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5. Characterizing Therapeutic Pluralism Policies in Latin America: A Qualitative Content Analysis.

Author

Gallego-Pérez, DF, Declercq, E, Saper, RB, Barnes, LL, Wardle, J, Gallego-Pérez, DF, Declercq, E, Saper, RB, Barnes, LL, and Wardle, J

Abstract

Introduction: The 1978 Alma Ata Declaration initiated international recognition of non-biomedical healing systems and their relevance for primary health. World Health Assembly (WHA) resolutions have called for the study and inclusion of traditional and complementary medicine (T&CM) into national health systems through policy development. The increased public, political, and scholarly attention given to T&CM has focused on clinical efficacy, cost-effectiveness, mechanisms of action, consumer demand, and supply-side regulation. Although >50% of WHO member states have T&CM policies, scant research has focused on these policies and their public health implications. This paper defines a novel term "therapeutic pluralism," and it aims at characterizing related policies in Latin America. Methods: A qualitative content analysis of Latin American therapeutic pluralism policies was performed. Policies' characteristics and the reported social, political, and economic forces that have made possible their development were assessed. Pre-defined policy features were categorized on an MS-Excel; in-depth text analyses were conducted in NVivo. Analyses followed the steps described by Bengtsson: decontextualization, recontextualization, categorization, and compilation. Results: Seventy-four (74) policy documents from 16 of the 20 sovereign Latin American countries were included. Mechanisms for policy enactment included: Constitution, National Law, National Policy, National Healthcare Model, National Program Guideline, Specific Regulatory Norms, and Supporting Legislation, Policies, and Norms. We propose a four-category typology of policy approaches in Latin America: Health Services-centered, Model of Care-based, Participatory, and Indigenous People-focused. Common themes countries used when justifying developing these policies included: benefits to the health system, legal and political mandates, supply and demand, and culture and identity. Social forces these policies referenced as i

Published
2023

10. Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh/Medecine informelle et lutte contre la tuberculose au Bangladesh ou comment transformer en ressources des elements consideres comme des handicaps/Aprovechar al maximo los recursos: medicos de aldea informales y control de la tuberculosis en Bangladesh

Author

Salim, M.A. Hamid, Uplekar, Mukund, Daru, Paul, Aung, Maug, Declercq, E., and Lonnroth, Knut

Subjects
Tuberculosis -- Risk factors, Tuberculosis -- Care and treatment, Tuberculosis -- Diagnosis
Abstract

In 1998, the Damien Foundation Bangladesh invited semi-qualified, private "gram dakter" (Bangla for "village doctors") to participate in tuberculosis (TB) programmes in a population of 26 million people in rural Bangladesh. The organization trained 12 525 village doctors to not only refer suspected TB cases for free diagnosis but also to provide directly observed treatment (DOT) free of charge. Source of referral and place of DOT was recorded as part of the standardized TB recording and reporting system, which enabled us to quantify the contribution of village doctors to case detection rates and also allowed disaggregated cohort analysis of treatment outcome. During 2002 and 2003, 11% of all TB cases with positive sputum smears in the study area had been referred by village doctors; the rate of positive tests in patients referred by village doctors was 14.4%. 18 792 patients received DOT from village doctors, accounting for between 20% and 45% of patients on treatment during the 1998-2003 period. The treatment success rate was about 90% throughout the period. Urine samples taken during random checks of treatment compliance were positive for isoniazid in 98% of patients treated by village doctors. Within the framework of Public-Private Mix DOTS, services provided by semi-qualified private health care providers are a feasible and effective way to improve access to affordable high quality TB treatment in poor rural populations. The large informal health workforce that exists in resource poor countries can be used to achieve public health goals. Involvement of village doctors in TB control has now become national policy in Bangladesh. Resume Medecine informelle et lutte contre la tuberculose au Bangladesh ou comment transformer en ressources des elements consideres comme des handicaps En 1998, la Fondation Damien au Bangladesh a invite des <> (terme local designant les <>) partiellement qualifies et prives a participer aux programmes de lutte contre la tuberculose (TB) dont beneficient 26 millions d&apos;habitants des zones rurales du Bangladesh. Cette organisation a forme 12 525 medecins de village non seulement a orienter les cas suspects de TB vers un diagnostic gratuit, mais egalement a delivrer un traitement sous observation directe (DOT) gratuit egalement. La source de la notification et le lieu d&apos;administration du traitement DOT ont ete enregistres dans le cadre du systeme standardise d&apos;enregistrement et de notification des cas de TB, ce qui a permis de quantifier la contribution en pourcentage des medecins de village a la detection des cas et de realiser une analyse desagregee des resultats du traitement au sein de la cohorte. De 2002 a 2003, les medecins de village avaient notifie 11% de l&apos;ensemble des cas de TB a frottis positif recenses dans la zone etudiee et dirige 14,4 % des patients presentant un test positif vers un specialiste. Ces medecins avaient egalement delivre un traitement DOT a 18 792 malades, soit une proportion de 20 a 45 % des malades sous traitement pendant la periode 1998-2003. Le taux de succes du traitement etait de 90% pour cette meme periode. Des echantillons d&apos;urine preleves au hasard pour controler l&apos;observance du traitement etaient positifs pour l&apos;isoniazide chez 98 % des malades traites par des medecins de village. Dans le cadre des programmes DOTS mixtes public/prive, les services fournis par les dispensateurs de soins de sante partiellement qualifies et prives offrent aux populations rurales demunies un moyen efficace pour acceder plus facilement a un traitement antituberculeux de qualite. Il est donc possible de faire appel aux importants moyens humains de la medecine informelle dans les pays pauvres pour realiser les objectifs de sante publique. La participation des medecins de village a la lutte contre la TB fait maintenant partie de la politique nationale du Bangladesh. Resumen Aprovechar al maximo los recursos: medicos de aldea informales y control de la tuberculosis en Bangladesh En 1998, la Fundacion Damien de Bangladesh invito a <> (<> en bangla) privados semicualificados a participar en programas de tuberculosis para una poblacion de 26 millones de personas del Bangladesh rural. La organizacion capacito a 12 525 medicos de aldea no solo para derivar los casos sospechosos de tuberculosis a servicios de diagnostico gratuito, sino tambien para proporcionar gratuitamente tratamiento bajo observacion directa (DOT). La fuente de derivacion y el lugar de administracion del DOT se registraron como parte del sistema normalizado de registro y notificacion de la tuberculosis, lo que nos permitio cuantificar la contribucion de los medicos de aldea a las tasas de deteccion de casos y, ademas, efectuar analisis de cohortes desglosados de los resultados terapeuticos. Durante 2002 y 2003, el 11% de todos los casos de tuberculosis con baciloscopia de esputo positiva en el area de estudio fueron derivados por medicos de aldea; la tasa de pruebas positivas entre los pacientes derivados pot esos medicos fue del 14,4%. 18 792 pacientes recibieron DOT de los medicos ae aldea, lo que supone un 20%-45% de los pacientes sometidos a tratamiento durante 1998-2003. La tasa de exito terapeutico fue de alrededor del 90% durante el periodo considerado. Las muestras de orina obtenidas en los controles aleatorios del cumplimiento del tratamiento fueron positivas a la isoniazida en el 98% de los pacientes tratados por los medicos de aldea. En el marco de la DOTS publicoprivada, los servicios ofrecidos por dispensadores de atencion sanitaria privados semicualificados son una opcion viable y eficaz para mejorar el acceso a un tratamiento antituberculoso asequible y de calidad en las poblaciones rurales pobres. La amplia fuerza laboral sanitaria informal existente en los paises con pocos recursos puede ser aprovechada para alcanzar metas de salud publica. La participacion de medicos de aldea en la lucha contra la tuberculosis ha pasado a format parte de la politica nacional en Bangladesh., [TEXT NOT REPRODUCIBLE IN ASCII] Introduction Bangladesh ranks fifth among the 22 highest tuberculosis-burden countries in the world with an estimated tuberculosis (TB) incidence rate of 246 cases per 100 [...]

Published
2006

11. The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries.

Author

Kennedy, HP, Balaam, M-C, Dahlen, H, Declercq, E, de Jonge, A, Downe, S, Ellwood, D, Homer, CSE, Sandall, J, Vedam, S, Wolfe, I, Kennedy, HP, Balaam, M-C, Dahlen, H, Declercq, E, de Jonge, A, Downe, S, Ellwood, D, Homer, CSE, Sandall, J, Vedam, S, and Wolfe, I

Abstract

Background

The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States.

Method

We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system.

Results

The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems.

Conclusions

The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.

Published
2020

18. The importance of evaluating primary midwifery care for improving the health of women and infants

Author

Jonge, A de, Vries, R. de, Lagro-Janssen, A.L.M., Malata, A., Declercq, E., Downe, S., Hutton, E.K., Jonge, A de, Vries, R. de, Lagro-Janssen, A.L.M., Malata, A., Declercq, E., Downe, S., and Hutton, E.K.

Abstract

Contains fulltext : 154197.pdf (publisher's version ) (Open Access), In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all. This care includes preventive and supportive care that works to strengthen women's capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population's curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.

Published
2015

22. Midwifery and quality care: findings from a new evidence-informed maternity care framework.

Author

Renfrew, MJ, McFadden, A, Bastos, MH, Campbell, J, Channon, AA, Cheung, NF, Delage, D, Downe, Soo, Kennedy, HP, Malata, A, McCormick, F, Wick, L, Declercq, E, Renfrew, MJ, McFadden, A, Bastos, MH, Campbell, J, Channon, AA, Cheung, NF, Delage, D, Downe, Soo, Kennedy, HP, Malata, A, McCormick, F, Wick, L, and Declercq, E

Abstract

Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Delage D, Downe SM, Kennedy HP, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed maternity care framework. The Lancet, Invited Series. (Accepted, May 2014)

Published
2014

28. Relative water level change in the intracoastal zone of Belgium and northern France over the last 2500 years

Author

Louwye, S. and Declercq, E.

Subjects
ANE, France, Tidal deposits, ANE, Belgium, Coastal zone, Water levels
Abstract

Water level positions during the Subatlantic in the coastal plain of Belgium and Northern France are assessed by means of indicators such as tidal levees, upper tidal flat deposits and mature salt marshes. The indicators are evaluated for the reconstruction of local mean high water and local mean spring high water levels in the intracoastal zone. No significant altitude difference is observed between the indicators genetically related to the Dunkerque II inundation phase, i.e. before the land reclamations of the 10th century AD, and the medieval Climate Optimum (AD 1000-1350). There is no evidence for a high relative local water level or a water level rise during the medieval Climate Optimum. It is shown that a hydrological phenomenon, probably an estuary effect, caused water levels to rise significantly in restricted areas of the former tidal flat during the Dunkerque II phase. A comparison between the local water level record and the tide gauge records at Oostende indicates a more marked fluctuation over the last 160 years than during the preceding 700 years.

Published
1998

37. Analysis of the competitive position of short sea shipping: Development of policy measures

Author

Peeters, C., Verbeke, A., Declercq, E., and Wijnolst, N.

Subjects
short sea shipping, policy measures
Abstract

This study on the potentialof Short Sea Shipping (SSS) in Europe, with a focus on four corridors, consists of four parts. In the first part (Chapter I) the existing intra-European SSS-traffic is identified and analyzed for each relevant category of goods and transport corridor. In the second part (Chapter II), a new methodology is proposed for the strategie analysis of the competitive position of SSS vis-à-vis transport altematives. This methodology is applied to ten case studies with substantial policy relevanee within the corridors under consideration. The third part (Chapter III provides an analysis of the potential offour 'innovative' types of SSS-vessels, namely fast cargo ships, sea-river ships, selfunloading bulk carriers and selfunloading and -loading unitload ships. Finally, in the fourth part (Chapter IV), ten major policy recommendations are formulated to guide EU-policies in the area of SSS.

Published
1995

38. SYNTHESIS AND ANTI-HIV EVALUATION OF ALKYL AND ALKOXYETHYL PHOSPHODIESTER AZT DERIVATIVES

Author

CALOGEROPOULOU, T KOUFAKI, M TSOTINIS, A BALZARINI, J and DECLERCQ, E MAKRIYANNIS, A

Subjects
virus diseases, lipids (amino acids, peptides, and proteins)
Abstract

A series of new AZT conjugates with alkyl and oxyalkyl ether phospholipids was synthesized and evaluated for inhibitory activities against HIV-1 and HIV-2. The alkoxyethyl derivatives 6a-c proved 3- to 5-fold more active against HIV-1 and H1V-2 than the alkyl analogues 6d-f. A trend for higher activity with longer alkyl side-chains was observed. However, the analogues with the shortest chain possessed the most favourable therapeutic index.

Published
1995

42. Optimal location of intermodal terminals in Europe : an evaluation model

Author

Moreira, Ana M. D., Ribeiro, Rita A. 1954, Declercq, E., Massachusetts Institute of Technology. Laboratory for Information and Decision Systems., Moreira, Ana M. D., Ribeiro, Rita A. 1954, Declercq, E., and Massachusetts Institute of Technology. Laboratory for Information and Decision Systems.

Abstract

Title from cover. "August, 1998.", Includes bibliographical references (leaf 5)., Supported in part by The European Commission, project EMOLITE. ST-96-SC.1018, Moreira, M.D., Ribeiro, R.A., Declercq, E.

Published
2003

43. Amélioration de la qualité en médecine générale sur base d'enregistrement de données de consultation: diabète de type 2 et hypertension artérielle

Author

UCL - MD/ESP - Ecole de santé publique, Vandenberghe, H., Bastiaens, H., Jonckheer, Pierre, Orban, T., Declercq, E., Lafontaine, M.-F., Van Casteren, V., UCL - MD/ESP - Ecole de santé publique, Vandenberghe, H., Bastiaens, H., Jonckheer, Pierre, Orban, T., Declercq, E., Lafontaine, M.-F., and Van Casteren, V.

Published
2003

47. AIDS and HIV infection in Belgium

Author

Declercq E

Subjects
Male, medicine.medical_specialty, Acquired Immunodeficiency Syndrome, business.industry, Human immunodeficiency virus (HIV), AIDS Serodiagnosis, General Medicine, medicine.disease_cause, medicine.disease, Infectious Disease Transmission, Vertical, Acquired immunodeficiency syndrome (AIDS), Belgium, Family medicine, medicine, Disease Transmission, Infectious, Humans, Female, business
Published
1994

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