WHAT'S NEW THIS THURSDAY: AID DISPLACEMENT; KILIFI SURVEILLANCE SYSTEM; TV, RADIO AND KNOWLEDGE; INCREASED BIRTHWEIGHT

Wednesday, 23rd of May 2012

WHAT’S NEW THIS THURSDAY: RE-THINKING AID DISPLACEMENT IN THE HEALTH SECTOR; THE KILIFI HEALTH AND DEMOGRAPHIC SURVEILLANCE SYSTEM; TV, RADIO AND KNOWLEDGE ON CONTRACEPTION AND HIV/AIDS; INCREASED BIRTHWEIGHT

RE-THINKING AID DISPLACEMENT IN THE HEALTH SECTOR

Writing in The Lancet in 2010, Lu and colleagues argued that official development assistance to the health sector is displaced, so that health ministries reduce their spending in recipient programs by $0.43 for every dollar received. This article generated much discussion; see

http://www.scopus.com/results/citedbyresults.url?sort=plf-f&cite=2-s2.077950861532&src=s&imp=t&sid=LaZrfkFdNqaWp8jwzZScsGA%3a30&sot=cite&sdt=a&sl=0&origin=inward&txGid=LaZrfkFdNqaWp8jwzZScsGA%3a2

Writing in PLOS Medicine, two authors from Stanford seek to rebut those views. Summary is below; full text is at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001214

Summary Points

At the core of the current aid debate is the question of whether development assistance for health provided to developing country governments increases health expenditures.

It has recently been suggested that development assistance for health to governments leads to a displacement of government spending, reinforcing skepticism about health aid.

Here we examine a database of public financing for health from 1995 to 2006 and demonstrate that prior conclusions drawn from these data are unstable and driven by outliers.

While government spending may be displaced by development assistance for health in some settings, the evidence is not robust and is highly variable across countries. We recommend that current evidence about aid displacement cannot be used to guide policy.

‘Kilifi DHSS is the largest population (260,000) under surveillance in tropical Africa for births, death, pregnancy and migration. The unique featue of KDHSS is that it was designed from the outset to link with morbidity surveillance at a district hospital/clinical research centre. The focus of research work has been on the incidence of infectious disesases in children,defining risk factors including genetic risks, and interventions to prevent infectious diseases – particularly vaccines.’

The NLM homepage lists 548 publications from Kilifi, most of them open source. How many university departments are this prolific?

International Journal of Epidemiologyije.oxfordjournals.org

Int. J. Epidemiol. (2012) First published online: April 28, 2012

Profile: The Kilifi Health and Demographic Surveillance System (KHDSS)

J Anthony G Scott¹,²,³,^*, Evasius Bauni¹,³, Jennifer C Moisi¹,², John Ojal¹, Hellen Gatakaa¹,

Christopher Nyundo¹, Catherine S Molyneux¹,², Francis Kombe¹, Benjamin Tsofa¹,

Kevin Marsh¹,², Norbert Peshu¹ and Thomas N Williams¹,²,³

+ Author Affiliations

1. ¹Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya, ²Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK and ³INDEPTH Network, Accra, Ghana
↵*Corresponding author. KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi 80108, Kenya. E-mail: ascott@ikilifi.org

Accepted March 21, 2012.

Abstract below; full text is at http://ije.oxfordjournals.org/content/early/2012/04/27/ije.dys062.full?etoc

Summary The Kilifi Health and Demographic Surveillance System (KHDSS), located on the Indian Ocean coast of Kenya, was established in 2000 as a record of births, pregnancies, migration events and deaths and is maintained by 4-monthly household visits. The study area was selected to capture the majority of patients admitted to Kilifi District Hospital. The KHDSS has 260 000 residents and the hospital admits 4400 paediatric patients and 3400 adult patients per year. At the hospital, morbidity events are linked in real time by a computer search of the population register. Linked surveillance was extended to KHDSS vaccine clinics in 2008.

KHDSS data have been used to define the incidence of hospital presentation with childhood infectious diseases (e.g. rotavirus diarrhoea, pneumococcal disease), to test the association between genetic risk factors (e.g. thalassaemia and sickle cell disease) and infectious diseases, to define the community prevalence of chronic diseases (e.g. epilepsy), to evaluate access to health care and to calculate the operational effectiveness of major public health interventions (e.g. conjugate Haemophilus influenzae type b vaccine). Rapport with residents is maintained through an active programme of community engagement. A system of collaborative engagement exists for sharing data on survival, morbidity, socio-economic status and vaccine coverage.

TV, RADIO, AND KNOWLEDGE ON CONTRACEPTION AND HIV/AIDS

‘Television viewing in particular is found to be strongly associated with the use of modern contraception. . .’

Full text is at http://www.measuredhs.com/pubs/pdf/AS24/AS24.pdf

Executive Summary

This is a study of the association of radio and television exposure with different aspects of reproductive

behavior and with knowledge, attitudes, and behavior in connection with HIV/AIDS. The measures of

mass media are limited to the frequency that women and men report listening to the radio and watching

television, which are standard questions in the Demographic and Health Surveys (DHS). Only the

frequency is assessed; the DHS does not obtain information on programmatic content.

The first part of the report focuses on contraceptive behavior, the number of children desired, and the

number of births in the preceding three years. The guiding rationale is that the media open windows to the

outside world, presenting aspects of modern life that can compete with traditional values about marriage

and childbearing. The analysis is based on DHS data from 48 developing countries. Television viewing in

particular is found to be strongly associated with the use of modern contraception and with a smaller

number of children desired and fewer births in the recent past. These associations generally persist after

adjustment for the amount of schooling, wealth, urban residence, and other covariates.

The second part of the study focuses on 27 countries in sub-Saharan Africa and explores the implications

of radio and television exposure for HIV/AIDS knowledge, attitudes, and risk behavior. Similar to the

analysis of reproductive behavior, the conclusion is that exposure to television and radio is an important

covariate for knowledge of the causes of HIV/AIDS and how to prevent infection. In this part of the

study, the main assumption is that the media provide valuable information on the sources of infection,

how to avoid it, where to get tested, the importance of condom use, and various other related subjects. In

general, radio exposure appears to be more important than television as a conduit of such information.

INCREASED BIRTHWEIGHT

‘[P]roviding women with deworming and weekly iron-folic acid supplements before pregnancy is associated with increased birth weight in rural Vietnam.’

Public Library of Science Open Access Research Article

Increased Birth Weight Associated with Regular Pre-Pregnancy Deworming and Weekly Iron-Folic Acid Supplementation for Vietnamese Women

Full text is at http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0001608

Author Summary

Low birth weight is an important risk factor for neonatal and infant morbidity and mortality and may impact on growth and development. Maternal iron deficiency anaemia contributes to intrauterine growth restriction and low birth weight. Hookworm infections and an iron-depleted diet may lead to iron deficiency anaemia, and both are common in many developing countries. A pilot program of deworming and weekly iron-folic acid supplementation for non-pregnant women aiming to prevent iron deficiency was implemented in northern Vietnam. We compared the birth weight of babies born to women who had had access to the intervention to babies born in districts where the intervention had not been implemented. The mean birth weight of the intervention districts' babies was 124 g more than the control districts' babies; the prevalence of low birth weight was also reduced. These results suggest that providing women with deworming and weekly iron-folic acid supplements before pregnancy is associated with increased birth weight in rural Vietnam. This intervention was provided as a health system integrated program which could be replicated in other at-risk rural areas. If so it could increase the impact of prenatal and antenatal programs, improving the health of both women and newborns.