ABSTRACT
The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.
PIP: Treatments of diarrhea in children under 5 by the Hospital Infantil de Mexico (Federico Gomez), Mexico City, in 1983-84 versus 1986 were compared with respect to drugs and laboratory tests, and costs were estimated. An outpatient oral rehydration unit was opened in the emergency room, reducing by 25% numbers of inpatients with diarrhea. Other than increased use of ORS, no changes in hospitalized patients were evident except a trend toward more laboratory tests, and prescription of amoxicillin and chloramphenicol over amikacin. There was little evidence that laboratory tests or antibiotic prescriptions were appropriate in most cases. Only 1 patient had a positive Shigella culture, and those with negative fecal cultures received more antibiotics than those with no cultures taken. Intravenous solutions were used in 85%, while only 17% were dehydrated and 22% had electrolyte imbalances, possibly because as a method of rehydration they require less nursing time than oral solutions. The average patient costs were 1200 pesos for lab tests and 180 pesos for drugs. In addition, prior to hospitalization, many patients had received ineffective or dangerous drugs such as Kaopectate-antibiotic mixtures, intestinal motility agents such as loperamide, Lactobacillus cultures, and iodochlorohydroxyquinoline.
Subject(s)
Diarrhea/economics , Drug Therapy/economics , Fluid Therapy/economics , Antidiarrheals/therapeutic use , Child, Preschool , Diarrhea/drug therapy , Diarrhea/therapy , Female , Hospitals, Pediatric , Humans , Infant , Male , MexicoABSTRACT
PIP: IEC campaigns targeted at acquired immunodeficiency syndrome (AIDS) must seek to achieve the maximum impact within a contest of extremely limited resources. This implies a careful assessment of population groups and behaviors that carry the highest risk. Rather than expending large sums of money on mass media campaigns, the approach should be to target IEC activities at the social networks of those most at risk. This may include, for example, prostitutes, homosexual men, hotel and tourist employees, students, and military personnel. Once epidemiologic studies have identified the at-risk population, volunteers form these groups should be recruited and trained to reach their peers through the networks available to them. This education component of IEC work takes priority. The second step involves information diffusion to health providers who are likely to come into contact with human immunodeficiency virus (HIV)-infected individuals, especially those who have access to pregnant women and mothers. Some of these providers are not aware of the risks involved in the reuse of immunization needles. The third step--communication with the general public--is aimed at making the population aware of the factors that place people at risk of HIV infection. Radio seems to be the media capable of reaching the greatest numbers, although traditional means of communication should not be neglected. The IEC effort should consider options at the community, institutional, and individual levels and address those factors that enable, reinforce, and predispose appropriate health behaviors.^ieng
Subject(s)
Acquired Immunodeficiency Syndrome/prevention & control , Communication , Delivery of Health Care , Health Education/organization & administration , Acquired Immunodeficiency Syndrome/epidemiology , Africa/epidemiology , Female , Health Resources , Humans , Male , Mass Media , Risk Factors , Transients and Migrants , West Indies/epidemiologyABSTRACT
PIP: Most of Brazil's medical and hospital services are delivered through the private sector but are paid for by the government through the National Institute of Medical Care and Social Security (INMAPS). During 1981 and 1982, INMAPS took a number of measures designed to cut costs and improve operation of this system. It has also introduced a number of changes since 1983 directed at cost control. Still, it appears that health costs in Brazil are frequently higher than those in developed countries. This problem has gone hand in hand with substantial expenditures on high technology services that are frequently not needed or that are very costly and benefit relatively few patients. In seeking to confront and ameliorate these problems, what is needed is development of a system or environment that will encourage a more socially efficient use of health services. In this regard it is important to recall that creation of such a system requires a more effective use of prices as signals to physicians, who are the system's decision-makers.^ieng
Subject(s)
Delivery of Health Care/economics , Brazil , Cost Control/methods , Humans , Practice Patterns, Physicians'/economics , Technology, High-Cost/economicsABSTRACT
This paper examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. A study conducted in a Peruvian highland community shows that contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, husbands are concerned with family size and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: the men's positive attitude toward modern contraception contrasts with the women's traditional desire for a large family. In this study population, modern contraception is a novelty that has reached only a few families. The majority of the couples practice natural and traditional family planning methods, which are not reliable. Villagers do not use modern contraceptives as a result of cultural barriers created by family planning services that do not take into account the lifestyle of these people, insufficient knowledge of human physiology, comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.
PIP: This paper, based on fieldwork done in 1984 in a Peruvian highland community with a population of about 3,500, examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. The village is poor, with many of the villagers involved in migrant labor, but there have been modernization influences: most villagers are bilingual, men average 8 years of schooling and wives 6. Government family planning programs (FP) were initiated at the local health post in 1982. This study, sampling 54 couples, 2/3 in consensual unions shows 1st pregnancy is usually at 18, and about 5 live births take place by age 31. Only 12 couples reported not using any form of contraception, 27 unreliable natural or traditional methods, and 15 modern methods. Non-contracepting women tended to breastfeed longer and have less schooling, and tended not to be working full-time. Contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, some husbands are concerned with family size (for economic, child welfare, and health reasons) and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: men's positive attitude toward modern contraception contrasts with women's traditional desire for a large family. Villagers do not use modern contraceptives because of barriers created by FP services that do not take into account the lifestyle of these people (e.g. language, work hours, respect for privacy), disturbing and poorly explained side-effects, especially of pills and injected depo-provera, insufficient knowledge of human physiology, contraception failures due to inappropriate use (often because of poor explanations by health post staff), comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.