Perceptions about Probiotic Yogurt for Health and Nutrition in the Context of HIV/AIDS in Mwanza, Tanzania.

Recently, the food and malnutrition issues have taken centre stage within the arena of HIV/AIDS epidemic, with several calls being made for context-specific health and nutrition interventions to deal with the emerging food insecurity and malnutrition issues in settings with high burdens of HIV/AIDS. The use of probiotics as nutritional supplements in HIV/AIDS-affected and resource-poor settings has also been advocated. This paper presents the results of a qualitative study on community knowledge and perceptions about probiotics and their potential impact on people’s everyday life in the context of the HIV/AIDS epidemic. In-depth interviews (n=26) were conducted with residents in Mwanza, Tanzania. The results showed that people living with HIV/AIDS, who were using probiotic yogurt produced through a joint partnership of Western Heads East, Tanzania Medical Research Institute and the Tukwamune Women’s Group, reported perceived beneficial effects, such as gain in weight and improved health and well-being. Yet, these beneficial effects might be resulting in growing misconceptions about probiotic yogurt being ‘medicine’ for the treatment of HIV/AIDS; this is leading some people living with HIV/AIDS to abandon taking their antiretroviral medications based on the view that the probiotic yogurt is making them feel much better. The findings illustrate the potential challenges with regard to the introduction of nutritional food supplements into new contexts plagued by malnutrition and infectious diseases. Public-health education and awareness programmes are needed when introducing novel foods into such contexts.

Effect of maternal education on choice of location for delivery among Indian women.

Background. Delivery in a healthcare facility is associated with better outcomes for both mother and child. However, in India, a large proportion of deliveries take place outside health facilities. We studied the effect of maternal education on the choice of location for delivery in the Indian population. Methods. Data from the National Family Health Survey 3 (NFHS-3) were used. The survey included women who were selected using a multi-stage (2-stage for urban areas and 3- stage for rural areas), stratified (based on demographic or social factors) sampling technique; the primary sampling units selected were proportional to population size, and the subsequent steps used simple random sampling. Effect of maternal education on the choice of place for delivery (home, public or private facility) was investigated through a multinomial logistic regression model. The model adjusted for several factors at individual, household and community level, the survey design effect and included sampling weights. Results. Of the 124 385 women aged 15–49 years included in the NFHS-3 dataset, 36 850 (29.6%) had had one or more childbirth during the past 5 years. A little more than half of all the deliveries were at home, and approximately a quarter each of the remaining deliveries were at public and private facilities, respectively. Maternal education was strongly and independently associated with the choice of location of delivery. For the choice sets of public facility versus home delivery and private facility versus home delivery, a clear dose–response relationship was apparent—higher maternal education was associated with a higher probability of delivery at a public or private health facility compared to home. Conclusion. Level of maternal education was a significant independent predictor of choice of location for childbirth among Indian women. Compared to cash incentives to increase facility-based delivery, improving maternal education may be a better way to achieve long term and sustained increase in facility deliveries in India.

Injection safety and its impact in India: a literature analysis.

Unsafe injection practices have been implicated in the worldwide spread of hepatitis B, hepatitis C, HIV or any parasitic disease with a blood phase, such as malaria, filaria and syphilis. Review of injection safety in India also revealed that use of injection is often inappropriate, injections are administered with unreliable safety measures. Studies in India have documented the association of injection use and spread of hepatitis C and kala-azar also. Some measures to address the issue are also discussed.

What is managed care? A conceptual primer.

Managed care is a new concept for many health policymakers. Developed in the USA as a response to increasing healthcare costs, it is being exported across the world, and many countries are incorporating elements of managed care into their health systems. In the absence of a basic understanding of managed care, reality may not meet expectations. This article explains what managed care is, traces its development in the context of the American healthcare system, discusses its achievements (or lack thereof) to date and considers its relevance to healthcare delivery in India.