The economic benefits of targeted response strategies against foot-and-mouth disease in Australia.

Recent developments in control of highly infectious diseases attempt to improve emergency response efforts by more clearly focusing or targeting response tools according to risk. For example, advances in surveillance testing and sampling deliver their results by more accurately and precisely targeting the population of interest. In this work, targeted implementation of trading zones and vaccination were examined for simulated outbreaks of foot-and-mouth disease (FMD) in Australia. Trading zones allowing unaffected Australian states to resume exports following an outbreak of FMD were assessed using multiple tools. A Victorian incursion scenario with traditional stamping out and vaccination as control options, was simulated using the AADIS model Version 2.47, to characterise the geographic extent of potential outbreaks, the number of animals infected, and the date of last cull indicating duration of the outbreak. Information on disease spread from the AADIS simulations was then used to identify the boundaries of trading zones for the incursion scenario, in which vaccination with trading zones was found to further reduce disease impacts relative to stamping out alone with trading zones. The number of animals culled due to disease provided supply shocks for stamping out alone and vaccinate-to-retain, while the number of vaccinated animals was added to the number of animals culled due to disease for the supply shock of vaccinate-to-remove. The day of last cull was combined with historical FMD trade recovery and Australian export data to estimate the share of Australian exports that would be embargoed under trading zones. The market impacts - changes in equilibrium quantities and prices - of the supply shock, trading zones, and consumer reactions - were simulated within ABARES' AgEmissions partial equilibrium model of Australian agriculture. For this simulated large outbreak, where vaccinate-to-remove was utilised along with trading zones, producer losses were reduced by AUD 4 billion in present value terms over 10 years estimated at a 7% discount rate (PV10,7%) compared to an outbreak where stamping out alone is applied with trading zones. Introducing FMD virus risk mitigation measures for wool to further target trading zones reduced the economic impacts by an additional AUD 3.6 billion (PV10,7%). Outbreak response cost savings and additional potential costs under vaccinate-to-retain with trading zones were also compared to the vaccinate-to-remove control with trading zones. Results emphasised the importance of outbreak characteristics in determining trading zones and targeting of vaccination. Economic analyses identified how additional investments in targeting outbreak response is of value to producers.

Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana.

BACKGROUND: Poor maternal health delivery in developing countries results in more than half a million maternal deaths during pregnancy, childbirth or within a few weeks of delivery. This is partly due to unavailability and low utilization of maternal healthcare services in limited-resource settings. The aim of this study was to investigate the access and utilization of maternal healthcare in Amansie-West district in the Ashanti Region of Ghana. METHODS: An analytical cross-sectional study, involving 720 pregnant women systematically sampled from antenatal clinics in five sub-districts was conducted from February to May 2015 in the Amansie-West district. Data on participants' socio-economic characteristics, knowledge level and access and utilization of maternal health care services were collected with a structured questionnaire. Odds ratios were estimated to describe the association between explanatory variables and maternal healthcare using generalized estimating equations (GEE). RESULTS: 68.5, 83.6 and 33.6% of the women had > 3 antenatal care visits, utilized skilled delivery and postnatal care services respectively. The mothers' knowledge level of pregnancy emergencies and newborn danger signs was low. Socio-economic characteristics and healthcare access influenced the utilization of maternal healthcare. Compared to the lowest wealth quintile, being in the highest wealth quintile was associated with higher odds of receiving postnatal care (adjusted odds ratio [aOR]; 95%CI: 2.84; 1.63, 4.94). Use of health facility as a main source of healthcare was also associated with higher odds of antenatal care and skilled delivery. CONCLUSION: This study demonstrates suboptimal access and utilization of maternal healthcare in rural districts of Ghana, which are influenced by socio-economic characteristics of pregnant mothers. This suggests the need for tailored intervention to improve maternal healthcare utilization for mothers in this and other similar settings.

Perceived satisfaction with health services under National Health Insurance Scheme: Clients' perspectives.

The study aims to explore the perceived satisfaction of insured clients in financing health services through National Health Insurance in Ghana. A quantitative method was used to recruit 380 respondents, selected by multistage cluster sampling. Data were collected through the administration of questionnaires. More than half, 57.9%, of respondents were males, and the average age was 34 years. Most respondents, 74.3%, were insured. Overall, 53.12% of insured clients were dissatisfied with the services of providers. Factors, such as benefit package of insurance, willingness to pay higher premium, and perceived discrimination were significantly associated with poor satisfaction with health services. The current advocacy for and awareness about the use of health insurance as a prepayment plan should be prioritised in policy initiatives. The benefit package for the insurance should be increased in order to cover all disease conditions that afflict the Ghanaian population.

Incentives to yield to Obstetric Referrals in deprived areas of Amansie West district in the Ashanti Region, Ghana.

BACKGROUND: Obstetric referrals, otherwise known as maternal referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of Obstetric referral systems is however marred by the lack of accessible transportation and socio-economic disparities in access to healthcare. This study evaluated the role of socio-economic factors, perception and transport availability in honouring Obstetric referrals from remote areas to referral centres. METHODS: This was a cross-sectional study, involving 720 confirmed pregnant women randomly sampled from five (5) sub-districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured questionnaire using face-to-face interviewing and analyzed using STATA 11.0 for windows. Logistic regression models were fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals. RESULTS: About 21.7 % of the women studied honoured referral by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58 %) and lack of transport (17 %). A higher household wealth quintile increased the odds of being referred and honouring referral as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as emergencies and severe were also more likely to honour obstetric referrals (OR = 2.3; 95 % CI = 1.3, 3.9). CONCLUSION: Clients' perceptions about severity of health condition and low income remain barriers to seeking healthcare and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Implementing social interventions could improve the situation and help attain maternal health targets in deprived areas.