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PubMed2004

Sexually transmitted disease management in Uganda's private-for-profit formal and informal sector and compliance with treatment.

OBJECTIVE: The objective of this study was to investigate the management of sexually transmitted diseases (STDs) in the Ugandan private sector clinics and drug shops. STUDY: Men with urethral discharge who had consulted clinics (264) or drug shops (141) for treatment in 5 districts were interviewed using a precoded questionnaire 1 to 3 weeks after initiation of treatment. RESULTS: Seventy-seven percent of patients sought treatment within 1 week of onset of symptoms but only 7% were properly managed (treated according to National Guidelines, told to use a condom or abstain, and to refer their partner). The reported cure rate was 47% and only 9% were treated according to National Guidelines. Eighteen percent of patients used condoms during treatment, 36% persuaded their partner to go for treatment, and 87% completed the recommended treatment course. Of patients not reporting cure, 56% would still recommend the treatment to a friend. CONCLUSION: Quality of STD management by private providers is poor. Improvement should occur concurrently at public and private facilities. Possible strategies include training and social marketing of prepackaged treatment for STDs.

Adolescent↗
PubMed1999

Collaboration between developing and developed countries and between developing countries in occupational health research and surveillance.

Collaborative occupational health and safety studies between counterparts in developing and developed countries and between developing countries have demonstrated their potential for improving occupational health and safety. Such collaboration in occupational health and safety is encouraged in the development of infrastructure in research empowerment and capacity building. This action includes the setting of priorities, the identification and documentation of problems, sponsorship, data bases and surveillance systems, technical support, methodology, publishing, research and training programs, controlled intervention, information exchange, and networking. Examples of priorities in occupational health and safety in the developing world include the informal sector (informally hired and independent workers), temporary work, pesticides, accidents, dusts, carcinogens, solvents, ergonomics, women and child labor, human immunodeficiency virus/acquired immunodeficiencey syndrome (HIV/AIDS), and transfer of hazardous materials and technologies. The sustainability of occupational health and safety structures and functions in the developing countries is a primary concern. Socioethical principles emphasize local, national, mutual and global gains. Examples of collaboration are given. Pervasive problems and strategies toward their solution are highlighted.

Developed Countries↗
PubMed2006

Injection practices in the formal & informal healthcare sectors in rural north India.

BACKGROUND & OBJECTIVES: Unsafe injections in health settings contribute to a large burden of preventable blood-borne diseases. Current strategies to enhance injection safety in India almost exclusively target the formal health sector. However, injections are provided not only by doctors and nurses in the formal sector, but also by practitioners from the informal sector, such as traditional healers, who are not necessarily trained or authorized to administer these. The present study was undertaken to determine the extent to which patients using formal healthcare services also consult and receive injections in the informal sector, quantify the injections received by these patients and their relatives, and assess knowledge and attitudes in relation to injections. METHODS: A cross-sectional survey of 280 in patients and 120 of their relatives was undertaken between November 2004 and February 2005 in two rural hospitals in Bihar and Jharkhand states. RESULTS: Sixty one per cent of patients had consulted a healthcare practitioner in the month prior to admission, and 39 per cent of these had consulted in the informal sector at least once. Forty three per cent had received at least one injection in the month prior to admission, and 43 per cent of these were given by informal practitioners. About 13 per cent of relatives had received at least one injection in the last three months, 69 per cent of which were given by informal practitioners. Thirty per cent did not know that unsafe injections can spread diseases. INTERPRETATION & CONCLUSION: The findings of this survey highlight the fact that informal practitioners in India are commonly administering injections with clear implications for patient safety. There is a need to promote strategies for injection safety among both formal and informal practitioners.

Adolescent↗
PubMed1996

Why do men with urethritis in Cameroon prefer to seek care in the informal health sector?

OBJECTIVE: To study the impact of cost of treatment for sexually transmitted diseases (STDs) on the preference of men with urethritis to seek care in the informal sector. SUBJECTS AND METHODS: A random sample of young men from the general population of Yaoundé and Douala, Cameroon, and of employees of a Yaoundé factory underwent a structured interview on the occurrence of STD-related complaints and health seeking behaviour. Men who consulted in the formal sector were compared with men consulting in the informal sector, with regards to cost of medication and level of education. RESULTS: Sixteen percent of men in the general population and 20% of factory employees reported a history of urethritis in the 12 months preceding the interview. Of the men in the general population 53% had sought care in the formal sector; among the factory employees this proportion was 56%. Men who did not consult in the formal sector spent significantly less on drugs than men who did consult in the formal sector: median cost $14.4 versus $24.0 (p = 0.02) for drugs purchased in pharmacies; median cost $8 versus $32 for drugs purchased in small stores or from acquaintances. Preference for formal health services was associated with higher educational attainment. CONCLUSION: In large towns in Cameroon the utilisation of formal health services for STD related complaints is low and the high cost of treatment in the formal sector may play an important role in the choice of care option.

Adolescent↗
PubMed2004

An economic analysis of communal goat production.

The economic impact of different extension messages used was calculated using enterprise budgeting (gross margin analysis). Input data were gleaned from the literature, from participatory appraisals, as well as a field study, spanning 12 months, of small-scale communal goat farming systems in Jericho in the Odi District of North West Province. The number of offspring weaned per annum, as a proportion of does owned, was selected as the desired output for analysis. This study has shown that small-scale communal goat farmers are not adopting or implementing extension messages to improve production capacity. In South Africa the majority of goats are slaughtered in the informal sector. If the informal sector is to be persuaded to market goats commercially through formal channels, then knowledge of the economics of goat farming on communal lands should be provided. The economic aspects of extension messages are probably an important factor in determining acceptance and sustainability yet appear to be seldom investigated. The probable reason for lack of adoption of standard extension messages, which promote improved nutrition, parasite control, vaccination and treatment of goats, was economic. In other words, the so-called 'poor management practices' used by communal farmers appeared to be economically more profitable than the 'good management practices' suggested to increase production. The price of communal goats was not related to their mass. A higher level of inputs would probably have resulted in a heavier kid, however it was established that this would not have influenced the price received as a majority of the goats were slaughtered for ritual purposes where age, colour and sex were more important to the purchaser than body mass. It is standard practice in commercial farming systems to evaluate the economic benefits of all management practices before they are implemented. Production animal veterinarians use veterinary economics to compare different scenarios to control diseases or select management practices in commercial herds. It is suggested that the inputs and outputs of small-scale farming systems should be carefully analysed and that veterinary economics should also be used to evaluate the probable impact of extension messages formulated by veterinarians and animal health technicians.

Animal Husbandry↗
PubMed2002

The reproductive and occupational health of women street vendors in Johannesburg, South Africa.

While the informal sector is rapidly emerging as the major source of employment in poor countries, little attention has been paid to the health hazards encountered by workers in this sector. Women, the majority of informal sector workers in most parts of the world, are particularly at risk. This paper reports on 422 women street vendors trading in 323 city blocks in Johannesburg, South Africa. The median age was 29 years, 66% were single, 29% had primary education and 58% had secondary schooling. Foreign-born women accounted for 15% of the sample and a further 59% of the women were not born in Johannesburg. More than a third of the women did not work for themselves and 48% earned <115 US dollars per month. Fertility was positively related to age and inversely related to education, while reported infertility was related to gynaecological disease. More than half the women used, mainly injectable, contraceptives and only 5% reportedly had PAP smears taken. Most of the women sold food and clothing, 51% lifted heavy weights and a small proportion of the women worked with fire. Over half of the women (54%), mainly those over 40 years and the self-employed, complained of a work-related illness or injury, mainly burns, cuts, headaches and musculoskeletal problems. The type of health problem was related to age and 32% had received treatment. More than half (52%) of the respondents reported that they were not comfortable with the working environment, for reasons ranging from lack of shelter and dirt (34%), noise (26%) and having to clean the area themselves (24%). While only 2% reported that they felt unsafe, violence and abuse was ever present. Approximately one in four women reported some form of abuse, either verbal or physical, while 7% reported that they had been sexually harassed. A substantial proportion (29%) of the women reported that they had been robbed of money or goods while trading in the streets. The implications of these findings are discussed.

Adult↗
PubMed1999

A Delphi survey of research priorities and identified areas for collaborative research in health sector library and information services UK.

The survey aims were to determine research priorities in the Health Library and Information Services sector in the United Kingdom as to their perceived value for the professional and impact on user needs and to identify areas suitable for collaborative research. A 34-member panel consisting of the Chairs of professional groups, journal editors, educationalists, key organizations and representatives from the Health Libraries Group, Libraries for Nursing and University Health Science Libraries professional groups, participated in a three-round postal questionnaire survey using the Delphi Technique. Consensus was achieved for a final set of 20 research priorities. The priorities and their category groups are discussed in the context of (i) the current R&D scene, and (ii) the health information environment. Six developmental recommendations are provided.

Cooperative Behavior↗
PubMed1999

Assessment of health services for treatment of sexually transmitted infections among Nigerian adolescents.

BACKGROUND: The available evidence indicates that Nigerian adolescents use various health practitioners for the treatment of sexually transmitted diseases (STDs). However, the quality of the STD treatment used by adolescents has not been investigated previously. GOAL OF THIS STUDY: To investigate the quality of services provided by health practitioners for the treatment and prevention of STDs among adolescents in Benin City, Nigeria. STUDY DESIGN: In-depth interviews were conducted with 48 formal and informal sector health practitioners who were identified by key informants as being the main providers of STD treatment in the city. Their facilities were visited to evaluate the quality of services they provide for STD treatment. RESULTS: Health providers in the informal sector showed inadequate knowledge of the appropriate treatment methods for STDs. Although providers in the formal sector had better knowledge, they lacked appropriate management guidelines and were poorly oriented to the problems of STDs in adolescents. There was consensus among the health providers that adolescents most frequently use informal treatment for STDs. Nevertheless, among all providers, there was evidence of inadequate counseling of adolescents, a poor attitude toward the promotion of condom use, and inadequate use of referral opportunities. CONCLUSIONS: Comprehensive public health measures are needed to address these problems in Nigeria. These include the provision of reproductive health education for adolescents, the retraining of health providers, and the consolidation of services for the prevention and treatment of STDs.

Adolescent↗
PubMed2006

Climate variability and change and their potential health effects in small island states: information for adaptation planning in the health sector.

Small island states are likely the countries most vulnerable to climate variability and longterm climate change. Climate models suggest that small island states will experience warmer temperatures and changes in rainfall, soil moisture budgets, prevailing winds (speed and direction), and patterns of wave action. El Niño events likely will strengthen shortterm and interannual climate variations. In addition, global mean sea level is projected to increase by 0.09-0.88 m by 2100, with variable effects on regional and local sea level. To better understand the potential human health consequences of these projected changes, a series of workshops and a conference organized by the World Health Organization, in partnership with the World Meteorological Organization and the United Nations Environment Programme, addressed the following issues: the current distribution and burden of climate-sensitive diseases in small island states, the potential future health impacts of climate variability and change, the interventions currently used to reduce the burden of climate-sensitive diseases, additional interventions that are needed to adapt to current and future health impacts, and the health implications of climate variability and change in other sectors. Information on these issues is synthesized and key recommendations are identified for improving the capacity of the health sector to anticipate and prepare for climate variability and change in small island states.

Acclimatization↗
PubMed1992

Drug retailer training: experiences from Nepal.

Sale of modern medicines by untrained peddlers, general merchants, and other drug sellers is common throughout the developing world. Drug sellers operating in the 'informal sector' are often the first source of health care outside the home. Reasons given by patients for using private drug sellers include expediency, convenience, efficacy of the medicines, dependability of supply, and reasonable cost. At the same time, self-medication through private drug sellers can be ineffective, wasteful, and at times distinctly harmful. Regulatory approaches to controlling drug selling in the informal sector, widely endorsed on paper through national drug control legislation, require a cadre of professional regulatory staff and enforcement mechanisms which are too often beyond the current economic and political reach of countries. In Nepal, where rugged terrain has limited infrastructure development, the doctor to population ratio is 1:23,000, utilization of government health services averages only 0.2 visits per person per year. Retail drug outlets outnumber health posts and health centers by a ratio of 4:1 and private drug sellers often offer the only access to modern medicine for much of the population. Community surveys have found that drug retailers are very often the first and only source of health care outside the home. Given the importance of retail drug outlets and the lack of trained pharmacists, the Department of Drug Administration in 1981 established a 45-hr course for drug retailers which emphasized practical training as well as formal teaching on pharmacology, ethics, storage of drugs, and legal issues. By the end of 1989, 4096 drug retailers had graduated from the course. Still run by the Ministry of Health Department of Drug Administration, the course has proven to be administratively feasible and has been quite popular with drug retailers. Initial reservations expressed by doctors and some pharmacists were soon overcome, and the course is now well accepted by professional groups. Because the course is offered in different locations, geographic coverage has also been very good despite Nepal's logistic constraints. The operating cost of the course averages about U.S. $18 per trainee. Informal evaluations have resulted in plans for refresher training more narrowly focused on safe dispensing and appropriate referral for a limited number of important public health problems. Since 50-90% of pharmaceutical expenditures typically pass through the informal private sector in developing countries, it is suggested that other countries consider focused drug retailer training as a response to the problems of manpower shortages and drug dispensing by unqualified staff.

Costs and Cost Analysis↗
PubMed1984

A model of child nutrition, fertility, and women's time allocation: the case of Nicaragua.

"This study had two main goals. The first was to test the hypothesis that women who work in the informal sector of the labor force have better-nourished children, ceteris paribus, than women who work in the formal sector. A simple home production model for child nutrition incorporating this hypothesis was specified and the behavior of a utility-maximizing household investigated. The empirical estimates of the nutritional status production function provided no convincing support for the hypothesis." The second goal was "to investigate the joint determinants of child nutrition and of women's fertility and work choices....[It is suggested] that increases in women's education and formal sector wages will induce declines in fertility and improvements in child nutrition. Increases in informal sector wages will improve nutrition but have little impact on fertility, and income effects are minimal on all three variables." Data are from a household survey conducted in Nicaragua in 1977 and 1978.

Americas↗