Facility- and community-based peer support interventions can benefit maternal uptake and retention in Option B+.

Objective: We aimed to quantify the relationship between national income and infant and under-five mortality in developing countries. Design: We conducted a systematic literature search of studies that examined the relationship between income and child mortality (infant and/or under-five mortality) and meta-analysed their results. Setting: Developing countries. Main outcome measures: Child mortality (infant and /or under-five mortality). Results: The systematic literature search identified 24 studies, which produced 38 estimates that examined the impact of income on the mortality rates. Using meta-analysis, we produced pooled estimates of the relationship between income and mortality. The pooled estimate of the relationship between income and infant mortality before adjusting for covariates is À0.95 (95% CI À1.34 to À0.57) and that for under-five mortality is À0.45 (95% CI À0.79 to À0

BackgroundOut of pocket (OOP) health spending can potentially expose households to risk of incurring large medical bills, and this may impact on their welfare. This work investigates the effect of catastrophic OOP on the incidence and depth of poverty in Malawi.MethodsThe paper is based on data that was collected from 12,271 households that were interviewed during the third Malawi integrated household survey (IHS-3). The paper considered a household to have incurred a catastrophic health expenditure if the share of health expenditure in the household’s non-food expenditure was greater than a given threshold ranging between 10 and 40%.ResultsAs we increase the threshold from 10 to 40%, we found that OOP drives between 9.37 and 0.73% of households into catastrophic health expenditure. The extent by which households exceed a given threshold (mean overshoot) drops from 1.01% of expenditure to 0.08%, as the threshold increased. When OOP is accounted for in poverty estimation, additional 0.93% of the population is considered poor and the poverty gap rises by almost 2.54%. Our analysis suggests that people in rural areas and middle income households are at higher risk of facing catastrophic health expenditure.ConclusionWe conclude that catastrophic health expenditure increases the incidence and depth of poverty in Malawi. This calls for the introduction of social insurance system to minimize the incidence of catastrophic health expenditure especially to the rural and middle income population.

Introduction Malawi has embarked on a ‘test-and-treat’ approach to prevent mother-to-child transmission of HIV (PMTCT), known as ‘Option B+’, offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral treatment (ART) regardless of CD4-count or clinical stage. We conducted a cross-sectional qualitative study to explore early experiences surrounding ‘Option B+’ for patients and health care workers (HCWs) in Malawi. Methods Study participants were purposively selected across six health facilities in three regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in ‘Option B+’ (N=24) and focus group discussions were conducted with HCWs providing Option B+ services (N=6 groups of 8 HCWs). Data were analysed using a qualitative thematic coding framework. Results Patients and HCWs identified the lack of male involvement as a barrier to retention in care, and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to ‘digest’ a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss-to-follow-up of women initated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies. Conclusions As ‘Option B+’ continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer-support and confidentiality.

BackgroundAn understanding of the complex relationship between health status and welfare is crucial for critical policy interventions. However, the focus of most policies in developing regions has been on current welfare to the neglect of forward-looking welfare analysis. The absence of adequate research in the area of future poverty or vulnerability to poverty has also contributed to the focus on current welfare. The objectives of this study were to estimate vulnerability to poverty among households in Ghana and examine the relationship between health status and vulnerability to poverty.MethodThe study used cross section data from the Fifth Round of the Ghana Living Standards Survey (GLSS 5) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. A three-step Feasible Generalized Least Squares (FGLS) estimation procedure was employed to estimate vulnerability to poverty and to model the effect of health status on expected future consumption and variations in future consumption. Vulnerability to poverty estimates were also examined against various household characteristics.ResultsUsing an upper poverty line, the estimates of vulnerability show that about 56% of households in Ghana are vulnerable to poverty in the future and this is higher than the currently observed poverty level of about 29%. Households with ill members were vulnerable to poverty. Moreover, households with poor hygiene conditions were also vulnerable to future poverty. The vulnerability to poverty estimates were, however, sensitive to the poverty line used and varied with household characteristics.ConclusionThe results imply that policies directed towards poverty reduction need to take into account the vulnerability of households to future poverty. Also, hygienic conditions and health status of households need not be overlooked in poverty reduction strategies.