Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs.

Aims: The primary objective of the present study was to evaluate the economic burden of specific learning disability (SpLD) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent/guardian to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to SpLD were Indian Rupees (INR) 5,936,053, 29,261,220, and 42,295,000, respectively. Indirect costs comprised 83.1% of the total costs. Expenditure on tuitions and remedial education comprised 61.61% and 64.39% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,888. The average annual total costs per student were INR 90,773. Longer duration of poor school performance was predictive of higher direct, indirect, and total costs; and higher socioeconomic status was predictive of lower intangible costs. Conclusion: SpLD is a cost-intensive disability (intangible > indirect > direct costs). Tuitions, which are not the therapy for SpLD, are the most costly component of indirect costs. Remedial education is the most costly component of direct costs.

Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infants.

OBJECTIVE: To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995-1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure. METHODS: Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991-1994 (n = 78) and 1997-2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks. RESULTS: In 1997-2001 compared with 1991-1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18-24 months showed a favourable outcome in 1997-2001. CONCLUSIONS: We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother-infant bonding and developmental outcome.

The burden and determinants of reproductive tract infections in India: a population based study of women in Goa, India.

BACKGROUND/OBJECTIVE: Reproductive tract infections (RTI) present major health, social, and economic problems in developing countries. Our objective was to describe the prevalence and risk factors of RTIs in a population based sample of women aged 18-45 years. METHOD: 2494 women of 3000 randomly selected from the population defined by a primary health centre catchment area consented to participate. Participants were interviewed regarding complaints and risk factors. Laboratory specimens were collected for the diagnosis of RTIs. Analyses of risk factors were carried out separately for the outcomes of sexually transmitted infections: chlamydia, gonorrhoea, trichomoniasis; and endogenous infections: bacterial vaginosis (BV) and candida. RESULTS: Endogenous infections were relatively common (BV 17.8%; candida 8.5%), and sexually transmitted infections (STI) were infrequent (4.2%). Factors indicative of poverty and marginalisation were associated with STIs and BV. Gender disadvantage, particularly spousal violence, was associated with BV, while concern about a husband's extramarital relationships, an indicator of sexual risk, was associated with STI. Husband's discharge was strongly associated with STI, and a non-white vaginal discharge was associated with both STI and BV. Condom use and oral contraceptive use were associated with a reduced risk of BV. CONCLUSIONS: Most of the population burden of RTIs is attributed to endogenous infections. Socioeconomic deprivation and gender disadvantage are associated with raised risk for BV, while the risk factors for STIs indicated that disadvantaged women were likely to be infected by their husbands.

Results of school eye screening of 5.4 million children in India--a five-year follow-up study.

PURPOSE: To assess results of a vision screening programme in schools in India, 5 years after its introduction. MATERIAL: Questionnaires on school eye screening activities were sent to 200 randomly selected districts. METHODS: Data from 61 districts were analysed, using process indicators to assess performance at different stages of the screening procedure. RESULTS: Teachers screened 5.39 million children in 61 districts. Refraction was done on 205,082 children (3.8%) and 43,922 children (0.8%) were provided with spectacles. Children of 10-15 years have more refractive errors. Different stages in the procedure are evaluated. CONCLUSION: Vision screening in schools has been taken up successfully in many districts in India. This has reduced the workload of eye care staff and increased the coverage. The simplicity of the procedure facilitates widespread application. Many parents take their children to the private sector for services. Monitoring and reporting needs to be improved.

The assessment of preventable infant and child deaths in developing countries: some applications of a new index.

This article briefly reviews epidemiological and demographic measures used to assess preventable deaths in developing country situations. Problems with the use of the infant mortality rate (IMR) as a health-policy indicator are illustrated. The Matlab experience of rural Bangladesh is used to develop a new index for preventable infant and child deaths. This index, based on a statistical transformation of usual demographic measures, links mortality levels and cause-of-death structure. The use of this index is illustrated with applications to Asia and Africa. It is claimed that the index exhibits more clearly the difficulty involved in the control of particular causes of death, thus providing important information for health policy makers.

[A demographic profile of Bangladesh]. / Profil demographique du Bangladesh.

PIP: Population trends in Bangladesh are reviewed. Consideration is given to population density, food supply, and methods of resolving the country's population problems. The author concludes that programs designed to raise the status of women have the best chance of success.^ieng

A population laboratory for studying disease processes and mortality--the Demographic Surveillance System, Matlab Comilla, Bangladesh.

PIP: Describes the Demograhic Surveillance System (DSS) of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), initiated in 1963. The DSS consists of periodic censuses of the study population with intervening registration of vital events. The surveillance area currently consists of 159 villages, containing an estimated population (1974) of 160 thousand, in Matlab, Comilla district. Immediate objectives are assessment of maternal and child health and family planning services in the area, research related to diarrheal diseases, measurements and determinants of fertility and mortality, and development of a demographic field site for training of people involved in national programs. Data are collected through a 3 tiered system: vital events are recorded by female village workers, whose work is checked by field assistants, then coded and processed in Dacca, and put on computer. Selected results from DSS studies are discussed, focusing on particular aspects of mortality or morbidity and epidemiological studies regarding diarrhea and nutrition, to illustrate the possibilities of a population laboratory in these contexts. The DSS has 7 advantages: 1) enables an accurate count of the population; 2) provides accurate sampling frames; 3) provides precise age data; 4) enables studies of client cooperation with health services; 5) facilitates prospective research designs; 6) collects demographic data which may reflect national statistics; 7) serves as a field training site. However, limitations of expense, data collected on causes of events, error correction, and study design must be considered. Computerization should make it possible to turn the DSS into a registration system. Population laboratories in other parts of the world, with differing focuses, are briefly described, and some of their studies are compared to those of the DSS.^ieng

Estimates of fertility in Bangladesh.

PIP: The attempt is made to estimate fertility levels in Bangladesh on the basis of data collected during the 1974 Census. In the 1st section attention is directed to providing an overall picture of the demographic situation in the country. Comparisons between the 1961 and 1974 data demonstrates that the 1974 Census data provide consistent results. Factors such as the degree of urbanization, literacy and economic participation rates--considered as indicators of development--all seem to show little progress during the intercensal period. The use of child/women ratios (CWRs) provides plausible evidence of the likelihood of a fertility decline. A decline in CWR values is small for "all areas" but a marked decline can be noted for "urban areas." The recorded mean number of children is less in 1974 than in 1961 for women under age 35 whereas for the older groups the 1974 Census shows higher mean numbers. The Bangladesh Fertility Survey (BFS) data result for the total fertility rate of 6.58 is very close to that estimated for the 1974 Census--6.59. The reverse survival method also indicates that birthrates have been lower during the 1969-1974 period.^ieng

Assessment of the value of factor VIII procoagulant and antigen ratio in the diagnosis of carriers of haemophilia.

The detection rate of carriers of haemophilia was evaluated using the ratio of factor VIII procoagulant activity (VIIIc) to factor VIII antigen (VIIIag). In normals the corelation coefficient of VIIIc to VIIIag was 0.82. In 15 obligatory carriers of haemophilia whose VIIIc and VIIIag levels were studied in the authors' labotatory there was no correlation between VIIIc and VIIIag and the ratio of VIIIc to VIIIag was below the lowest normal value in 12 (80%). In all five obligatory carriers whose VIIIc levels were estimated in the referring institution and VIIIag levels in the authors' laborary the ratio was below the lowest normal value. In 17 sisters of haemophiliacs studied here or referred for estimation of VIIIag only, an abnormal ratio was found in seven. Of 25 mothers of haemophilic children without a family history of haemophilia carriers is close to that expected on theoretical grounds but the interpretation of the results is complicated by the small numbers of patients all of whose studies were performed entirely in the authors' laboratory. In two normal individuals, one of who was on a contraceptive pill, there were no fluctuations of the ratio of VIIIc to VIIIag during the menstrual cycle. In one obligatory carrier with a normal ratio there was also no fluctuation. It is concluded here that a measurement of the ratio of VIIIc to VIIIag is a valuable adjuvant in genetic counselling in haemophilia.