BACKGROUND Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource-poor settings remains poorly defined. METHODS We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal spec...

In Africa, human immunodeficiency virus (HIV)-associated extrapulmonary tuberculosis (TB) is common and poses diagnostic difficulties. Ultrasound is useful to find suggestive signs such as effusions or abdominal lymphadenopathy. Because trained radiologists are scarce in resource-poor settings, even this simple and relatively inexpensive diagnostic tool is frequently unavailable to patients in ...

The purpose of this health workforce plan is to provide guidance for the staffing of the Bolikhamxay. Province health services and the training of health service personnel to the year 2020. It must be stressed, however, that this plan is in its first iteration and does not provide all the solutions. Rather, it identifies issues that need to be further investigated and resolved at the local leve...

OBJECTIVE To describe out-of-pocket costs of inpatient care for children under 5 years of age in district hospitals in Kenya. METHODS A total of 256 caretakers of admitted children were interviewed in 2-week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio-e...

BACKGROUND The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and char...

BACKGROUND It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight...

BACKGROUND Acute appendicitis in rural South Africa is associated with significant morbidity due to prolonged delays before definitive surgical care. OBJECTIVE This audit aimed to quantify the delay in our healthcare system. METHODS From September 2010 to September 2012, all patients with confirmed acute appendicitis were interviewed and asked about the onset of symptoms and subsequent even...

BACKGROUND Several countries have developed policies that restrict or limit duration of stay, clinical privileges or the number of residency permits allocated to migrating physicians. Switzerland is currently preparing a new law limiting overall foreign immigration. The impact of such restrictive policies is currently unknown. In a case study of anaesthesia care in Switzerland we modelled, tren...

OBJECTIVE To describe healthcare worker (HCW)-identified system-based bottlenecks and the value of local engagement in designing strategies to improve referral processes related to emergency obstetric care in rural Ghana. DESIGN Qualitative study using semistructured interviews of participants to obtain provider narratives. SETTING Referral systems in obstetrics in Assin North Municipal Ass...

BACKGROUND An 'opt-out' policy of routine HIV counseling and testing (HCT) is being implemented across sub-Saharan Africa to expand prevention of mother-to-child transmission (PMTCT). Although the underlying assumption is that pregnant women in rural Africa are able to voluntarily consent to HIV testing, little is known about the reality and whether 'opt-out' HCT leads to higher completion rate...