Measuring health program effectiveness in the field: an assessment tool.

To assist field workers in program evaluation and to explicitly discuss program strengths and weaknesses, a practical method to estimate the effectiveness of public health interventions within the existing program capacity was developed. The method and materials were tested in seven countries (Afghanistan, Zimbabwe, Tanzania, Uganda, Guatemala, the Philippines, and Ghana). In this method, four core components are assessed using a questionnaire: (1) the efficacy of the intervention; (2) the level of existing human resources (i.e., quality of recruitment, training, and continuing education); (3) the infrastructure (i.e., supplies, salary, transportation, and supervision); and (4) the level of community support (i.e., access and demand). Using the assessment tool provided, program staff can determine if all necessary elements are in place for a successful program that can deliver the specific intervention. Based on the results of the assessment program, weaknesses can be identified, explicitly discussed, and addressed. The usefulness of this tool in humanitarian relief may be twofold: (1) to assess the design and implementation of effective programs; and (2) to highlight the inevitable need for capacity building as the disaster situation evolves.

Cost of lost work and bed days for us workers in private industry--national health interview survey, 2003.

Data from the 2003 National Health Interview Survey (n = 12,943) of US workers aged 18 to 64 years were used to estimate the annual cost of lost work (ACLW) and lost productivity (ACLP) due to bed days. The average lost workdays (LWDs) was estimated to be 8.39 for US workers compared with 5.62 bed days (BDs). The prevalence of high LWDs (>or=30 days) was 2.9% for US workers compared with 1.3% for BDs (>or=30 days). Regression analyses showed that female workers had higher adjusted mean LWDs and BDs than did male workers. Workers in the mining industry had the highest mean of 26.71 LWDs compared with 5.58 LWDs for workers in the wholesale industry. The total ACLW and ACLP was estimated to be $62.8 billion ($US 2003; 95% CI = $57.53-$67.52 billion).

Cost-analysis of different management policies for patients with mild hepatitis A virus infection in Kazakhstan.

OBJECTIVE: For patients with mild hepatitis A virus (HAV) infection, this study compared estimates of total costs associated with managing cases under a policy of mandatory hospitalization in the Republic of Kazakhstan and estimates of total costs associated with managing cases in outpatient settings. Costs were estimated both from the perspective of the Ministry of Health and from a broader societal perspective. METHODS: Data were collected by using a standardized structured questionnaire. For cases of mild HAV infection, medical records were obtained from 200 patients managed by hospitalization and from 251 patients managed in an outpatient setting. Personal interviews were also conducted to collect information on productivity losses and out-of-pocket expenses. RESULTS: Nationally, we estimated about 21,600 cases of mild HAV infection annually. The mean annual treatment costs in hospital for mild HAV infection was estimated at 3.39 million US dollars (2001 US dollars) (95% confidence interval [CI] = [3.26 million US dollars-3.52 million US dollars]). The total annual mild HAV infection cost to the society, including direct medical and nonmedical costs and productivity losses due to 721,440 lost work days, was estimated at 6.26 million US dollars (95% CI [6.05 million US dollars-6.47 million US dollars]). In sensitivity analyses, the total annual cost of mild HAV infection ranged from 4.37 million US dollars to 24.66 million US dollars. The survey results showed that a relatively minor change in the current policy of mandatory hospitalization could result in an estimated total annual savings of 4.62 million US dollars (2001 US dollars) in Kazakhstan. CONCLUSION: Adoption of an outpatient management policy for cases of mild HAV infection would generate substantial cost savings to the Ministry of Health and society.

Blood lead levels in U.S. workers, 1988-1994.

Limited research has been conducted to measure the association between elevated blood lead levels and sociodemographic factors among U.S. workers in various industries and occupations using population-based survey data. Data from the Third National Health and Nutrition Examination Survey ( n = 10,127) were used to determine the blood lead levels in the U.S. workers. The prevalence of elevated blood lead levels > or = 50 microg/dL was 0.001% (1560) among U.S. workers compared with 0.2% (19,953) workers with elevated lead levels > or = 40 microg/dL. Regression analyses indicated that workers in the repair service industry were correlated with higher blood lead levels than those workers in the construction industry. Although low blood lead levels were found for the entire working population, the results showed that there were still high blood lead levels in certain occupations and industries during 1988 to 1994.

Urinary cadmium levels in the U S working population, 1988-1994.

Few studies have estimated the prevalence and mean urinary cadmium levels in U.S. workers and the factors associated with high cadmium exposure. In this study, urinary cadmium measurements were obtained on 11228 U.S. workers aged 18 to 64 years who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Urinary cadmium levels ranged from 0.01 to 15.57 microg/L, with a geometric mean of 0.30 microg/L (0.28 microg/g creatinine) for all U.S. workers. The prevalence of urinary cadmium levels >or=5 microg/L was 0.42% (551000) for U.S. workers aged 18 to 64 years. Among U.S. workers in the metal industry (two-digit Standard Industrial Classification or SIC codes 33 and 34), the geometric mean urinary cadmium level was 0.48 microg/L (0.39 microg/g creatinine), and 0.45% of these workers had urinary cadmium levels >or=10 microg/L. The prevalence of urinary cadmium levels >or=15 microg/L was 0.0028% (3907). The agriculture industry (two-digit SIC codes 01, 02, and 07-09) was associated with low urinary cadmium levels, compared with repair services industries (two-digit SIC codes 75 and 76). Results from ordinary least squares regression analyses indicated that smokers had significantly higher urinary cadmium levels than nonsmokers (p

Disability and its economic impact among adults with diabetes.

The objective of this study was to estimate the annual cost of disability among people with diabetes. Data from the 1994 Behavioral Risk Factor Surveillance System (n = 83,566) of US individuals aged 18 to 64 years were used to estimate the annual cost of disability among people with self-reported diabetes. After we adjusted for relevant socioeconomic characteristics, logistic regression analyses demonstrated that people with diabetes are more likely to stop working outside the home (for men: adjusted odds ratio, 3.1; 95% confidence interval, 1.2 to 8.0; for women: adjusted odds ratio, 2.9; 95% confidence interval, 1.0 to 8.8). The annual cost of disability among people with diabetes was estimated at $9.3 billion in 1994. Disability among people with diabetes is a major public health problem. Efforts to reduce disability in this population could create substantial gains in productivity.