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Determination of Knowledge, Behaviour and Attitudes of University Students and Youth and the Evaluation of Two Peer Education Programmes in Turkey and in Armenia |
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Kilic, Alper
Today, the number of people living with HIV/AIDS (Acquired Immunodeficiency Syndrome) exceeds 40 million and the number is still increasing. Worldwide, approximately half of the HIV infected people are in the age group 15-24. In Turkey and in Armenia the numbers of HIV infected people are increasing despite the low prevalence.
Currently a cure for HIV is not available and therefore changing behaviours of the young people still plays a key role in preventing new infections. One of the key health education methods on the prevention from HIV transmission, peer education method has been widely used in different parts of the world.
The increasing number of HIV/AIDS transmission both in Turkey and Armenia led the organisations working on HIV/AIDS and health education area to organise peer education sessions on HIV/AIDS. This cross sectional study aims to evaluate two peer education programmes among the youth and university students in Turkey and in Armenia. Face to face surveys conducted among 351 university students in Turkey, and youth in general population in Armenia (n= female; n= male mean age: 21.6) with conventional sampling methods. The university students and young people who took part in the survey contained of those who have participated in peer education and those who have not participated to the peer education programmes. The participants of the study were assessed in terms of their knowledge on prevention from HIV and its transmission methods, perception and attitude towards people with HIV/AIDS, and their risk behaviours related to the HIV/AIDS.
Survey results have shown that survey participants from both Armenia and Turkey, have similar knowledge, perception and risk behaviours regarding the HIV/AIDS. In both countries, the level of knowledge on the HIV, its ways of transmission, and prevention methods are rather low. Additionally, issues such as confidentiality of the HIV positive people and their involvement in the work force have to be addressed by the educators.
Almost half of the total number of participants has reported that they were sexually active. In Armenia, survey participants have reported higher number of sexual activity when compared with the survey participants in Turkey. The survey showed that there was a very low level of condom use in all groups.
In both countries, the peer education group demonstrated slightly more knowledge on the transmission of the HIV. Furthermore, it was observed that the students? attitude towards PLWHA had improved in the peer education group in comparison to those who had not taken part in peer education sessions. However, risk behaviours related with the HIV had not significantly changed among any of the groups participating. Peer education participants did not report higher ratios of condom usage.
This research suggests that the peer education programmes are being effective, and more has to be done in order to increase awareness and change behaviour of the young people. However, it also suggests that these two peer education programmes were inadequate with regard to prevention of risk behaviours.
Graduate date:
2007-03-29 |
Last update:
2007-07-18 |
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Epilepsy and Neurocysticercosis: an Incidence Study in a Peruvian Rural Population |
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Villaran, Manuel
Background: Epilepsy is defined as two or more unprovoked epileptic seizures; seizures are uncontrolled, paroxysmal neuronal discharges in any part of the brain, causing physical or mental symptoms which may be convulsive or nonconvulsive.
Neurocysticercosis is the most common central nervous system helminthic infection. It is caused by the ingestion of Taenia solium eggs released in feces of the tapeworm carriers. Seizures are one of the most common acute neurologic manifestations of this infection, and epilepsy is rated among the most serious neurologic disorders. They are caused by the inflammatory process that takes place surrounding the parasite as it decays. Another severe, life threatening form of the disease is racemose cysticercosis, which can cause intracranial hypertension and/or hydocephalus.
Although there is a strong relationship between neurocysticercosis and epilepsy prevalence in endemic areas, incidence studies are scarce. Previously reported incidences range from 30 to 50/100,000 in industrialized countries and 30 ? 120/100,000 in developing countries.
Objectives: To determine the incidence of epilepsy in a neurocysticercosis endemic area.
Methods: A community-wide screening survey for possible seizure cases was performed between years 2000 and 2005 in seven villages of Tumbes (Northern Peru), a well known cysticercosis endemic area, using a validated questionnaire. Positive respondents were later examined in the field by neurologists. Seizure cases were categorized as single seizure, active epilepsy, or inactive epilepsy. Non-contrasted brain CT scans and contrasted MRI?s were performed in all individuals with seizures.
Results: Follow up was carried out in 817 individuals (most of them permanent residents), with a mean duration of 4.38 years (range: 0-5.49) for a total of 3575 person-years of observation. Eight individuals (0.98%) developed seizures during the study, resulting in a cumulative incidence of 2.16 / 1000 (95% C.I. 0.97 ? 4.40). Two of the eight individuals with seizures had a positive serologic test from the beginning and one turned positive by the time the first epileptic seizure episode took place, therefore 3/8 (37.5%) of these individuals were at some point seropositive. Four of the eight individuals presented neuroimages compatible with neurocysticercosis (50%), all of them calcification. However, one was left out the analysis because the calcification was very near the falx and it could have been the result of a physiological process.
Conclusion: The incidence of epilepsy in this endemic cysticercosis area is one of the highest among the reported rates in developing countries. Out of the eight individuals with epileptic seizures, four presented evidence of cysticercosis.
Graduate date:
2007-01-25 |
Last update:
2007-07-18 |
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Evaluation of the treatment outcome of patients with Buruli Ulcer after surgical treatment in Ghana |
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Institution:
Prince Leopold Institute for Tropical Medicine
Author:
Schunk, Mirjam
Problem statement
Buruli Ulcer disease (BUD) has been recognized to be an emerging public health problem in many topical countries, especially in the West African Region. In Ghana prevalence rates of up to 150 per 100.000 individuals were reported form most affected districts, making BUD the most prevalent mycobacterial disease in these areas. Although the disease related mortality is very low, disfiguring and disabling sequelae are common if the disease is left untreated or is treated in an advanced stage. Until recently surgical excision of the affected skin was the only treatment option. Because of encouraging results of drug trials antimycobacterial treatment was introduced in the standard treatment advised by WHO in 2004. In the context of improving the quality of clinical management, the need for follow-up studies to monitor the treatment outcome has been emphasised. However, there are only few studies of long-term outcome and relapse rates so far. In the published studies recurrence rates after hospital treatment vary from 2 to 35 %.
Objectives
A follow-up study of BUD patients who received surgical treatment was conducted with the aim of assessing the frequency of recurrences and the frequency of functional limitations as late sequelae of BUD in the follow-up sample as well as to analyse the occurrence of recurrences and /or functional limitations in association to clinical and treatment specific factors and to evaluate psychosocial aspects in the follow-up sample.
Methods
The follow-up was conducted in the catchment area of the Agogo Presbyterian Hospital, Asante Akim North District, Ashanti Region and the Dunkwa Government Hospital, Dunkwa-on-Offin, Upper Denkyira District, Central Region, Ghana. In both districts BUD is highly endemic. In total 129 laboratory confirmed BUD patients who received surgical treatment in either of the two treatment centres from September 2003 to September 2006 were included in the study. Baseline clinical data were extracted from Buruli Ulcer surveillance forms and hospital records, if available. Between February and March 2006, 16 field trips were conducted to visit included patients in their homes. The retrieved patients were interviewed using a semi-structured questionnaire for post-treatment history with a special focus on possible recurrences and sequelae as well as the psychosocial impact of the disease. In addition physical examinations were performed to clinically assess treatment outcome.
Results
Out of a total of 129 laboratory confirmed BU-patients, 79 (61%) were retrieved for follow-up. In the follow-up sample there were 7 (9%) recurrences, 6 cases of recurrences had occurred in the interim time between first treatment and follow-up, only one recurrent case was observed at follow-up. In the analysis of factors influencing the probability of recurrence no significant association was found between recurrence and size/ type of primary lesion, wound closure technique, use of antimycobacterial treatment, duration of disease before treatment and place of treatment.
27% (n=21) of the followed-up patients showed a functional limitation caused by a reduced range of motion of one or more joints as a sequel to the BU-infection. There was no significant correlation concerning type and size of primary lesion; however, no functional limitation was caused by a nodule as primary lesion. Regarding the wound closure technique a significant association was noted. In 90% (n=19) of the patients presenting with functional limitations at follow-up, skin grafts were applied for wound closure.
In patients over 15 years of age (n=55) the acceptance of the outcome after clinical interventions was with 73% (n=40) quite high. 29% (n=16) in this group reported that due to functional impairments or other sequelae they were not able to fulfil all tasks of daily life.
Conclusions
The results show a low recurrence rate in our study group. Since no single factor proved to have an essential influence on the occurrence of recurrent cases, the low incidence of recurrences is attributed to an effective clinical management of BUD in the study area, including early detection efforts, adherence to treatment guidelines, growing expertise of surgery and introduction of the use of antimycobacterial treatment in addition to surgical excision of the BUD lesions. However, functional limitations were relatively frequent. This emphasises the importance of the improvement of pre- and post-operative wound care to avoid functional sequelae and the urgent need for the provision of rehabilitation programmes.
With ongoing efforts to optimize clinical management for BUD, routine follow-up surveillance is essential to evaluate the impact of theses measures on treatment outcome.
Graduate date:
2007-07-19 |
Last update:
2007-07-18 |
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Feasibility of scaling up child health interventions: Exploring constraints that affect the implementation of breastfeeding and antibiotics for pneumonia child interventions in Uruguay health settings
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Sarganas, Giselle
Objective: To explore constraints affecting the implementation of breastfeeding and antibiotics for pneumonia child interventions in Uruguay health settings by using the conceptual framework developed by Gericke et al. (2003, 2005) and to make suggestions on the feasibility of scaling up these interventions.
Design: This exploratory case study includes a conceptual and an empirical assessment of the degree of complexity of the selected child health interventions. For the conceptual assessment, international recommendations and global documented constraints and related recommendations were analysed. For the empirical assessment, field visits and semi-structured face-to-face interviews were conducted.
Results: The conceptual assessment of breastfeeding showed that this intervention requires knowledge, continuous education, advocacy and promotion. In the empirical assessment constraints were identified under the framework?s categories ?human resources?, ?pre existing demand? and ?regulation?. In the conceptual assessment, antibiotics for pneumonia proved to be a more complex intervention which requires a regular supply and consistent availability of the product, technically skilled health workers for its delivery, and a well informed community. The empirical assessment identified constraints in the categories ?supplies?, ?regulation?, ?human resources?, ?ease of usage? and ?pre existing demand?.
Suggestions: For scaling up the breastfeeding intervention in Uruguay health settings it is recommended to reinforce education of the general public and update health workers training; to start breastfeeding promotion earlier and include both partners; to elaborate supportive policies in the labour market; and the supervision and control of breast milk substitutes. For scaling up antibiotics for pneumonia child intervention in Uruguay health settings it is recommended to dispel the irrational demand and the irrational delivery of antibiotics by educating the community and health workers; to use a check list and an antibiotic sample for facilitating the explanation to caregivers regarding antibiotic usage; and to regulate the amount of antibiotics provided by public pharmacies in coherence with national guidelines.
Conclusion: The conceptual assessment facilitated the empirical assessment and structured identification of constraints. The framework proved to be a very useful systematic tool for the conceptual as well as for the empirical assessment of the selected child interventions. It is feasible to scale up breastfeeding and antibiotics for pneumonia child interventions in the selected health settings in Uruguay by narrowing the capacity gap through changes to the intervention design and upgrading capacity to overcome the constraints identified in this analysis.
Graduate date:
2007-02-01 |
Last update:
2007-07-18 |
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Gesundheitsversorgung unter den Bedingungen der italienischen "Centri di Permanenza temporanea ed Assistenza." Erfahrungen und Wahrnehmungen der "Gäste" und des medizinisch-psychologischen Fachpersonals |
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Poluda, Julian
Am Ende des Jahres 1998 wurde unter der Mittelinksregierung Prodi die landesweite Konstruktion von ?Zentren des zeitweiligen Aufenthalts? (Centri die Permanenza temporanea - CPT) beschlossen. Diese fungieren als Aufnahme/-Abschiebelager für Migranten mit irregulärem Aufenthaltsstatus auf italienischem Territorium. Zurzeit gibt es in Italien 16 über das ganze Land verteilte CPTs, die landesweite Konstruktion weiterer CPTs ist in Planung. Während sich bereits die Erfahrungen im Herkunftsland wie auch während der Migration negativ auf psychische wie physische Gesundheit von Migranten auswirken können, sorgt das soziale Umfeld der von der Außenwelt weitestgehend isolierten Aufnahme/-Abschiebelager für weitere potentielle Belastungsfaktoren. Jedoch liegen bislang kaum Kenntnisse der Versorgungsbedürfnisse der in den Abschiebelagern internierten Migranten sowie der dort geleisteten Gesundheitsversorgung vor.
Die vorliegende Studie möchte daher, über die Exploration der Vorstellungen und
Meinungen des medizinisch-psychologischen Personals wie auch der internierten
Migranten selbst, eine Einschätzung der bestimmenden Gesundheitsprobleme im
CPT ermöglichen. Auf Grundlage dieser Erkenntnis erfolgt dann eine Untersuchung
der medizinisch-psychologischen Versorgung innerhalb der italienischen CPTs,
wobei dem Einfluss der sozialen Determinanten im CPT besondere Aufmerksamkeit gilt. Dabei bildet die Perspektive der Betroffenen den Schwerpunkt der Auseinandersetzung, so dass ein explorativer, qualitativer Studienansatz gewählt wurde. Semistrukturierte Tiefeninterviews mit den ?Gästen? wie auch mit dem medizinisch-psychologischen Personal konzentrieren sich auf Gesundheitssituation, medizinisch-psychologische Versorgung und die weiteren Versorgungsdienstleistungen im CPT. Ausgehend von einer bio-psycho-sozialen
Krankheitsauffassung wird dabei versucht, ein Verständnis der vielfältigen
Interaktionen von interpersonellen, soziokulturellen, aber auch soziopolitischen
Einflussfaktoren auf das Wohlbefinden wie auch auf die Versorgung der Betroffenen
zu entwickeln.
Die Untersuchung der Gesundheitssituation und -Versorgung in den CPTs ergab
deutliche Hinweise auf eine hohe Prävalenz psychosomatischer Erkrankungen.
Desweiteren weisen psychologischer Symptomkomplex, Vorgeschichte der ?Gäste? im CPT und Berichte über Akte der Selbstverletzung auf das hohe Vorkommen 7 psychotraumatischer Belastungsreaktionen hin. Wissensdefizite in der psychologischen Betreuung von Migranten, personelle Unterbelegung mit
psychologisch geschultem Fachpersonal, transkulturelle Missverständnisse zwischen Arzt und Patient, eine unzureichende Kooperation zwischen Ärzten und
psychologischem Personal und Probleme in der Arzt-Patientenbeziehung tragen zu
Defiziten in der medizinisch-psychologischen Versorgung bei.
Weitere medizinisch-psychologische Problemfelder betreffen die Diagnose und
Therapie bei Infektionskrankheiten, die gynäkologische Versorgung und die Therapie von Abhängigkeitserkrankungen.
Die sozialen Bedingungen der CPTs erschweren maßgeblich die medizinischpsychologische Versorgung und zeigen sich zugleich für die Entstehung neuer Krankheiten mitverantwortlich. Hervorzuheben sind dabei die psychologischen Auswirkungen von Kriminalisierung, rechtlicher Unsicherheit, dem Verlust individueller und kollektiver Bewältigungsressourcen und die fehlende Möglichkeit der Eigenbestimmung über das eigene Leben.
Die Ergebnisse der vorliegenden Studie lassen daher den Schluss zu, dass die zur
Zeit existierenden Aufnahme/-Abschiebelager für Migranten nach Gesundheitsaspekten nicht geeignet sind und dass konkreter Handlungsbedarf für
die Verbesserung der Gesundheitsversorgung und der Lebensbedingungen in den
italienischen CPTs besteht.
Graduate date:
2006-12-20 |
Last update:
2007-07-18 |
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HEALTH SYSTEM INTERVENTION ANALYSIS: The Recommending-Financing Gap of International Organizations for Health System Interventions. Meddling or Money?
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Dini, Lorena
International Organizations have been launching many initiatives to support the efforts of developing countries and countries in transition to improve their development status and to achieve goals such as ?Health for all?, ?Millennium Development Goals? or the ?Poverty Reduction Strategy?. As these have been implemented, questions have arisen as to how to improve aid effectiveness, how to track aid flows at global and national levels, and how to harmonize donor practices. The development community?s work in developing countries depends on a complex mix of factors that go beyond the political, economic, environmental, social and humanitarian causes. Development professionals have recognized that even with the best intentions it is possible to have little or no impact or even to harm rather than help others. Nevertheless, flows of aid to developing countries through partnerships based regional programmes could be designed in such a way, at the global level, that the efforts are cost-effective, with minimal or no duplication or overlap, gaps or waste of resources. Priorities of international organizations could be aligned so as to ensure consistent elaboration and complementarity of goals focused towards the attainment of the overall vision. Such harmonization of the work of international organizations could increase aid effectiveness, and developing countries and countries in transition could make more progress.
Health Systems are recognized as multisectoral systems in the complex development world, affecting and affected by economic, social and political development. In recent years, strengthening health systems has been given a high priority in the development agenda.
This is a multiple case study, designed to develop and test tools to explore the relationship between recommended and financed health system interventions in the work of the major international organizations. This pilot study considers the work of three international organizations, the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and the World Bank (WB), in two regions, the Latin America and Caribbean Region (LAC) and the Central and Eastern European countries and New Independent States of the Former Soviet Union (CEE-NIS), over a period of four years, from 2001 to 2004.
To document recommendations on health system interventions, the yearly reports issued by two organizations, the World Health Organization and the World Bank, were selected. Information on financing of health system interventions through projects was obtained from the projects database of the World Bank and from the OECD CRS database on disbursements on aid to health. To retrieve information on recommended health system interventions from the selected documents, two data collection methods were piloted in parallel, Content Analysis Coding (CAC), a coding-while-reading method, and the Frequency of Key Term Count (FKC), a computer based count of pre-selected key terms. Collection of data on financed health system interventions was done using the Content Analysis Coding method. Data on recommended and financed health system interventions identified in each document was classified according to the World Health Organizations framework of four health system functions, Stewardship, Financing, Resource generation, and Service provision. Health systems interventions identified in each document were ranked according to priorities the document?s authors gave them (as assessed using procedures developed and piloted in this study), using a four to-one hierarchical ranking system that permits comparison between recommended and financed priorities. Yearly and four year average priorities are presented in percentages and in priority rankings for each recommended and financed health system function analysed.
Based on this pilot study and the tools developed and tested in it, the author proposes two indicators, a Recommending-Financing Score for Health System Functions (R-F Score) and a Recommending-Financing Gap for Health System Interventions (R-F Gap for HSI).
The R-F Score is proposed as a measure of the consistency of the priorities rankings given to each health system function in recommendations, and the priority ranking given to the same health system function in terms of financing, for a given period.
The R-F Gap for HSI covers all health system functions and is proposed as a measure of the degree of harmonization in the work of international organizations regarding recommended and financed health system interventions during a period.
According to the initial estimates of this pilot study, the analysed ?pairs? of international organizations show variations in their degrees of consistency between the priorities rankings given to each health system function in recommendations and the priority ranking given to the same health system function in terms of financing, for the 2001 to 2004 period.
Most of the analysed ?pairs? show variation in the degree of harmonization of their work regarding recommended and financed health system interventions during the four years analysed for the LAC and for the CEE-NIS region.
Despite variations in the degree of harmonization, this pilot study?s initial estimates show improvement in the work of the selected international organizations regarding health system interventions, particularly after 2003. This improvement is in accordance with international initiatives, including the Monterrey Consensus (International Conference on Financing for Development (March 2002) and the Conference on Harmonization on Aid Effectiveness (June 2003), for the improvement of strategic aid delivery and harmonizing development assistance to developing countries and countries in transitions regarding strengthening of health systems.
By considering the Recommending-Financing Gap of International Organizations for health system interventions and the Recommending-Financing Score for each health system function, new avenues and opportunities for targeting and strengthening particular health system functions could be revealed. This could allow more strategic allocations of resources and more efficient delivery of aid.
Graduate date:
2007-05-21 |
Last update:
2007-07-18 |
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household coverage rate and utilisation of insecticidal mosquito nets one year after start of a community-participatory malaria prevention project in a rural village in northern Tanzania |
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Ineichen, Johannes
Background: Malaria is a leading cause of morbidity and mortality in many tropical countries including Tanzania. Despite that Insecticidal mosquito nets (ITNs) are a major tool in malaria prevention both for individuals and for communities, ITN household coverage rate in Manyara region in northern Tanzania was 8.1% according to the last Demographic and Health Census of 2004-05. In the rural village of Massieda (Manyara Region) with 3647 inhabitants a community-participatory malaria prevention project has been started in April 2006. Socially marketed ITNs have been offered to community members, who furthermore have been sensitised about malaria disease and prevention opportunities including appropriate ITN use.
Study Objectives: to assess the ITN household coverage and ITN utilisation of community members one year after project start.
Methods: In this cross-sectional survey a systematic random sample of 110 households out of 550 has been selected. Needed information has been collected from household representatives by an interviewer-administered questionnaire. Additional data on malaria occurrence and outpatient numbers were collected from the local dispensary records.
Results: Data of 102 households and of 767 household residents and overnight guests have been included in the analysis after accounting for non-responders. The ITN household coverage rate was 59% (60/102). Forty-six percent (326/703) of persons staying in the surveyed households preceding night have used an ITN, and of children aged below five years 60% (76/126), and of pregnant women 56% (5/9). ITN household coverage of houses located within two hours walking time to the next water source was higher compared to more distant houses (74% vs. 51%; Chi2, p = 0.03). Houses built of tin roofs or stone walls rather possessed ITNs compared to traditional flat-ceiling houses (91% vs. 55%, Fisher?s exact, p = 0.025). No association has been observed between ITN household possession or ITN use of children aged below five years and occurrence of fever in the last two weeks. Dispensary records revealed that proportion of malaria patients out of all outpatients has decreased from 33% in 2005 to 28% in 2006 (Chi2, p = 0.016).
Conclusion: The project is one among several possible factors that might have contributed to the high ITN household possession rate, ITN utilisation rates and declining proportion of malaria patients. Mosquito nuisance near water sources might enhance residents? willingness to obtain ITNs. Low ceilings of traditional houses might be hindrance factors for inhabitants to install ITNs, as might be economic constraints. A health impact of ITN use on fever in children has not been observed, whereby fever is an inaccurate proxy indicator for malaria illness.
Graduate date:
2007-07-19 |
Last update:
2007-07-18 |
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Migration and health in China: the situation of female migrant workers and strategies to limit the spread of HIV. A literature review. |
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Institution:
Charité Universitätsmedizin Berlin, Humboldt University and Free University Berlin (tropEd Home Institution)
Author:
Müller, Leonie Macbeth
Economic reforms since the late 1970s have resulted in much rural to urban migration in China. This paper is a literature review and looks at the connection between female rural to urban migration in China, limiting the spread of HIV and how the healthcare system is placed to deliver adequate HIV prevention and control in China in general and for the migrant population in particular. The issue of access to social services and medical care for migrants is framed in the context of the hukou system, a household registration system unique to China. An overview of the HIV epidemic is given including gender considerations and potential HIV-related economic implications for China?s development. Conceptual approaches to HIV responses are discussed prior to looking at China?s current prevention and control strategies. HIV demands on the healthcare system are also discussed. The final recommendations include a stronger need for inter-sector collaboration amongst the various actors already working in HIV and those who could potentially be recruited to work in the field. A strengthened healthcare system, with an emphasis on rural areas is called for to deliver timely and adequate HIV treatment and prevention.
Graduate date:
2006-08-10 |
Last update:
2007-07-18 |
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