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BackgroundPreterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000-1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings.MethodsWe describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children's Fund.ResultsFollowing the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m2 to 212 m2. Costs of improvements were lowest at the national referral hospital (financial: $31,354; economic: $45,051; 2020 USD) and varied across the four smaller hospitals (financial: $68,330-$95,796; economic: $99,430-$113,881). In a standardised 20-bed neonatal unit offering a level of care comparable to the four smaller hospitals, the total financial cost could be in the range of $70,000 to $80,000 if an existing space could be repurposed or remodelled, or $95,000 if a new unit needed to be constructed. Even after improvements, the facility assessments demonstrated broad variability in laboratory and pharmacy capacity as well as the availability of essential equipment and supplies.ConclusionsThese five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable.Trial registrationClinicalTrials.gov, NCT02811432 . Registered: 23 June 2016.

BackgroundThere are 2.5 million neonatal deaths each year; the majority occur within 48 h of birth, before stabilisation. Evidence from 11 trials shows that kangaroo mother care (KMC) significantly reduces mortality in stabilised neonates; however, data on its effect among neonates before stabilisation are lacking. The OMWaNA trial aims to determine the effect of initiating KMC before stabilisation on mortality within seven days relative to standard care. Secondary objectives include exploring pathways for the intervention's effects and assessing incremental costs and cost-effectiveness between arms.MethodsWe will conduct a four-centre, open-label, individually randomised, superiority trial in Uganda with two parallel groups: an intervention arm allocated to receive KMC and a control arm receiving standard care. We will enrol 2188 neonates (1094 per arm) for whom the indication for KMC is 'uncertain', defined as receiving ≥ 1 therapy (e.g. oxygen). Admitted singleton, twin and triplet neonates (triplet if demise before admission of ≥ 1 baby) weighing ≥ 700-≤ 2000 g and aged ≥ 1-

As well as improving population health, promoting equity in health is one of the key goals of health policy in low- and middle-income countries (LMICs). However, it is less clear how equity is defined, or how it may impact on resource allocation decisions. We investigated the degree to which health inequalities have been considered in economic evaluation of health interventions in LMICs, and what demographic or socioeconomic characteristics were used to define equity relevant subgroups. We reviewed publications since 2010 from three main databases following the search strategy developed by including the key terms 'health inequalities/health disparities/health equity,' 'economics' and 'low- and middle-income countries' in the title or abstract. Twelve studies were identified, mainly focusing on interventions for the more vulnerable groups such as children and women. Some attempts have been made to assess interventions' impact on health inequality and there is increasing interest in evaluating it, although research in this area is lacking. Population subgroups highlighted in the included studies were those differing in socioeconomic status. Most studies reported the results across subgroups to illustrate inequality impact, and the newly developed methods, extended cost-effectiveness analysis and distributional cost-effectiveness analysis, have also been applied. [ABSTRACT FROM AUTHOR]

Background: Structural factors can present barriers for uptake of and adherence to existing HIV prevention products like oral PrEP among people at high risk of HIV infection, including female sex workers (FSWs). It is important to understand these structural factors that could potentially influence long-acting PrEP uptake among FSWs. The aim was to explore the structural factors that influence female sex work in Kampala and investigate any major differences in individual characteristics among them. Methods: We collected qualitative data using semistructured interviews. Ten FSWs were sampled randomly from women attending a clinic and operating in bars, lodges and on the streets. Ten others were sampled from social media and snowballing, with the initial contact being the social media contact and nine peer referrals. Topics included reasons for joining or leaving sex work, work locations, relationships with clients and peers, interaction with authorities, impact of criminalisation, and perceived or experienced stigma. Results: Participants were aged 23-43 years. The highest level of education registered from the cohort was senior four, while the lowest level in the snowball sample was diploma. The reported price for condomless sex ranged from 10,000 - 50,000 shillings in the cohort, and 1,000,000 - 7,400,000 shillings in the snowball sample. The structural factors that influence female sex work in Kampala include regulations outlawing sex work, violent and abusive relationships with clients and authorities, factors that affect entry into and exit from sex work, factors that affect how sex workers are organised and how they work, and stigma. Results indicate differences among FSWs in the two samples, with the snowball sample having higher income, higher education, and using social media and online platforms more than those that work on streets, in bars and in lodges. Conclusion: This study documents a section of FSWs with higher education levels, earnings from sex work, and operating mostly in an online or private environment. In line with the UNAIDS strategy of leaving no one behind and reaching the populations at the greatest need of care, interventions should be designed to reach all FSWs in Kampala, including FSWs that do not work in bars, lodges and streets. [ABSTRACT FROM AUTHOR]