BackgroundThe case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.MethodsAn end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment.ResultsContracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers.ConclusionContracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.

Child maltreatment remains a significant problem in the USA. There is a dearth of literature examining the association of socioeconomic status (SES) and incidence of child maltreatment among hospitalized children across the entire USA. Our aim was to study the association between SES and incidence and mortality from child maltreatment among hospitalized children in the USA. We used 2013–2014 data from the Nationwide Inpatient Sample, a discharge database representative of all hospitals in the USA. International Classification of Diseases-9 codes for general child maltreatment were used to identify patients discharged with a primary diagnosis of child maltreatment. Trends in the incidence and outcomes of child maltreatment were compared with SES based on quartiles (Qx) of median household income. In 2013–2014, there were a total of about 2.3 million pediatric discharges. Out of these, a total of 8985 had a primary diagnosis of child maltreatment. Approximately 40 per cent of the cases were from families with the lowest SES (Q1). In-hospital mortality was 2.4 per cent in Q1 (lowest SES) compared with 0.4 per cent in Q4 (highest SES). We conclude that children from lower SES households have a higher incidence of child maltreatment and have worse outcomes, including significantly higher in-hospital mortality among hospitalized children. This trend was generally consistent across all age groups and ethnicities. To our knowledge, this is the first report studying the association between SES and children with child maltreatment among hospitalized children across the entire USA.

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Aims: To study the prevalence of gall stones and associated risk factors in Basra. Methods: The study involved 325 patients referred to the endoscopy unit in AL-Sadder Teaching hospital for dyspeptic symptoms. Only patients with positive endoscopic findings were included in the study. During the procedure antral biopsy was immediately immersed in a urease solution for detection of H.pylori. Upper abdominal ultrasonography examination was performed on each patient underwent endoscopy for detection of hidden gall stone.Statistical analysis of the data was conducted by computer, using SPSS program version15, X2 test was used to determine the association between selected risk factors and gall stone disease, P < 0.05 was considered significant. Results: The prevalence of gall stones was markedly and significantly higher among females and it is gradually increased with the increase of age, 38.0% among patients less than 40 years of age to 56.2% among those 50 years or older. The prevalence of gall stone disease among patients with positive history of contraceptive use, women with parity 5 or more and in the H.pylori positive patients were statistically significant (p < 0.05). But there is no significant associations were found with education, family history, BMI or diabetes mellitus. Conclusions: This study confirms that in Basra population the prevalence of gall stones gradually increased with the increase of age, and patients with gall stones were predominately females, of high parity and positive history of contraceptive pills use. The prevalence of gall stones among H.pylori positive patients was much higher than that among H.pylori negative patients.

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