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BACKGROUND: Labour induction using Misoprostol or Dinoprostone results to similar maternal and foetal clinical outcomes. However, the clinical outcome measures have rarely been combined with effects of interventions on patients' health related quality of life. This study aimed to assess postpartum health related quality of life of parturient after labour induction with vaginal administration of misoprostol versus dinoprostone. METHODS: This was a comparative cross sectional study in which pregnant women who underwent labour induction with misoprostol and dinoprostone during the study period were included. Data were collected within 24 hours post-delivery using the 36 item short form health survey questionnaire which consists of 24 attributes distributed in five domains including bodily pains and physical performance three attributes each, mental health seven attributes, general health two attributes, social functioning six attributes and three attributes for labour induction satisfaction. We first estimated scores of all attributes in each domain using Likert scales and then the domain scores were converted into a 0 to 100 scales to express in percentage of total scores. Quality of life was compared in the two study groups using the independent samples T Test. Multivariate regression analysis was performed to control for marital status, gravidity, parity, baseline cervical status, time interval from induction to delivery and mode of delivery. RESULTS: Women who received misoprostol reported better health related quality of life compared to those who received dinoprostone (mean score 92.89 vs. 87.25;P<.00). Misoprostol group had significantly higher scores in all domains of health related quality of life; reduced bodily pain (93.76 vs. 84.19;P<.00), physical performance (83.64 vs. 73.58;P<.00), mental health (96.40 vs. 93.55; P<.00), general health (93.78 vs. 90.23;P=.01), social functioning (94.81 vs. 91.25;P<.00) and satisfaction perceptions (94.96 vs. 90.71;P<.00). CONCLUSION: Health related quality of life information is of particular value in routine care of natal and postnatal mothers. Current and updated guidelines should address the impacts of labour induction interventions on maternal health related quality of life, and encourage the use of quality of life information in provision of holistic natal and postnatal care services. Clinical trials are recommended to determine the effectiveness of labour induction with either of the two methods and address the historical adverse outcomes associated to the use of misoprostol.
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BACKGROUND: In Tanzania, the distribution and coverage of insecticide-treated nets (ITNs) is inequitable. Arguments about the most effective and equitable approach to distributing ITNs centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. The Government has decided to provide free ITNs to all children under five in the country. It is still uncertain whether this strategy will achieve equitable coverage and use. This study examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs and a district without free ITN distribution. METHODS: A cross-sectional comparative household survey was conducted in two districts: Mpanda in Rukwa Region (with free ITN roll out) and Kisarawe in Coast region (without free ITNs). Heads of 314 households were interviewed in Mpanda and Kisarawe. The concentration index was estimated and regression analysis was performed to compare socioeconomic inequalities in ownership and use of ITNs. RESULTS: Ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda, with nearly perfect equality in use (concentration index 0.009) and ownership (concentration index 0.010). In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with a marked inequality concentration index 0.132. ITN use in Kisarawe district was 42% with a pro rich concentration index of 0.027. CONCLUSIONS: The results shed some light on the possibilities of reducing inequality in ownership and use of ITNs and attaining Roll Back Malaria and Millennium Development Goals through the provision of free ITNs to all. This has the potential to decrease the burden of disease and reduce disparity in disease outcome.
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BACKGROUND: Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. METHODS: The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. RESULTS: Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. CONCLUSIONS: We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action.