title: Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study Private pharmacy practice and regulation. A randomized trial in Lao P.D.R. Tuberculosis patients and practitioners in private clinics in India. Oral rehydration therapy and social marketing in rural Kenya. Syndromic management of urethral discharge in Ghanaian pharmacies Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua. Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study.
abstract: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting OBJECTIVES The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country . METHODS The intervention comprised inspections of the pharmacies , information , and distribution of documents to drug sellers and sanctions . It was implemented at two different intensity levels , active and regular intervention . The methods used to assess the effect of the interventions were interviews with the district drug inspectors , drug sellers and customers , inspection of drug purchases , and indicator surveys of pharmacies . Indicators for pharmacy-specific quality as well as for dispensing quality were developed . RESULTS The main finding was one of strong overall improvements from initially low levels . The improvements were particularly marked by increases in the availability of essential material s for dispensing by 34 % and in order in the pharmacy by 19 % . Information given to customers increased from 35 % to 51 % and the mixing of different drugs in the same package went down from 17 % to 9 % . The pharmacies in the active intervention districts showed greater improvements for four of the six indicators , although statistically significant compared with the regular intervention districts only for the essential material s indicator . CONCLUSIONS It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements . It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting SETTING Rural and urban areas of Maharashtra , a large state in Western India . OBJECTIVE To underst and tuberculosis ( TB ) management practice s among  private medical practitioners ( PPs )  and the treatment behaviour of the patients they manage . DESIGN Prospect i ve study of help-seeking patterns and treatment behaviour among 173 pulmonary TB patients diagnosed in private clinics , and the TB management practice s of 122 PPs treating these patients . RESULTS The first source of help for 86 % of patients was a PP . The diagnostic and treatment practice s of PPs were inadequate ; 15 % did not consider sputum examination to be necessary , and 79 different treatment regimens were prescribed by 105 reporting PPs . Sixty-seven percent of the patients diagnosed in private clinics remained with the private sector , and the rest shifted to public health services within six months of treatment . The treatment adherence rate among the patients in private clinics was 59 % . There were discrepancies between the reported management practice s of the PPs and what their patients actually followed . CONCLUSION The study identifies and highlights the need to educate PPs and their TB patients , and indicates ways in which PPs could be meaningfully involved in efforts to revitalize the national TB control programme In just a few years , oral rehydration therapy ( ORT ) has become the st and ard treatment to reduce infant diarrhoeal disease mortality in the developing world . The paper describes an ORT intervention campaign in a rural area in Western Kenya ( Kakamega District ) . After about a year of careful preparation , the campaign was launched in January 1986 and compared the use of a value-added product ( flavoured sachets ) sold through private outlets in addition to primary care distribution of an unflavoured sachet in an experimental cell ( Bukura Division ) . In a control cell ( Novakholo Division ) , only unflavoured sachets were distributed free of charge through primary health care facilities . Using local perceptions of diarrhoeal disease management , the campaign in the experimental cell was carefully design ed and mass communication techniques employed and adapted accordingly . Outcome assessment s of the campaign , which lasted until March 1987 , included the overall ORT utilisation over time . Changes in perceptions towards diarrhoeal disease management , direct assessment s of mixing a ' safe and effective ' solution accurately and other relevant process parameters were evaluated . Comparing several recent ORT intervention projects , the paper concludes that a combination of a commercial approach and mass communication techniques can further ORS use . If a proper incentive system for shopkeepers is installed and message design and ORS product are fully tailored to the perception and preferences of the target population , the commercial availability of ORS will create an extra dem and of the product . However , this will not replace distribution of ORS salts delivered free of charge through primary care sources Objectives : To evaluate the training of  pharmacists in Accra , Ghana , in the syndromic management of STIs . Methods : We r and omly selected 50 pharmacy outlets that had received the training ( intervention ) and 50 outlets that had not received the training ( no intervention ) . Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a st and ardised question naire after each encounter . Results : Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low ( no intervention 18 % ; intervention 39 % ; p < 0.05 ) . More encouraging , treatment for gonorrhoea was usually correct without the intervention ( 64 % ) and improved further in the intervention outlets ( 76 % ) . The treatment for chlamydia was less often appropriate but also improved ( 31 % and 41 % ) . Condom promotion was poor , with almost no outlets offering condoms . Conclusions : The current training led to improvements in the treatment of urethral discharge . Future training needs to be improved , especially with regard to condom promotion . Moreover , since less than one third of simulated clients were seen by pharmacists , the training should be exp and ed to other pharmacy staff . With enhanced training of all pharmacy staff , the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised OBJECTIVE To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health ( SRH ) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction . DESIGN A community-based quasi-experimental intervention study from 2000 to 2002 . SETTING Low-income areas of Managua . INTERVENTION Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics ; training and support for health care providers . STUDY PARTICIPANTS A r and om sample of 3009 girls from 12 to 20 years completed self-administered question naires : 700 respondents had used this care in the last 15 months , 221 with voucher ( users-with-voucher ) and 479 without voucher ( users-without-voucher ) . MAIN OUTCOME MEASURES User satisfaction ; Satisfaction with clinic reception ; Clarity of doctors ' explanations . RESULTS User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [ Adjusted odds-ratio ( AOR ) = 2.2 ; 95 % confidence interval ( 95 % CI ) = 1.2 - 4.0 ] . Voucher use was associated with more frequent satisfaction with clinic reception , especially among sexually active girls not yet pregnant or mother ( AOR = 6.9 ; 95 % CI = 1.5 - 31.8 ) . The clarity of doctors ' explanations was not perceived differently ( AOR = 1.4 ; 95 % CI = 0.9 - 2.2 ) . User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors ' explanations ( P < 0.001 ) . Longer consultation times , shorter waiting times , older age , and having a female doctor positively influenced user satisfaction . CONCLUSION Voucher use by teenage girls was associated with a better perceived SRH care . This is an important result , given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives . Though more research is needed , confidential and guaranteed access appear key factors to voucher success BACKGROUND The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care ( SRHC ) accessible to adolescents from disadvantaged areas of Managua . METHODS A quasi-experimental intervention study was performed in which 28,711 vouchers that gave free access to SRHC in 20 health centers , were distributed to adolescents . To evaluate the impact , community sampling took place in markets , neighborhoods , and outside schools where self-administered question naires were distributed . The study comprised a r and om sample of 3,009 female adolescents , ages 12 to 20 years old , 904 voucher receivers and 2,105 nonreceivers . Their use of SRHC , and knowledge and use of contraceptives and condoms were measured . RESULTS Voucher receivers had a significantly higher use of SRHC compared with nonreceivers , 34 % versus 19 % ( adjusted odds ratio , 3.1 ; 95 % confidence interval , 2.5 - 3.8 ) . The highest influence was seen among respondents at schools , where use was 24 % relative to 6 % in nonreceivers ( adjusted odds ratio , 5.9 ; 95 % confidence interval , 3.7 - 9.5 ) . Voucher receivers answered significantly more questions correctly that were related to knowledge of contraceptives and sexually transmitted infections than nonreceivers . At schools , sexually active voucher receivers had a significantly higher use of modern contraceptives than nonreceivers , 48 % versus 33 % ( adjusted odds ratio , 2.3 ; 95 % confidence interval , 1.2 - 4.4 ) ; and in neighborhoods , condom use during last sexual contact was significantly greater among voucher receivers than nonreceivers ( adjusted odds ratio , 2.5 ; 95 % confidence interval , 1.4 - 4.5 ) . CONCLUSION The voucher program succeeded in increasing access to SRHC for poor and underserved girls . The needs of adolescents were met with a relatively simple intervention through existing health facilities . Many adolescents appeared willing to protect themselves against the risks of sexual intercourse . This suggest that access to SRHC can play an important role in changing youth behavior and increase the use of contraceptives and condoms
target: It was , however , evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people .
background: Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries .
  The private sector represents an important source of care for all socioeconomic groups , including the poorest and substantial concerns have been raised about the quality of care it provides .
  Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals .
  Limited information is available on the extent to which these interventions have successfully exp and ed access to quality health services for poor and disadvantaged population s. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor .