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Child development center (CDC) Trivandrum—An inclen success story

16s “ECONOMICS OF AIDS CARE IN A TERTIARY MEDICAL INSTITUTION IN INDIA.” K.R. John and Dilip Mathai, CEU, Christian Medical College, Vellore, India. Objective: To study the cost of care and the extent of cost recovery for patients admitted with AIDS in a tertiary level teaching hospital. Design: A non concurrent cohort study design was used. From the records the use of the resources including, consultations, tests, drugs, Nursing time, disposable at each patient contact and admission was enumerated and extend of expenditure and cost recovery was studied. Setting: The study was conducted in a tertiary level teaching hospital. Participants: 35 confirmed AIDS patients admitted from 1989 to 1992 at CMC hospital were followed up until they died. The events of utilization were followed up in the hospital. Intervention: The modes of care in terms of the drugs, investigations, consultations, disposable and the nursing time received by the patients was looked at with the view of costing of the intervention. Outcome Measure: The main outcome measure was the cost per patient. Results: Majority of the patients (71%) admitted were from lower socioeconomic status. The mean age was 34.5 yrs. The total no. of admissions were 74. The mean survival since the first admission was 3 months. The important associated conditions includes TB (74%), oral candidiasis (31.4%) and cryptococcal meningitis (8.75). Th e average cost per patient for the hospitalization was 4742 Rs (158 $) (CI 5479-4005 Rs). The important drug categories used were antibiotics, antidiarrhoeals anti TB drugs and antifungal. The mean cost for the drugs was 808 Rs (26.9$), investigations 428 Rs (14.3$) and disposable 259 Rs (8.6 $) The mean cost recovery possible was 2266 Rs (75.5 $), (CI 2770-1762 Rs). Th e cost recovery was significantly lower (p.03) for the female patients. Conclusions: The study shows that majority of the interventions could be done in a primary health care setting. 47.8% of the total expenditure is recovered. The data is of use for planning and financing of AIDS care in the developing country context. PUBLIC AND CLINICAL POLICY “EFFECT OF REPEATED DENTAL HEALTH EDUCATION ON THE ORAL HEALTH STATUS OF PRIMARY SCHOOL CHILDREN IN A RURAL DISTRICT IN KENYA!’ Erastus K. Njeru, J. Mwai, E.N. Ngugi, and D. Mwaniki, CEU, University of Nairobi, Kenya. Objective: To compare two models of Dental Health Education (DHE) delivered by teachers in primary schools, one model where teachers gave DHE only once and the other model where DHE was given once a week for 8 weeks. With spiralling costs of dental health care and shrinking health budgets, affordable community based methods must be sought for promotive and preventive care. Since teachers are always in contact with children, very little resource investment is required. Design: A randomized field trial. Four schools were selected using simple random sampling. Two schools were randomly assigned to the once-only model and two schools assigned to the repeated model. Setting: Primary Schools in a rural area. Participants: All the 121 standard one pupils in the selected primary schools took part in the study. Intervention: Class teachers were given a one-day seminar and instructed on what to teach the pupils. In the once-only model the teachers gave these instructions once and in the repeated model, the teachers gave the instructions once a week for 8 weeks. Main Outcome Measures: Plaque accumulation score and gingival bleeding scores at baseline and after 8 weeks. Results: There was a statistically significant difference in the gingival bleeding scores changes, p = 0.016 between the two models. However, there was no statistically significant difference in the plaque score changes, p = 0.094. Conclusions: Teachers can be used to effectively improve dental health if messages are given repeatedly. ‘CHILD DEVELOPMENT CENTER (CDC) TRIVANDRUMAN INCLEN SUCCESS STORY! M.K.C. Nair, CEU, Medical College, Trivandrum, India. Introduction: Success of INCLEN trainees in conducting original research and translating research results into health policy are taken as important outcome measurements of INCLEN programme. Objective: To present the story of child development research done in Kerala, leading to establishment of CDC Trivandrum and Government policy actions for prevention of Childhood disability. Design: After return from epidemiology training at Newcastle CERTC, two randomized controlled trials were completed and presented at INCLEN meetings, one proving that early interventional therapy done by mother at home is effective in improving neurodevelopmental status of at-risk babies and another proving that Pyritinol, a widely used drug among post asphyxial encephalopathy babies is not effective. Trivandrum Developmental Screening Chart (TDSC) and Nursery Evaluation Scale Trivandrum (NEST) designed &validated at CDC for early community detection of developmental delay and presented at INDIACLEN meetings are now included in Indian text books of Pediatrics. Results: Action Plan for Child in Kerala a Government of Kerala policy document for next 5 years has committed in chapter 10, to have prevention of disability programmes established through existing Integrated Child Development Scheme (ICDS) functionaries in all districts of Kerala in a phased manner by 1998, using CDC model of early intervention. Training is done at CDC, funded by UNICEF. A new course Diploma in Clinical Child Development (DCCD) is started at CDC to create core community level trainers. The first CDC in India is now registered as an autonomous Center of Excellence in child development and perinatal epidemiology. Conclusions: The Kerala model for prevention of disability would be a model for all developing countries, thanks to INCLEN. “EFFICIENCY AND USE OF HEALTH FACILITIES IN UGANDA: POLICY IMPLICATIONS? David Okello, D. Guwatudde, R. Lubanga, and A. Sebina, CEU, Makerere University, Kampala, Uganda. Objectives: Compare government and NC0 facilities regarding: resource utilization, financing, costs and consumer satisfaction. Design: Cross-sectional survey of records on resource use, costs and financing of services. Consumer satisfaction was assessed using structured interview and focus group discussions. Setting: Health facility at 3 different levels: hospitals, health centers and dispensaries. Participants: Two districts randomly selected from each of the five regions of Uganda. Within each district one government and one NC0 unit were selected from each level. Toeether. 81 facilities were covered. and 480 outpatients, randomly identified at the exit points of a sample of 29 units (15 government and 14 NGO) were interviewed. Discussions were held with 13 focus groups of patient-attendants. Results: Bed size of hospitals ranged from 70-200, health centers from 12-20 and many dispensaries had bed facilities. Hospitals were overcrowded, while smaller units were under utilized. The smaller units were staffed mainly by unskilled personnel. NC0 units had better remuneration, drug availability and maintenance. User fees contributed to less than 0.2% of recurrent costs in government, and 31-46% in the NGOs. Expenditure of user fees in government did not meet expectations of consumers. Consumer satisfaction for services was slightly lower in government. Overall, resources for health care were less in government, and the available resources were concentrated in hospitals. Conclusions: Government should seek more resources and ensure efficient use of what there is. The user charge system could be effective, but it should result in visible improvement in the quality of services. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Epidemiology Elsevier

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