01), mostly within 6 months. On-time prescription refills improved for the FB plus NE group by 19.6 % more than the group receiving NE alone after 6 months (p < 0.01), with no further change at 12 months. Change in missed appointments and self-reported missed ART doses did not significantly differ by intervention group.
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6.

La situación económica: social determinants of contraceptive use in rural Honduras.

Hall, Marissa G; Garrett, Jenna J; Barrington, Clare
| Idioma(s): Inglés
Contraceptive use is an important determinant of unintended pregnancy, but little is known about the social and structural factors that determine women's contraceptive use in rural Honduras. In this study, we aim to characterise the individual and social determinants of contraceptive use among women in rural Honduras. In 2011 and 2012, we conducted 14 interviews and 2 focus groups with women 18 years and older. In our analysis, we created a family-planning narrative for each participant and coded transcripts around key emergent themes related to these determinants. We found that social determinants--including poverty, gender dynamics and availability of family-planning methods--had a strong influence on contraceptive use among women in our sample. Study participants stated that they were faced with a difficult economic situation compounded by rising prices of basic goods and diminishing job opportunities. Paradoxically, at the same time that the economic situation led women to seek contraception, it also contributed to the structural barriers that limited their ability to obtain their method of choice and maintain continuous contraceptive use. Our findings suggest the need for multi-level efforts to create an enabling and sustainable environment for family planning among women in rural Honduras.
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7.

Determinantes sociales de la exclusión a los servicios de salud y a medicamentos en tres países de América Central./ [Social determinants of exclusion from health services and medicines in three Central American countries].

Acuña, Cecilia; Marina, Nelly; Mendoza, Adriana; Emmerick, Isabel Cristina Martins; Luiza, Vera Lucía; Azeredo, Thiago Botelho
| Idioma(s): Español
OBJECTIVE: Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua. METHODS: A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA). RESULTS: Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines. CONCLUSIONS: The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.
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8.

Determinantes sociales de la exclusión a los servicios de salud y a medicamentos en tres países de América Central/ Social determinants of exclusion from health services and medicines in three Central American countries

Acuña, Cecilia; Marina, Nelly; Mendoza, Adriana; Emmerick, Isabel Cristina Martins; Luiza, Vera Lucía; Azeredo, Thiago Botelho
| Idioma(s): Español
OBJETIVO: Examinar los determinantes sociales que afectan la conducta de la población en relación con la búsqueda y obtención de medicamentos, y su relación con la exclusión de los servicios de salud para datos agregados de tres países de América Central: Guatemala, Honduras y Nicaragua. MÉTODOS: Estudio observacional descriptivo de corte transversal, mediante la aplicación de una encuesta de hogares. La muestra del estudio se seleccionó de acuerdo al método de conglomerados. Los datos fueron analizados con el programa SPSS® V.17, utilizando estadística descriptiva y análisis bivariado, multivariado y por componentes principales (ACP). RESULTADOS: Aunque la mayoría de las personas pudo acceder a la atención en salud, la exclusión en salud (razón de probabilidades [RP] 4,10; intervalo de confianza de 95% [IC95%]) fue el principal determinante de la falta de acceso a los medicamentos. Las características de la vivienda (RP 0,747, IC95%), la formalidad del empleo del jefe(a) de hogar (RP 0,707, IC95%) y las condiciones socioeconómicas del hogar (RP 0,462, IC95%) fueron también importantes determinantes de la falta de acceso a los medicamentos. CONCLUSIONES: Los fenómenos de la falta de acceso a servicios de salud y a medicamentos no son independientes entre sí. Se corroboró que el sistema de salud, como determinante social intermediario de la salud, es un factor importante para la mejora del acceso a medicamentos. Las políticas públicas orientadas a alcanzar la cobertura universal deben contemplar esta relación para ser eficaces. OBJECTIVE: Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua. METHODS: A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA). RESULTS: Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines. CONCLUSIONS: The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.
Resultados  1-10 de 1.225