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Objective To evaluate equity in the allocation and distribution of vaccines for coronavlrus disease 2019 (COVID-19) to countries and territories participating in the COVID-19 Vaccines Global Access (COVAX) Facility. Methods We used publicly available data on the numbers of COVAX vaccine doses allocated and distributed to 88 countries and territories qualifying for COVAX-sponsored vaccine doses and 60 countries self-financing their vaccine doses facilitated by COVAX. We conducted a benefit-incident analysis to examine the allocation and distribution of vaccines based on countries' gross domestic product (GDP) per capita. We plotted cumulative country-level per capita allocation and distribution of COVID-19 vaccines from COVAX against the ranked per capita GDP of the countries and territories to generate a measure of the equity of COVAX benefits. Findings By 23 January 2022 the COVAX Facility had allocated a total of 1 678 517 990 COVID-19 vaccine doses, of which 1 028 291 430 (61%) doses were distributed to 148 countries and territories. Taking account of COVAX subsidies, we found that countries and territories with low per capita GDP benefited more than higher-income countries in the numbers of vaccines. The benefits increased further when the analysis was adjusted by population age group (aged 65 years and older). Conclusion The COVAX Facility is helping to balance global inequities in the allocation and distribution of COVID-19 vaccines. However, COVAX alone has not been enough to reverse the inequality of total COVID-19 vaccine distribution. Future studies could examine the equity of all COVID-19 vaccine allocation and distribution beyond the COVAX-facilitated vaccines. Objectif Mesurer le niveau d'equite en matiere de repartition et de distribution des vaccins contre la maladie a coronavirus 2019 (COVID-19) dans les pays participant au mecanisme COVAX (COVID-19 Vaccines Global Access). Methodes Nous avons utilise les donnees accessibles au public sur le nombre de doses de vaccin COVAX allouees et distribuees a 88 pays et territoires ayant droit aux lots offerts par COVAX, ainsi qu'a 60 pays financant eux-memes leurs doses avec l'aide de COVAX. Nous avons effectue une analyse d'incidence des benefices afin d'etudier la repartition et la distribution des vaccins en fonction du produit interieur brut (PIB) par habitant. Enfin, nous avons represente, sous forme de graphique, la repartition et la distribution cumulees des vaccins contre la COVID-19 provenant de COVAX pour chaque habitant a l'echelle nationale, puis les avons comparees au classement du PIB par habitant des pays et territoires concernes, en vue de mesurer le niveau d'equite des avantages COVAX. Resultats Au 23 janvier 2022, le mecanisme COVAX avait attribue 1 678 517 990 doses de vaccin contre la COVID-19, dont 1 028 291 430 (61%) ont ete distribuees a 148 pays et territoires. En tenant compte des subsides COVAX, nous avons decouvert que, 'en termes de nombre de vaccins, les pays et territoires possedant un faible PIB par habitant en ont davantage beneficie que les pays a revenu plus eleve. Ce benefice s'est accru lorsque nous avons parametre l'analyse selon la categorie d'age de la population (65 ans et plus). Conclusion Le mecanisme COVAX aide a attenuer les inegalites de repartition et de distribution des vaccins contre la COVID-19. Neanmoins, lui seul ne suffit pas a inverser la tendance a la disparite en matiere de distribution de tels vaccins. Les futures etudes pourraient s'interesser a l'equilibre de repartition et de distribution de tous les vaccins contre la COVID-19, et pas uniquement ceux fournis dans le cadre du mecanisme COVAX. Objetivo Evaluar la equidad en la asignacion y distribucion de las vacunas para la enfermedad por coronavirus de 2019 (COVID-19) a los paises y territorios que participan en el Mecanismo de acceso mundial a las vacunas contra la COVID-19 (Mecanismo COVAX). Metodos Se utilizaron los datos disponibles publicamente sobre el numero de dosis de vacunas del Mecanismo COVAX asignadas y distribuidas a 88 paises y territorios que cumplian los requisitos para recibir las dosis de vacunas patrocinadas a traves del Mecanismo COVAX y a 60 paises que autofinanciaban sus dosis de vacunas con el apoyo del Mecanismo COVAX. Se realizo un analisis de beneficios e incidencias para revisar la asignacion y distribucion de las vacunas segun el producto interno bruto (PIB) per capita de los paises. Se trazo la asignacion y distribucion acumulativa per capita a nivel de pais de las vacunas contra la COVID-19 del Mecanismo COVAX frente al PIB per capita clasificado de los paises y territorios para generar una medida sobre la equidad de los beneficios del Mecanismo COVAX. Resultados A 23 de enero de 2022, el Mecanismo COVAX habia asignado un total de 1 678 517 990 dosis de vacuna contra la COVID-19, de las que 1 028 291 430 (61 %) se distribuyeron a 148 paises y territorios. Teniendo en cuenta las subvenciones del Mecanismo COVAX, se comprobo que los paises y territorios con un PIB per capita bajo se beneficiaron mas que los paises con mayores ingresos en lo que respecta al numero de vacunas. Los beneficios aumentaron aun mas cuando el analisis se ajusto por grupos de edad de la poblacion (mayores de 65 anos). Conclusion El Mecanismo COVAX esta ayudando a equilibrar las desigualdades a nivel mundial en la asignacion y distribucion de las vacunas contra la COVID-19. Sin embargo, el Mecanismo COVAX por si solo no ha sido suficiente para revertir la desigualdad en la distribucion total de las vacunas contra la COVID-19. Los estudios futuros podrian analizar la equidad de toda la asignacion y distribucion de las vacunas contra la COVID-19 ademas de las vacunas que se obtienen a traves del Mecanismo COVAX., Introduction Equitable vaccine distribution can be a major factor towards global control of the coronavirus disease 2019 (COVID-19) pandemic. (1) The COVID-19 Vaccines Global Access (COVAX) Facility was created to [...]

CONTEXT: Researchers have long assumed that familiarity between an interviewer and a survey participant reduces the validity of responses, especially for such sensitive behaviors as abortion. However, little empirical evidence exists on this issue. METHODS: Data on 6,041 women aged 15-49 and 133 interviewers who took part in the second (2017) round of the Performance Monitoring and Accountability 2020 survey in Rajasthan, India, were used to examine the effect of interviewer--respondent acquaintance and participation in the prior survey round on women's reporting of induced abortion. Associations were identified using multivariate, multilevel models that adjusted for respondent, interviewer and community characteristics, and that included interviewer random effects. RESULTS: On average, interviewers completed interviews with 41 respondents from their assigned cluster; they reported that they were acquainted with 61% of respondents and that 13% of respondents had participated in the prior survey round. Four percent of women reported having had an abortion. Neither interviewer-respondent acquaintance nor participation in the previous survey round was associated with abortion reporting in any of the multivariate models or in additional sensitivity analyses. CONCLUSIONS: The findings do not support the hypothesis that respondent familiarity with the interviewer or the survey process is associated with lower reporting of sensitive behaviors, like abortion. Future studies should further explore these and other design features to identify those that provide statistically significant improvements in the reporting of abortion and other sensitive behaviors. Contexto: Los investigadores han supuesto durante mucho tiempo que la familiaridad entre un entrevistador y una participante en la encuesta reduce la validez de las respuestas, especialmente en lo referente a conductas sensibles como el aborto. Sin embargo, existe poca evidencia empírica sobre este tema. Métodos: Los datos de 6,041 mujeres de 15 a 49 años de edad y de 133 entrevistadores que participaron en la segunda ronda (2017) de la encuesta Monitoreo del Desempeño y Rendición de Cuentas 2020 en Rajasthan, India, se utilizaron para examinar el efecto de la familiaridad entre entrevistador y entrevistada, así como la participación en la ronda previa de la encuesta, en la forma en que las mujeres reportan abortos inducidos. Se identificaron asociaciones mediante el uso de modelos multivaríados y multinivel que se ajustaron a las caracteristicas de las mujeres entrevistadas, del entrevistador y de la comunidad y que incluyen los efectos aleatorios del entrevistador Resultados: En promedio, los entrevistadores completaron la encuesta con 41 personas entrevistadas de su conglomerado asignado; informaron que estaban familiarizados con el 61% de las entrevistadas y que el 13% de las entrevistadas habían participado en la ronda previa de la encuesta. Cuatro por ciento de las mujeres reportaron haber tenido un aborto. Ni la familiaridad entre la mujer entrevistada y el-entrevistador, ni la participación en la anterior ronda de la encuesta se asociaron con los informes de aborto en ninguno de los modelos multivariados, o en análisis de sensibilidad adicionales. Conclusiónes: Los hallazgos no apoyan la hipótesis de que la familiaridad de la persona entrevistada con el entrevistador o el proceso de la encuesta están asociados con un menor reporte de comportamientos sensibles, como el aborto. Los estudios futuros deberían explorar más a fondo estas y otras características de diseño para identificar aquellas que proporcionan mejoras estadísticamente significativas en los informes de aborto y otras conductas sensibles. Contexte: Les chercheurs supposent depuis longtemps que, lorsqu'un íntervieweur et une participante á l'enquete se connaissent, la valídité des réponses diminue, surtout en ce qui concerne les comportements sensibles tels que l'avortement. II n'existe cependantguere de données empiríques sur la question. Méthodes: Les données relatives á 6,041 femmes de 15 á 49 ans et 133 intervieweurs ayant participé au second cycle (2017) de l'étude Performance Monitoring and Accountability 2020 au Rajasthan (Inde) ont serví á examiner ce qui se passe, concernant la déclaration par la femme d'un avortement provoqué, quand l'intervieweur et la répondante se connaissent et qu'elle a participé au cycle précédent de l'enquete Les associations ont été identifiées au moyen de modéles multivariés et multiniveaux, sous correction des caractéristiques de la répondante, de l'intervieweur et de la communauté et avec effets aléatoires concernant l'íntervieweur. Résultats: En moyenne, les íntervíeweurs ont ínterrogé 41 répondantes du groupe qui leur a été affecté; ils ont déclaré connaître 61% des répondantes et ont indiqué que 13% d'entre elles avaient participé au cycle précédent de l'étude. Quatrepour cent des femmes ont déclaré s'être fait avorter. Ni le fait que l'íntervíeweur et la répondante se connaissent, ni la participation au cycle précédent de l'étude ne s'est révelé associé á la déclaration d'un avortement dans aucun des modèles multivariés, pas plus que dans les analyses de sensibilité complémentaires. Conclusions: Les résultats ne confirment pas l'hypothése d'une declaration moindre des comportements sensibles tels que l'avortement de la part des répondantes qui connaissent les íntervíeweurs ou le processus d'enquête Les études futures devront approfondír l'examen de ces éléments de conception, ainsi que d'autres, pour identifier ceux qui produisent une amélioration statistiquement significative de la déclaration de l'avortement et d'autres comportements sensibles., Social desirability pressures often cause survey respondents to underreport sensitive or stigmatized behaviors. (1) Induced abortion is considered a sensitive topic in nearly all settings, leading to substantial underestimates of [...]

Problem The burden oftrauma and injuries in Uganda is substantial and growing.Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda. Approach We developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability. Local setting The Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented In 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America. Relevant changes Over the years 2012 to 2017 we supported four cohorts of master's students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums. Lessons learnt Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme. Probleme La charge de morbidite liee aux traumatismes et aux blessures en Ouganda est importante et en augmentation. La penurie de personnes formees et le manque de donnees nationales sur les maladies non transmissibles et leurs facteurs de risque en Ouganda constituent deux lacunes importantes qui doivent etre comblees. Approche Nous avons elabore et mis en oeuvre un nouveau parcours au sein d'un master de sante publique existant, destine a developper des capacites de niveau universitaire et a promouvoir la recherche sur les principales priorites nationales relatives aux traumatismes et aux blessures. Nous avons egalement propose des possibilites deformation a un plus large public et organise un forum national de haut niveau sur les blessures pour encourager un dialogue national sur la charge induite par les traumatismes, les blessures et le handicap. Environnement local Le programme Consequences chroniques des traumatismes, des blessures et du handicap en Ouganda a ete mis en oeuvre en 2012 a l'Ecole de sante publique de l'Universite Makerere a Kampala, en Ouganda, en collaboration avec l'Ecole de sante publique Bloomberg de l'Universite Johns Hopkins a Baltimore, aux Etats-Unis d'Amerique. Changements significatifs Entre 2012 et 2017, nous avons soutenu quatre cohortes d'etudiants en master, pour un total de 14 etudiants (9 femmes et 5 hommes; age moyen 30 ans). Plus de 1300 personnes ont participe aux ateliers et seminaires du volet formation courte du programme. Le forum a accueilli trois symposiums de recherche et deux forums nationaux sur les blessures. Lecons tirees Le soutien institutionnel et l'engagement collaboratif sont importants pour elaborer et mettre en oeuvre avec succes des programmes de renforcement des capacites. L'integration des volets deformation aux structures universitaires existantes est essentielle pour leur viabilite. Un tutorat adapte pour les etudiants motives et brillants est utile pour les accompagner pendant toute la duree du programme. Problema La carga de traumatismos y lesiones en Uganda es notable y sigue creciendo. Dos deficiencias importantes que deben abordarse son la escasez de personal formado y la falta de datos nacionales sobre las enfermedades no contagiosas y sus factores de riesgo en Uganda. Enfoque Se ha desarrollado e implementado un nuevo curso dentro de un programa de master en salud publica existente, destinado a desarrollar la capacidad de nivel de postgrado y promover la investigacion sobre prioridades nacionales clave para traumatismos y lesiones. Tambien se ofrecieron oportunidades de formacion a un publico mas amplio y se establecio un foro nacional de alto nivel sobre lesiones para fomentar el dialogo nacional sobre la carga de los traumatismos, las lesiones y la discapacidad. Marco regional El programa Consecuencias cronicas de los traumatismos, las lesiones y la discapacidad en Uganda se implemento en 2012 en la Escuela de Salud Publica de la Universidad de Makerere en Kampala, Uganda, junto con la Escuela de Salud Publica Johns Hopkins Bloomberg en Baltimore, EE.UU. Cambios importantes Entre los anos 2012 y 2017 se respaldaron cuatro cohortes de estudiantes de master, con un total de 14 estudiantes (9 mujeres y 5 hombres, con una edad media de 30 anos). Mas de 1300 personas participaron en talleres y seminarios del componente de formacion a corto plazo del programa. El foro fue sede de tres simposios de investigacion y dos foros nacionales sobre lesiones. Lecciones aprendidas El apoyo institucional y el compromiso colaborativo son importantes para desarrollar e implementar programas de desarrollo de capacidades de exito. La integracion de los componentes de formacion dentro de las estructuras academicas actuales es clave para la sostenibilidad. Una tutoria apropiada para estudiantes muy motivados y con talento es valiosa para guiar a los estudiantes por el programa., Introduction Injuries are a leading cause of death in the African Region, where they claim over 900 000 lives annually, (1) and within Africa, Uganda has one of the highest [...]

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches In addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector Investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results overtime. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond. La reduction de la mortalite maternelle et infantile est une priorite des objectlfs du Millenaire pour le developpement (OMD) et le restera probablement apres l'echeance de 2015. Il existe des donnees sur les investissements, les interventions et les politiques habilitantes necessaires. On comprend mal pourquoi certains pays ont realise des progres plus rapidement que d'autres pays comparables. Les Facteurs de reussite des etudes sur la sante des femmes et des enfants ont cherche a combler ce manque de connaissances en utilisant les analyses statistiques et econometriques des donnees provenant de 144 pays a faible revenu et a revenu intermediaire et recueillies depuis 20 ans: une analyse comparative qualitative booleenne; une etude bibliographique et des etudes specifiques a chaque pays pour les 10 pays a progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard--les pays a progression rapide ont deploye des strategles personnalisees et se sont adaptes rapidement auxchangements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de reduire la mortalite maternelle et infantile. Premierement, ils impliquent de nombreux secteurs pour traiter les facteurs determinants et cruciaux pour la sante. Pres de la moitie de la reduction de la mortalite infantile dans les pays a faible revenu et a revenu intermediaire depuis 1990 resulte des investissements dans le secteur de la sante, l'autre moitie etant attribuee aux investissements realises dans les secteurs exterieurs a la sante. Deuxiemement, ces pays utilisent des strategies pour mobiliser les partenaires dans la societe, en utilisant des donnees solides et opportunes pour la prise de decisions et la responsabilisation, ainsi qu'une approche de planificaron triple pour prendre en consideration les besoins immediats, la vision a long terme et l'adaptation aux changements. Troisiemement, ces pays etablissent des principes directeurs qui orientent les progres, harmonisent les actions des parties prenantes et generent des resultats dans le temps. Cette synthese de donnees contribue a l'ensemble des connaissances requises pour accelerer les amellorations sur la sante des femmes et des enfants en vue de l'echeance de 2015 et au-dela. La reduccion de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguira siendo despues de 2015. Existen evidencias sobre las inversiones, las intervenciones y las politicas necesarias, pero se sabe menos acerca de por que algunos paises logran un progreso mas rapido que otros paises comparables. Los estudios relativos a los Factores de Exito en la Salud de las Mujeres y los Ninos han tratado de abordar esta brecha de conocimiento por medio de analisis estadisticos y econometricos de datos de 144 paises de ingresos bajos y medianos (PIBM) a lo largo de mas de 20 anos, analisis comparativos cualitativos booleanos, revision de la literatura y revisiones especificas de cada pais en 10 paises bien encarrilados para los ODM 4 y 5a. No existe una formula estandar, estos paises despliegan estrategias a medida y se adaptan rapidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres areas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reduccion de la mortalidad infantil en los PIBM desde 1990 es el resultado de Inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ambito sanitario. En segundo lugar, estos paises utilizan estrategias para movilizara socios a traves de la sociedad, utilizando evidencias oportunas y solidas para la toma de decisiones y la rendicion de cuentas, asi como un enfoque de planificacion triple para considerar las necesidades inmediatas, la vision a largo plazo y la adaptacion al cambio. En tercer lugar, los paises establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre como acelerar las mejoras en la salud de mujeres y ninos hacia el 2015 y mas adelante., Introduction Worldwide, accelerated progress is required to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) as highlighted in the United Nations Secretary-General's Global Strategy [...]

The authors conducted a household survey and observation to assess carbon monoxide (CO) knowledge and risks as well as prevalence of CO alarms in an urban community prior to the enactment of a mandatory ordinance requiring CO alarms in one U.S. city. From July to December 2009, household surveys and observations were completed in 603 residences. Participants were mostly African-American (61%), women (70%), 25-54 years in age (66%), and with a high school education or less (51%). Most homes visited contained CO-producing appliances, including gas stoves (86%), gas furnaces (82%), and gas water heaters (79%). Participants' overall mean percentage correct knowledge score was 57%. CO alarms were reported by 33% of participants and observed among 28% of households. Low rates of CO knowledge and CO alarm ownership, combined with high rates of CO-producing sources in homes, suggests the need for widespread campaigns to promote CO alarms. Recommendations are also made to integrate the lessons learned from the public health community's experience promoting smoke alarms., Introduction Carbon monoxide (CO) poisoning is a significant yet preventable public health problem that is only recently gaining the necessary attention of public health and safety officials and policy makers. [...]

Objective To estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. Methods A multistate model depicted six cohorts of 100 000 15-year-old girls who survived until the age of 45 years. Cohort members were modelled to have various degrees of FGM, to undergo childbirth according to each country's mortality and fertility statistics, and to have medically attended deliveries at the frequency observed in the relevant country. The risk of obstetric complications was estimated based on a 2006 study of 28 393 women. The costs of each complication were estimated in purchasing power parity dollars (I$) for 2008 and discounted at 3%. The model also tracked life years lost owing to fatal obstetric haemorrhage. Multivariate sensitivity analysis was used to estimate the uncertainty around the findings. Findings The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15-45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130 000 life years is expected owing to FGM's association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. Conclusion Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications. Estimation des couts obstetricaux des mutilations genitales feminines dans six pays d'Afrique Objectif Estimer le cout pour les systemes de santes des complications obstetricales des mutilations genitales feminines (MGF) dans six pays d'Afrique. Methodes Un modele multi-etats apermis de decrire six cohortes de 100 000 jeunes filies de 15 ans au depart, destinees a survivre jusqu'a I'age de 45 ans. Les femmes composant les cohortes ont ete modelisees comme subissant divers degres de MGF, comme donnant naissance a des enfants conformement aux statistiques de mortalite et de fecondite de chacun des pays et comme beneficiant d'une assistance medicale a I'accouchement selon la frequence observee dans leur pays. Le risque de complication obstetricale a ete estime a partir d'une etude de 2006 portant sur 28 393 femmes. Les couts pour chaque complication ont ete estimes en dollars de parite de pouvoir d'achat (I$) pour 2008 et ajustes par application d'un facteur de 3%. Le modele a egalement determine les annees de vie perdues du fait des hemorragies obstetricales mortelles. Les auteurs ont fait appel a une analyse de sensibilite multivariee pour estimer I'incertitude entachant les resultats. Resultats Les couts annuels des complications obstetricales liees aux MGF dans les six pays africains etudies se montaient a I$ 3,7 miliions et representaient 0,1 a 1% des depenses publiques pour la sante des femmes de 15 a 45 ans. Parmi les 2,8 millions de jeunes filles actuellement agees de 15 ans dans ces six pays africains, on s'attend a une perte de 130 000 annees de vie du fait des hemorragies obstetricales associees aux FGM, ce qui equivaut a amputer chaque duree de vie d'un demi-mois. Conclusion Au-dela des enormes traumatismes psychologiques qu'elles entranent, les MGF font supporter a la societe despertes de vie et des couts financiers importants. Le cout des efforts des Etats pour prevenir ces mutilations sera compense par les economies resultant des complications obstetricales evitees. Estimacion del costo de la atencion obstetrica por mutilacion genital femenina en seis paises africanos Objetivo Estimar el cesto para el sistema de salud de las complicaciones obstetricas causadas por la mutilacion genital femenina (MGF) en seis paises africanos. Metodos Mediante un modelo multiestado se representaron seis cohortes de 100 000 mujeres de 15 anos que vivirian hasta los 45 anos. En el modelo se contemplaba que las mujeres tendrian diversos grados de MGF, darian a luz de acuerdo con las estadisticas de mortalidad y fecundidad de cada pais, y disfrutarian de asistencia medica en el parto con la frecuencia observada en el pais en cuestion. El riesgo de complicaciones obstetricas se calculo tomando como base un estudio de 2006 que abarco 28 393 mujeres. Los cestos de cada complicacion se estimaron en dolares internacionales (I$) basados en la paridad de poder adquisitivo de 2008, con un descuento del 3%. EI modelo determino ademas los anos de vida perdidos por hemorragia mortal en el parto. Se realizo un analisis de sensibilidad multifactorial para estimar la incertidumbre de los resultados. Resultados El cesto anual de las complicaciones obstetricas relacionadas con la MGF en los seis paises africanos estudiados ascendio a I$ 3,7 millones y vario entre el 0,1% y el 1% del gasto publico en salud correspondiente a las mujeres de 15-45 anos. En la poblacion de 2,8 millones de mujeres de 15 anos que actualmente hay en esos seis paises africanos, cabe prever por tanto una perdida de 130 000 anos de vida como consecuencia de la asociacion de la MGF a hemorragias obstetricas, lo que equivale a un recorte de medio mes de la esperanza de vida. Conclusion Ademas del enorme trauma psicologico que entrana, la MGF acarrea grandes perdidas economicas y de vidas. El cesto de las actividades que emprendan los poderes publicos para prevenir la MGF se vera compensado por los ahorros Iogrados al evitar numerosas complicaciones obstetricas., Introduction The term 'female genital mutilation' (FGM) denotes any procedure involving partial or total removal of the external female genitalia, as well as injury to the female genital organs for [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.01.008 Byline: M. Arantxa Colchero (a)(b), Benjamin Caballero (b), David Bishai (a) Abstract: We assessed the effects of changes in income and occupational activities on changes in body weight among 2952 non-pregnant women enrolled in the Cebu Longitudinal Health and Nutrition Surveys between 1983 and 2002. On average, body mass index (BMI) among women occupied in low activities was 0.29kg/m.sup.2 (standard error 0.11) larger compared to women occupied in heavy activities. BMI among women involved in medium activities was on average 0.12kg/m.sup.2 (standard error 0.05) larger compared to women occupied in heavy activities. A one-unit increase in log household income in the previous survey was associated with a small and positive change in BMI of 0.006kg/m.sup.2 (standard error 0.02) but the effect was not significant. The trend of increasing body mass was higher in the late 1980s than during the 1990s. These period effects were stronger for the women who were younger at baseline and for women with low or medium activity levels. Our analysis suggests a trend in the environment over the last 20 years that has increased the susceptibility of Filipino women to larger body mass. Author Affiliation: (a) Department of Health Economics and Evaluation, National Institute of Public Health, Cuernavaca, Mexico (b) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Article Note: (footnote) [star] This work was supported in part by NIH grant 1R01TW005596-01 (PI: Linda Adair).

OBJECTIVE. To shed light on the extent to which childhood obesity affects the types of appropriate child safety seats for young children, by providing an estimate of the number of US children whose weight renders them unable to use safely the majority of child safety seat types currently available. METHODS. The types of appropriate child safety seats were assessed by using National Highway Traffic Safety Administration 2005 Child Safety Seat Ease of Use Ratings. Estimates of the numbers of children weighing above the maximal weight for those child safety seats were calculated by using the tabulations of growth curves based on National Health and Nutrition Examination Survey 1999 to 2000 data that were assembled by the National Center for Health Statistics and the US Census for the year 2000. RESULTS. A total of 283 305 children 1 to 6 years of age would have a difficult (if not impossible) time finding a safe child safety seat because of their age and weight. The vast majority of these children are 3 years of age and weigh >40 lb (182 661 children). For these children, there are currently only 4 child safety seat types available, each of which costs between $240 and $270. CONCLUSIONS. This study determined that there is limited availability of child safety seat types for the ever-increasing number of obese young children. There are substantial numbers of children who weigh more than the upper weight limit for most currently available child safety seats. While we await reductions in the childhood obesity epidemic, options for maximizing the protection of obese children in automobiles must be identified. Key Words child safety seats, obesity Abbreviations, CHILDHOOD OBESITY IS a critical public health threat for the 21st century. (1-4) Childhood obesity affects children in all 50 states, including boys and girls and younger children and adolescents [...]

The dynamics of labor force participation and joblessness during young adulthood influence access to social and material resources and shape exposure to different sources of psychosocial strain. Differences in these dynamics by race, ethnicity, and gender are related to changes in a behavioral determinant of poor health (tobacco use) for young adults aging into midlife. Using discrete-time hazards models, we estimate the relationship between labor force participation in the past year and smoking cessation for US adults (ages 14-21 years in 1979) followed in a population-representative sample until 1998 (i.e. the National Longitudinal Survey of Youth). We assess the unique role of racial, ethnic and gender differences in exposure, vulnerability, and reactivity to employment and joblessness by controlling for social and economic resources obtained through working and by controlling for early life factors that select individuals into certain labor force and smoking trajectories. There are three main findings: (1) joblessness is more strongly associated with persistent daily smoking among women than among men: (2) fewer social and economic resources for women out of the labor force compared to employed women explains their lower cessation rates; and (3) lower cessation among unemployed women compared to employed women can only partially be explained by these resources. These findings illustrate how differential access to work-related social and economic resources is an important mediator of poor health trajectories. Contextual factors such as social norms and psychosocial strains at work and at home may play a unique role among European American men and women in explaining gender differences in smoking. Keywords: USA; Gender inequality; Racial and ethnic differences; Labor force participation; Smoking cessation

We tested hypotheses that social living arrangement and drug use in one's network are independently associated with entry into opiate agonist treatment modalities. Injection drug users (IDUs) attending the Baltimore Needle Exchange Program who received a referral for drug abuse treatment were studied. Baseline interviews, HIV testing, and the Addiction Severity Index (ASI) were administered. Agency records were used to confirm entry into a treatment program offering opiate agonist maintenance therapy within 30 days of the baseline interview. Logistic regression was used to identify predictors of treatment entry. To date, of 245 IDUs, 39% entered such a program. Multivariate logistic regression models controlling for age and intervention status revealed that compared to individuals who lived alone, in a controlled, or nonstable environment (e.g., streets, abandoned house, transitional housing program, or boarding house), individuals who lived with a sexual partner were 3 times more likely to enter treatment (adjusted Odds Ratio [aOR]=3.04: p=0.013) and those who lived with family or friends were almost 3 times more likely to enter treatment (aOR=2.72; p=0.016). In the bivariate analyses, a marginal association was observed between being responsible for children or others and entry into treatment (p=0.066); however, this association was not significant in the multivariate model. Findings from this study suggest that supportive living environments may facilitate entry into treatment and may be helpful in devising appropriate and targeted interventions to encourage drug treatment entry. Keywords: Social network, living arrangement, treatment, injection drug users, INTRODUCTION Injection drug users (IDUs) represent the second largest risk group for HIV infection in the United States, accounting for approximately one-third of AIDS cases in the U.S. (1, 2). [...]

The objective of this research was to assess the association of child mortality with polygyny and maternal HIV status through a prospective community-based study in Rakai district, Uganda. We sought to test whether there was an indirect evidence that polygynous households in an HIV prevalent area may divert resources away from the children of HIV-infected mothers in favor of children with better survival prospects. We test this theory using data from a follow-up study which collected detailed behavioral and medical information at 10-month intervals on a cohort of over 4000 pregnant women and their infants (5300 person years of observation). Cox proportional hazards models estimated the mortality hazard (RR) associated with polygyny for children of HIV-negative and HIV-positive mothers. HIV prevalence in the full cohort of mothers was 11.9%, and 23% of mothers lived in polygynous households. Multivariate analysis showed an increased hazard of child mortality if the mother was HIV-positive (RR = 1.75, p < 0.001). Maternal education reduced mortality, whereas low birth weight increased mortality risk. Polygyny was associated with an increase in the hazard of child mortality in the full sample (RR = 1.36, p Keywords: Child survival; Polygyny; HIV/AIDS; STD; Uganda

When faced with a complex public health problem there is a natural urge to find solutions. We hire consultants, gather data, test hypotheses and examine P-values to identify risk factors: [...]

High parity has been hypothesised to lead to a shorter and less healthy life. Using the 2007 Taft Ageing Health and Fertility Survey consisting of 696 women aged 50–79, this paper examines the extent to which women's health in middle and older ages is affected by their childbearing histories. The results show that high parity (>8) is associated with a reduction of GP-rated health by 0.094 points on a scale from 1 to 10. These health reductions are four times as large as those of an extra year of age, and are robust to controlling for birth interval, age, area of residence, education, marital status, work history, economic satisfaction and surviving daughters. There is a positive but curvilinear relationship between shorter birth intervals (<2 years) and GP-rated health accounting for socio-demographic factors. Our analysis suggests that parity and birth intervals, along with socio-demographic characteristics, affect women's well-being in later life. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia. Methods Pre- and post-intervention comparison in a cluster randomized trial of primary care facilities. Seven health posts and 33 subhealth posts in Nepal were stratified by type and randomized into intervention and control groups. Health workers from the intervention facilities received 5 days training on the adapted PAL guidelines and their use. To collect prescription details, we used carbon-copy prescription pads in both groups. To measure the impact of PAL guidelines we used the World Health Organization's rational use of drug indicators and drug cost indicators, in a multivariate regression analysis. Results The PAL guidelines led to fewer prescriptions of multiple drugs and to more prescriptions of generic and essential drugs. The guidelines also lowered average prescription cost and wastage by disease except for chronic obstructive pulmonary disease although not to a statistically significant degree. Similarly, the prescription of antibiotics and adherence to guidelines improved, albeit not statistically significant. Conclusion There is evidence that the implementation of PAL guidelines promotes rational use of drugs for some respiratory diseases. The expected health effects of PAL guidelines should be compared with their implementation costs before continuing training on lung health, and strategies put in place to sustain the effects. [ABSTRACT FROM AUTHOR]