Inequities among the very poor: health care for children in rural southern Tanzania

Schellenberg, Joanna Armstrong; Victora, Cesar G; Mushi, Adiel K; Savigny, Don de; Schellenberg, David; Mshinda, Hassan; Bryce, Jennifer

doi:10.1016/s0140-6736(03)12515-9

Cited by 384 publications

(326 citation statements)

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“…Stunting is a cause of public concern in many developing countries, and reducing stunting prevalence is one of the key components of improving child health. These three indicators have been commonly used in previous literatures for assessing the health status of children (Table A3) [7,9,24,25]. …”

Section: Methodsmentioning

confidence: 99%

“…Twelve of these were included in previous studies (Table A3) for their well-documented effects on child mortality and health [12,16–18]. We added five additional interventions that have demonstrated a significant impact on child health and have available data in DHS and MICS: access to improved water, access to improved sanitation, BCG immunization, polio immunization, and care seeking for diarrhea [9,26–31]. …”

Section: Methodsmentioning

confidence: 99%

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Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Subramanian

et al. 2017

Global Health Action

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Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Subramanian

et al. 2017

Global Health Action

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“…Trained research nurses collected information on age, level of education, marital status, and indicators of the socioeconomic status (SES) including type of household amenities (Schellenberg et al, 2003), and frequency of meat purchase (red meat, fish or poultry) (Macdonald et al, 2004); and obtained anthropometric measurements using calibrated instruments. There were two study nurses per clinic; they underwent anthropometric training and standardization (Lohman et al, 1988) in workshops conducted before the beginning of recruitment and every year into the study.…”

Section: Study Population and Proceduresmentioning

confidence: 99%

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis

et al. 2005

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Objective: To examine the impact of HIV coinfection, socioeconomic status (SES) and severity of tuberculosis (TB) on the body composition and anthropometric status of adults with pulmonary TB. Design: Cross-sectional study. Setting: Five TB clinics in Dar es Salaam, Tanzania. Subjects: A total of 2231 adult men and women diagnosed with pulmonary TB, prior to the initiation of anti-TB therapy. Methods: We compared the distribution of anthropometric characteristics including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin-fold (TSF), and arm muscle circumference (AMC) by HIV status, SES characteristics, and indicators of TB severity (bacillary density in sputum and Karnofsky performance score). Similar comparisons were carried out with body composition variables from bioelectrical impedance analysis and albumin concentrations, in a subsample of 731 subjects. Results: In multivariate analysis, HIV infection was significantly associated with lower MUAC and AMC in both men and women, but not with BMI or TSF. Compared to HIV-uninfected women, those who were HIV infected had lower body cell mass (BCM) (adjusted difference ¼ À0.85 kg, P ¼ 0.04), intracellular water (À0.68 l, P ¼ 0.04), and phase angle (À0.52, P ¼ 0.02). Albumin concentrations were significantly lower in both men and women infected with HIV. Among HIV-infected men, CD4 cell counts o200/mm 3 were related to lower intracellular water, BCM, fat-free mass and phase angle. Independent of HIV infection, BMI and MUAC were positively related to SES indicators and the Karnofsky performance score; and inversely related to bacillary density. Conclusions: HIV infection is associated with indicators of low lean body mass in adults with TB; socioeconomic factors and TB severity are important correlates of wasting, independent of HIV. Sponsorship: The National Institute of Allergy and Infectious Diseases (UO1 AI 45441-01).

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“…They could be deployed for implementation of intervention programs to reduce child mortality, such as neonatal care and promotion of exclusive breastfeeding 30 recognition and treatment with antibiotics of sick newborns, 7 as curative care was among the tasks preferred in this study. Delivery of interventions in the home by CHWs was viewed as a critical aspect 31 and visiting homes was identified among the preferred tasks in this study.…”

Section: Discussionmentioning

confidence: 99%

Volunteers Motives in Relation to their Task Preference in Health Service Delivery: A Case of West Kenya

Ochieng¹,

Kaseje²

2017

Psychol Cogn Sci Open J

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CitationOchieng BM, Kaseje DCO. Volunteers motives in relation to their task preference in health service delivery: A case of West Kenya. Psychol Cogn Sci Open J. 2017; 3(4): 123-130. doi: 10.17140/PCSOJ-3-134 Copyright ©2017 Ochieng BM. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACTBackground: According to the World Health Organization (WHO), human resources is the key ingredient to the effective functioning of health systems. The growing human resource crisis in low-income countries has re-energized the debate concerning the role of community health volunteers in health service delivery. Researchers have studied task-shifting among community volunteers focusing on its impact on health outcomes. This study focused on how task preference could be related to volunteer motives in an African setting. Methods: We carried out a cross-sectional survey with the aim to investigate the relationship between motives and task preference among health volunteers compared with non-volunteers matched by gender, residence, and education in Western Kenya. The eight motives that were taken into account in the present study were obtained from existing literature, and tasks were derived from the common health activities undertaken by volunteers in Kenya. We recorded the preference of 1062 respondents for each of the tasks on a 1-5 Likert scale. The task preference among volunteers on the basis of motives and the status of the volunteers were compared. Results: Long-term health tasks such as mother and child healthcare, home visiting and curative care were significantly more associated with altruistic than with material gain motives (p=0.00). Short-term tasks such as helping in disease outbreaks, and participation in immunization campaigns were associated with both altruistic and material gain motives. The self-seeking motives tend to be associated only with short-term tasks. Conclusion: The preference for long-term health tasks was associated with non self-seeking motives; while short-term tasks were associated with both non self-seeking and self-seeking motives. It was concluded that the assessment of the motives of the volunteers was critical in assigning tasks to volunteers.

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Inequities among the very poor: health care for children in rural southern Tanzania

Cited by 384 publications

References 5 publications

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis

Volunteers Motives in Relation to their Task Preference in Health Service Delivery: A Case of West Kenya

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