Assessment of out-of-pocket and catastrophic expenses incurred by patients with Human Immunodeficiency Virus (HIV) in availing free antiretroviral therapy services in India.

OBJECTIVES: With the free availability of antiretroviral therapy in India, one expects that the out-of-pocket (OOP) expenditure would reduce and would not be a significant financial burden. However, the cost of seeking care is also dependent on accessibility of services, as well as other non-medical and indirect expenses. This study aims to analyze the OOP expenditure in availing antiretroviral therapy (ART) services and determine the prevalence and pattern of catastrophic and impoverishing health expenditure. The study also discusses the policy implications of these findings in the light of growing commitment toward universal health coverage. STUDY DESIGN: This was a cross-sectional study. METHODS: A total of 434 patients receiving antiretroviral treatment were interviewed. OOP expenses included a measure of direct medical expenditure, non-medical expenditure, and indirect expenditure incurred in availing ART services. A threshold level of 40% of 'capacity to pay' was taken as catastrophic expenditure. Based on previous research, different demographic, socio-economic, and clinical factors were selected as independent variables to determine their association with catastrophic expenditure. Logistic regression was conducted to study the association between independent and dependent variables keeping the level of significance at <0.05. RESULTS: The mean OOP expenditure among patients with human immunodeficiency virus (HIV) taking ART was Rs. 238.8 ± 193.7. Majority of these expenses were incurred on non-medical expenditure (58.1%), while indirect expenditure accounted for 29.7%. The direct health expenditure was the lowest (12.2%) type of expenditure in the total OOP expenditure. OOP spending was catastrophic in 8.1% (35/434) of households in our study. Patients belonging to nuclear family (odds ratio [OR] = 2.99; 95% confidence interval [CI] = 1.19-7.58), who are unemployed (OR = 2.56; 95% CI = 1.18-5.54), of lower socio-economic classes (OR = 8.46; 95% CI = 1.93-37.02), those who traveled more than 50 km for getting drugs (OR = 2.80; 95% CI = 1.26-6.23), and those having CD4 cell count lower than 200 (OR = 3.11; 95% CI = 1.32-7.32) were found to be independently and significantly associated with catastrophic OOP health expenditure among patients with HIV. CONCLUSIONS: A high direct and indirect expenditure was observed among patients with HIV seeking treatment in North India leading to catastrophic expenditure in a significant number of households. A service-level integration of HIV care at subdistrict levels within the Universal health coverage (UHC) framework could reduce catastrophic expenditure.

Iodine Deficiency in School Children in Aligarh District, India.

We carried out this study to assess iodine deficiency disorders among school children of 6-12 years age group in Aligarh district of India. The prevalence of goiter was 5.2%. Median Urinary Iodine Excretion level was 150 ug/L; 22.5% of students had biochemical iodine deficiency. 50.4% households were consuming adequately iodized salt.

Structure-activity correlation in transfection promoted by pyridinium cationic lipids.

The efficiency of the transfection of a plasmid DNA encoding a galactosidase promoted by a series of pyridinium lipids in mixtures with other cationic lipids and neutral lipids was assessed in CHO-K1 cells. We identify key molecular parameters of the lipids in the mixture - clog P, lipid length, partial molar volume - to predict the morphology of the lipid-DNA lipoplex and then correlate these same parameters with transfection efficiency in an in vitro assay. We define a Transfection Index that provides a linear correlation with normalized transfection efficiency over a series of 90 different lipoplex compositions. We also explore the influence of the same set of molecular parameters on the cytotoxicity of the formulations.

A community based study of Infant Mortality in rural Aligarh.

BACKGROUND: Infant mortality rate is regarded as an important and sensitive indicator of the health status of a community. It also reflects the living standard of the people and the effectiveness of interventions for improving maternal and child health. Multiple factors related to social and economic conditions, health care and environment have a significant role to play on childhood mortality and improving childhood mortality is a national priority. The present study was planned to 1) determine the mortality rate among neonates and infants. 2) identification of pattern of various factors in relation to infant mortality and 3) to identify the causes of death in this age group. METHOD: All the deaths in children under 12 months during July 2005 to June 2006 in Jawan block of district Aligarh, India were recorded. The cause of death was ascertained using the standard verbal autopsy procedure. RESULTS: In the study period, 446 live births and 37 deaths in children under one year of age were reported. The neonatal and infant mortality rates were 49.4 and 83.0 per thousand live births respectively. The main causes of infant deaths were birth asphyxia, diarrhoea, pneumonia, prematurity (including Low birth weight and malnutrition). CONCLUSION: Most of the death among infants are preventable, though promotion of institutional deliveries, strengthening of referral system, early recognition of danger signs and periodic retraining of health workers.

Early childhood mortality--a rural study.

The present study was conducted in 9 villages of Rural Health Training Centre, Jawan, Aligarh, India, having 1792 registered families. The infant mortality rate was 79.3 per 1000 live births. Higher mortality in children between 1-2 years (29.6/1000) in comparison to 2-5 years (16.2/1000) reflected the higher vulnerability of children below 2 years. Diarrhoea (21.2%) and neonatal factors (21.2%) were the major cause of infant mortality followed by pneumonia (18.2%) and tetanus (15.1%). Diarrhoea (32.2%), pneumonia (22.6%) and malnutrition (12.9%) were the major killers in children between 1-5 years. Mortality in females was higher than males in infancy. Risk factors associated with infant mortality included extremes of maternal age (< 20+ > 35 years) primipara or multipara and illiterate mothers.

Certain aspects of infant mortality -- a prospective study in a rural community.

PIP: A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.^ieng

Odontogenic keratocyst in an infant.

Odontogenic keratocysts occur as solitary lesions or in association with the basal cell naevus syndrome (BCNS), and have been documented in the age range 5 to 83 years. A rare case of an odontogenic keratocyst in a one-year-old girl is presented. Its characteristic tendency to recur, and its association with BCNS present important clinical implications.