Reduced case fatality among hospitalized children during a war in Guinea‐Bissau: a lesson in equity

Sodemann, Morten; Veirum, Jens Erik; Biai, Sidu; Nielsen, Jens; Balé, Carlitos; Jakobsen, Markus Due; Gustafson, Per; Aaby, Péter

doi:10.1111/j.1651-2227.2004.tb02696.x

Cited by 19 publications

(22 citation statements)

References 10 publications

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“…The interviewees, including military authorities, were willing to respond to questions addressing human resources, functioning of health facilities and HIV/AIDS issues. Our observation that health-related research can be pursued in the aftermath of an armed conflict, which indeed facilitates assessment and quantification of conflict impacts, is consistent with recent reports from other conflict zones across Africa (Ahuka et al , 2004;DeLargy & Alakbarov, 2004;Larsen et al , 2004;O'Heir, 2004;Sodemann et al , 2004;Tangermann et al , 2000). Perhaps the most extreme example arises from the first nationwide cross- sectional survey carried out 18 months after the March 2003 invasion of Iraq.…”

Section: Discussionsupporting

confidence: 90%

“…The importance of collaborative efforts between governments, UN agencies, national and international organisations and NGOs and a more strategic positioning of UN agencies and NGOs has been stressed before (O'Heir, 2004;Salama et al , 2004). A recent study carried out in Guinea-Bissau, for example, documented a decline in case fatality among hospitalised children during an armed conflict, which had been explained by a strengthened health system, including improved access to effective care and treatment (Sodemann et al, 2004). Another study carried out in Sierra Leone that focused on military personnel and commercial sex workers, showed that sound HIV/AIDS awareness campaigns during post-conflict periods can significantly reduce the transmission of HIV (Larsen et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

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Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: Prevention of and care for people with HIV/AIDS

et al. 2006

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In September 2002, an armed conflict erupted in Cô te d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the 'Forces Armées des Forces Nouvelles' (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west Cô te d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: Prevention of and care for people with HIV/AIDS

et al. 2006

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“…8 This was not explained by a general decline in mortality during the war, and children admitted to hospital during the war did not seem to be less sick or more advantaged socioeconomically. Mortality in the community increased by 34% during the war.…”

Section: Introductionmentioning

confidence: 97%

Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial

Biai

Rodrigues

Gomes

et al. 2007

BMJ

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Objective To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. Design Randomised controlled intervention trial. Setting Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits. Participants 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. Interventions Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (£25; €35)/month for nurses and $160 for doctors) and their compliance with standard case management was closely monitored. Main outcome measures In-hospital mortality and cumulative mortality within 4 weeks of hospital admission. Results In-hospital mortality was 5% for the intervention group and 10% in the control group (risk ratio 0.48, 95% confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95). Conclusions Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospital mortality. Financial incentives may be important for the dedication and compliance of staff members. Trial registration Clinical Trials NCT00465777.

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“…At krige ofte afslører dårlige sundhedsforhold, der var tilstede før krigen, viste sig i Bissau, Guinea-Bissau, under den vaebnede konflikt 1998(Sodemann et al 2004 …”

Section: Krig Er Afslørendeunclassified

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Sodemann¹,

Fischer²

2008

TFSS

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Reduced case fatality among hospitalized children during a war in Guinea‐Bissau: a lesson in equity

Cited by 19 publications

References 10 publications

Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: Prevention of and care for people with HIV/AIDS

Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: Prevention of and care for people with HIV/AIDS

Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial

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