Calculation of costs of pregnancy- and puerperium-related care: experience from a hospital in a low-income country.

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services.

The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization.

OBJECTIVE: To demonstrate an asymmetry of the internal jugular veins, a finding which will have consequences for catheterization. DESIGN: Prospective study. SETTING: The medical ICU of a university-affiliated teaching hospital. PATIENTS: Eighty critically ill consecutive patients. INTERVENTION: Measurement of the cross-sectional area of the internal jugular veins. Search for an asymmetry, defined as an area at least twice that of the contralateral vein. RESULTS: An asymmetry was noted in 62.5% of the patients. The dominant vein was the right in only 68 % of these cases. In addition, 23% of the 160 jugular internal veins had an area of 0.4 cm2 or less. CONCLUSIONS: Using a simple technique, ultrasound identifies the dominant internal jugular vein, thus indicating the safer side before blind catheterization.

Cost-effectiveness of family planning and maternal health service delivery strategies in rural Bangladesh.

Two alternative service delivery strategies to improve the effectiveness and efficiency of the Bangladesh national Family Planning and Maternal and Child Health programme have been tested: (1) service delivery at cluster spots, a centrally located neighbourhood spot, rather than at the client's home, and (2) increased frequency of outreach clinics merged with immunization spots. The cost-effectiveness of these strategies was compared with baseline estimates of the cost of providing services. The data were collected in two rural sites of Bangladesh, Mirsarai Thana of Chittagong and Abhoynagar Thana of Jessore, in August 1996. The results of this analysis indicate that cluster service delivery of contraceptive services in their present form are not more cost-effective than home delivery services. The cost per birth averted was lower in only one out of three services in each of the field sites. When the cost-effectiveness of increasing the frequency of SCs combined with EPI services was examined, the service delivery was found to be more cost-effective for all services in one thana and for two out of three services in the higher performing thana, Abhoynagar. This implies that the provision of a wider range of services is improving overall cost-effectiveness.

Living-related liver transplantation in Africa.

Liver transplantation is an effective therapy for end stage liver disease. Nevertheless in many areas of the world organ availability remains a major problem. We report here the success of the first living-related liver transplantation in Africa. The left lateral lobe of the mother was transplanted orthotopically to her 6 year old child suffering from liver cirrhosis complicating glycogen storage disease. The social and medical problems encountered are discussed. Living-related liver transplantation is a viable option in countries where cadaveric organ donation is either illegal or socially unacceptable.