Asset ownership among households caring for orphans and vulnerable children in rural Zimbabwe: the influence of ownership on children's health and social vulnerabilities.

Science.gov (United States)

Crea, Thomas M; Lombe, Margaret; Robertson, Laura A; Dumba, Lovemore; Mushati, Phyllis; Makoni, J C; Mavise, Gideon; Eaton, Jeffrey W; Munatsi, Brighton; Nyamukapa, Constance A; Gregson, Simon

2013-01-01

The high prevalence of human immunodeficiency virus/acquired immune deficiency syndrome in sub-Saharan Africa has resulted in a dramatic increase in orphans and vulnerable children (OVC) over the past decade. These children typically rely on extended family networks for support, but the magnitude of the crisis has resulted in traditional familial networks becoming overwhelmed and more economically and socially vulnerable. Previous research consistently demonstrates the positive influence of household asset ownership on children's well-being. Using data from impoverished households caring for OVC in rural Manicaland Province, Zimbabwe, this study explores the influence of household asset ownership on OVC health vulnerability (HV) and social vulnerability (SV). Findings indicate that asset ownership is associated with significantly lower SV, in terms of school attendance and birth registration. Yet, assets do not emerge as a direct influence of OVC HV as measured by disease and chronic illness, although having a chronically ill adult in the household increases HV. These findings suggest that asset ownership, specifically a combination of fixed and movable assets, may offset the influence of other risk factors for children's SV.

A study of descriptive data for orphans and non-orphans on key criteria of economic vulnerability in two municipalities in South Africa

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Donald Skinner

2013-05-01

Full Text Available Background: It is generally assumed that orphan status increases the risk to children of a range of negative outcomes. In South Africa, death of parents due to HIV-related illness is contributing to a rapid increase in the prevalence of orphans. This paper presents descriptive data from two South African communities, namely Kopanong, in the Free State and Kanana in the North West province, characterising the differences between orphans (double, maternal and paternal and non-orphans on key criteria of social vulnerability.Objectives: The objective was to obtain a better understanding of how different types of orphans and non-orphans may differ in these key areas as a crucial starting point for addressing the devastating consequences the AIDS epidemic has on these children’s lives. While the study focuses on two specific areas these will provide insight into the general situation of orphans in South Africa.Methods: A cross-sectional census survey was conducted in the two communities of Kopanong, comprising n = 5254 households and Kanana, comprising n = 12 984 households.Results: In Kopanong, 8.2% of children had lost both parents, 19.1% had lost their father and 6.5% their mother only, whilst in Kanana the results were 6.5%, 28.1% and 3.7% respectively. Loss of both parents appeared to have a consistent impact on material need, including access to food, clothing and essential services, whilst loss of a single parent seems to have a more variable impact. At present, there are very few child headed households, but this constitutes a risk in the longer term. Conclusions: Orphans appear to be more vulnerable in terms of material need. Children assessed in this study as being most in need were not accessing adequately many services directed at them. There is a need to extend understanding and measurement of emotional need and abuse.

A study of descriptive data for orphans and non-orphans on key criteria of economic vulnerability in two municipalities in South Africa

Directory of Open Access Journals (Sweden)

Donald Skinner

2013-05-01

Objectives: The objective was to obtain a better understanding of how different types of orphans and non-orphans may differ in these key areas as a crucial starting point for addressing the devastating consequences the AIDS epidemic has on these children’s lives. While the study focuses on two specific areas these will provide insight into the general situation of orphans in South Africa. Methods: A cross-sectional census survey was conducted in the two communities of Kopanong, comprising n = 5254 households and Kanana, comprising n = 12 984 households. Results: In Kopanong, 8.2% of children had lost both parents, 19.1% had lost their father and 6.5% their mother only, whilst in Kanana the results were 6.5%, 28.1% and 3.7% respectively. Loss of both parents appeared to have a consistent impact on material need, including access to food, clothing and essential services, whilst loss of a single parent seems to have a more variable impact. At present, there are very few child headed households, but this constitutes a risk in the longer term. Conclusions: Orphans appear to be more vulnerable in terms of material need. Children assessed in this study as being most in need were not accessing adequately many services directed at them. There is a need to extend understanding and measurement of emotional need and abuse.

"When the obvious brother is not there": political and cultural contexts of the orphan challenge in northern Uganda.

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Oleke, Christopher; Blystad, Astrid; Rekdal, Ole Bjørn

2005-12-01

It is estimated that two million of Uganda's children today are orphaned primarily due to AIDS. While recognising the immense impact of HIV/AIDS on the present orphan problem, this article calls for a broader historic and cultural contextualisation to reach an understanding of the vastness of the orphan challenge. The study on which the article is based was carried out among the Langi in Lira District, northern Uganda, with a prime focus on the situation of orphans within the extended family system. The data were collected through ethnographic fieldwork (8 months); in-depth interviews with community leaders (21), heads of households (45) and orphans (35); through focus group discussions (5) with adult men and women caring for orphans, community leaders and with orphans; and also through documentary review. A survey was conducted in 402 households. The findings reveal a transition over the past 30 years from a situation dominated by 'purposeful' voluntary exchange of non-orphaned children to one dominated by 'crisis fostering' of orphans. Sixty-three percent of the households caring for orphans were found to be no longer headed by resourceful paternal kin in a manner deemed culturally appropriate by the patrilineal Langi society, but rather by marginalised widows, grandmothers or other single women receiving little support from the paternal clan. This transition is partly linked to an abrupt discontinuation of the Langi 'widow inheritance' (laku) practice. It is argued that the consequential transformations in fostering practices in northern Uganda must be historically situated through a focus on the effects of armed conflicts and uprooting of the local pastoral and cotton-based economy, which have occurred since the late 1970s. These processes jointly produced dramatic economic marginalisation with highly disturbing consequences for orphans and their caretakers.

Relationships between poverty and AIDS Illness in South Africa: an investigation of urban and rural households in KwaZulu-Natal.

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Steinert, Janina Isabel; Cluver, Lucie; Melendez-Torres, G J; Herrero Romero, Rocio

2017-09-01

The association between poverty and HIV/AIDS in Sub-Saharan Africa remains contested. A better understanding of the relationship between the prevalence of poverty and the disease is essential for addressing prevention, treatment, and care. The present study interrogates this relationship, using a cross-sectional survey of 2477 households in urban and rural KwaZulu-Natal, South Africa. Structural equation modelling was employed to estimate the correlations between poverty and AIDS illness. The analysis revealed a correlation of r pb  = 0.23, denoting that a higher level of household poverty was associated with a higher likelihood of being AIDS-unwell. Post hoc t-test showed that receipt of a disability grant by AIDS-affected households was associated with significantly lower poverty, compared to AIDS-affected households not receiving the grant, t(654) = 3.67, p poverty and AIDS was decreased to r pb  = 0.15 (p poverty through economic interventions, and those that alleviate the impoverishing effects of AIDS illness for affected households.

Evaluation of public subsidy for medical travel: does it protect against household impoverishment?

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Suzana, Mariyam; Walls, Helen; Smith, Richard; Hanefeld, Johanna

2018-03-06

In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure. Most of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect - diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care. Evidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP

Inverse association of natural mentoring relationship with distress mental health in children orphaned by AIDS

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Munakata Tsunetsugu

2010-01-01

Full Text Available Abstract Background The magnitude of the AIDS-orphaned children crisis in sub-Saharan Africa has so overstretched the resource of most families that the collapse of fostering in the sub-region seems imminent (UNICEF, 2003, fueling the need for a complementary/alternative care. This paper examines the probability of the natural mentoring care to ameliorate distress mental health in children orphaned by AIDS. Methods 952 children, mean age about 14 years, from local community schools and child-care centers in Kampala (Uganda and Mafikeng/Klerksdorp (South Africa towns participated in the study. The design has AIDS-orphaned group (n = 373 and two control groups: Other-causes orphaned (n = 287 and non-orphaned (n = 290 children. We use measures of child abuse, depression, social discrimination, anxiety, parental/foster care, self-esteem, and social support to estimate mental health. Natural mentoring care is measured with the Ragins and McFarlin (1990 Mentor Role Instrument as adapted. Results AIDS-orphaned children having a natural mentor showed significant decreased distress mental health factors. Similar evidence was not observed in the control groups. Also being in a natural mentoring relationship inversely related to distress mental health factors in the AIDS-orphaned group, in particular. AIDS-orphaned children who scored high mentoring relationship showed significant lowest distress mental health factors that did those who scored moderate and low mentoring relationship. Conclusions Natural mentoring care seems more beneficial to ameliorate distress mental health in AIDS-orphaned children (many of whom are double-orphans, having no biological parents than in children in the control groups.

World and experiences of AIDS orphans in north central Namibia

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Brug, van der M.

2007-01-01

How do young AIDS orphans deal with the loss of their parents and their changed circumstances? This thesis discusses the social environment, experiences and perceptions of fourteen orphans in north central Namibia. The author followed the children for five months from September 2003 until March

Adolescent girls orphaned by AIDS in South Africa: Approaches in ...

African Journals Online (AJOL)

The effects of orphaning on adolescents girls are well documented in literature. Adolescents orphaned by AIDS have particular vulnerabilities to a range of mental health difficulties and with that they face specific challenges that include stigma and discrimination, poverty, school drop-out and sexual and labour exploitation.

Posttraumatic stress symptoms among adults caring for orphaned children in HIV-endemic South Africa.

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Kuo, Caroline; Reddy, Madhavi K; Operario, Don; Cluver, Lucie; Stein, Dan J

2013-06-01

There is growing evidence that mental health is a significant issue among families affected by AIDS-related parental deaths. The current study examined posttraumatic stress symptoms and identified risk factors among adults caring for AIDS-orphaned and other-orphaned children in an HIV-endemic South African community. A representative community sample of adults caring for children (N = 1,599) was recruited from Umlazi Township. Of the 116 participants who reported that a traumatic event was still bothering them, 19 % reported clinically significant posttraumatic stress symptoms. Of the 116 participants, caregivers of AIDS-orphaned and other-orphaned children were significantly more likely to meet threshold criteria for PTSD (28 %) compared to caregivers of non-orphaned children (10 %). Household receipt of an old age pension was identified as a possible protective factor for PTSD symptoms among caregivers of orphaned children. Services are needed to address PTSD symptoms among caregivers of orphaned children.

Extended family caring for children orphaned by AIDS: balancing essential work and caregiving in a high HIV prevalence nations.

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Heymann, J; Earle, A; Rajaraman, D; Miller, C; Bogen, K

2007-03-01

While over 90 per cent of the 15 million children who have been orphaned by HIV/AIDS are cared for by family members, there is little information about whether adults can meet orphans' essential caregiving needs while working to economically survive. Using a survey we conducted in Botswana of 1033 working adults, we analyse the experience of adults who are caring for orphans. Over one-third of working adults were caring for orphans and many with few financial resources: 82% were living on household incomes below US$10 purchasing power parity adjusted per person per day. Because of their caregiving responsibilities, they were less able to supplement income with overtime, weekend, evening, or night work. At the same time caregiving responsibilities meant orphan caregivers spent fewer hours caring for their own children and other family members. Nearly half of orphan caregivers had difficulties meeting their children's needs, and nearly 75% weren't able to meet with children's teachers. Pay loss at work compounded the problems: One-quarter of orphan caregivers reported having to take unpaid leave to meet sick childcare needs and nearly half reported being absent from work for children's routine health care. This paper makes clear that if families are to provide adequate care for orphans while economically surviving there needs to be increases in social supports and improvements in working conditions.

Perceived social support and the psychological well-being of AIDS orphans in urban Kenya.

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Okawa, Sumiyo; Yasuoka, Junko; Ishikawa, Naoko; Poudel, Krishna C; Ragi, Allan; Jimba, Masamine

2011-09-01

Parental deaths due to AIDS seriously affect the psychological well-being of children. Social support may provide an effective resource in the care of vulnerable children in resource-limited settings. However, few studies have examined the relationships between social support and psychological well-being among AIDS orphans. This cross-sectional study was conducted to explore associations between perceived social support (PSS) and the psychological well-being of AIDS orphans, and to identify socio-demographic factors that are associated with PSS. Data were collected from 398 pairs of AIDS orphans (aged 10-18 years) and their caregivers in Nairobi, Kenya. The participants provided information on their socio-demographic characteristics, the children's PSS, and the children's psychological status (based on measures of depressive symptoms and self-esteem). Of the 398 pairs, 327 were included in the analysis. PSS scores of AIDS orphans showed significant correlations with depressive symptoms (ρ =-0.31, psiblings (β=3.044, p=0.016), were also associated with higher PSS scores. In particular, HIV-infected children (n=37) had higher scores of PSS from a special person (β=2.208, p=0.004), and children living with biological siblings (n=269) also had higher scores of PSS from both a special person (β=1.411, p=0.029) and friends (β=1.276, p=0.039). In conclusion, this study showed that PSS is positively associated with the psychological well-being of AIDS orphans. Siblings and special persons can be effective sources of social support for AIDS orphans, which help to promote their psychological well-being.

A situational analysis of child-headed households in South Africa

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S. M. Mogotlane

2010-06-01

Full Text Available The aftermath of the HIV and AIDS pandemic has resulted in great suffering in terms of loss of income, poor quality of life, morbidity and mortality, with children being destitute and orphaned at an alarming rapid rate. Families and communities are currently unable to cope with the effects of HIV and AIDS with special emphasis on the care and support of the affected orphans and vulnerable children, who as a result have been compelled to look after themselves giving rise to a new type of family, the child-headed household. The emergence of this type of family requires government’s response in terms of care and support. The purpose of this study was to provide a broad picture of the location, prevalence, composition, functions, needs and challenges of child-headed households in South Africa, and explore available and required services, resources and safety nets for children in child-headed households. An exploratory and descriptive design was used for the purpose. The sample consisted of children heading households and those living in the households that are headed by children; government departments responsible for child welfare, such as, the Departments of Social Development, Health, Education and Agriculture; non-profit organisations and communities where these households are predominant. From the data collected, it was found that the rights of the affected children were compromised. Those heading the households were often not at school and were responsible for domestic chores. The households needed food, clothes, money, shelter, and education. Government in attempting to address these needs required clear policies which will provide a distinction between orphaned and vulnerable children and child-headed households.The study recommended a collaborative approach as it was shown that there was no single model of best practice to appropriately and effectively address the needs of child-headed households.

A situational analysis of child-headed households in South Africa.

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Mogotlane, S M; Chauke, M E; van Rensburg, G H; Human, S P; Kganakga, C M

2010-09-01

The aftermath of the HIV and AIDS pandemic has resulted in great suffering in terms of loss of income, poor quality of life, morbidity and mortality, with children being destitute and orphaned at an alarming rapid rate. Families and communities are currently unable to cope with the effects of HIV and AIDS with special emphasis on the care and support of the affected orphans and vulnerable children, who as a result have been compelled to look after themselves giving rise to a new type of family, the child-headed household. The emergence of this type of family requires government's response in terms of care and support. The purpose of this study was to provide a broad picture of the location, prevalence, composition, functions, needs and challenges of child-headed households in South Africa, and explore available and required services, resources and safety nets for children in child-headed households. An exploratory and descriptive design was used for the purpose. The sample consisted of children heading households and those living in the households that are headed by children; government departments responsible for child welfare, such as, the Departments of Social Development, Health, Education and Agriculture; non-profit organisations and communities where these households are predominant. From the data collected, it was found that the rights of the affected children were compromised. Those heading the households were often not at school and were responsible for domestic chores. The households needed food, clothes, money, shelter, and education. Government in attempting to address these needs required clear policies which will provide a distinction between orphaned and vulnerable children and child-headed households. The study recommended a collaborative approach as it was shown that there was no single model of best practice to appropriately and effectively address the needs of child-headed households.

A situational analysis of child-headed households in South Africa

Directory of Open Access Journals (Sweden)

S.M. Mogotlane

2009-09-01

Full Text Available The aftermath of the HIV and AIDS pandemic has resulted in great suffering in terms of loss of income, poor quality of life, morbidity and mortality, with children being destitute and orphaned at an alarming rapid rate. Families and communities are currently unable to cope with the effects of HIV and AIDS with special emphasis on the care and support of the affected orphans and vulnerable children, who as a result have been compelled to look after themselves giving rise to a new type of family, the child-headed household. The emergence of this type of family requires government’s response in terms of care and support. The purpose of this study was to provide a broad picture of the location, prevalence, composition, functions, needs and challenges of child-headed households in South Africa, and explore available and required services, resources and safety nets for children in child-headed households. An exploratory and descriptive design was used for the purpose. The sample consisted of children heading households and those living in the households that are headed by children; government departments responsible for child welfare, such as, the Departments of Social Development, Health, Education and Agriculture; non-profit organisations and communities where these households are predominant.From the data collected, it was found that the rights of the affected children were compromised. Those heading the households were often not at school and were responsible for domestic chores. The households needed food, clothes, money, shelter, and education. Government in attempting to address these needs required clear policies which will provide a distinction between orphaned and vulnerable children and child-headed households.The study recommended a collaborative approach as it was shown that there was no single model of best practice to appropriately and effectively address the needs of child-headed households.

Psychosocial Support for Children Orphaned by HIV/AIDS in Zimbabwe

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Chitiyo, Jonathan; Chitiyo, Argnue; Chitiyo, Morgan

2016-01-01

Healthy psychosocial development during childhood is a key determinant to the future well-being of all individuals. In many areas of Africa, demand for psychosocial support continues to grow in response to the increasing number of children left orphaned as a result of the HIV/AIDS pandemic. These orphans face various challenges and yet, in most…

Caregiver issues and AIDS orphans: perspectives from a social worker focus group.

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Paige, C Y; Johnson, M S

1997-10-01

This study examines social workers' perceptions of the needs of families coping with acquired immunodeficiency syndrome (AIDS). This research investigates the problems of family caregivers of children orphaned by human immunodeficiency virus (HIV)-related death of their parents. A qualitative semistructured interview format was used in a focus group of 18 social workers. Four questions were designed to assess family needs and resources, as well as to evaluate the social workers' perspectives of governmental policies affecting these families. A list of four problems and two recommendations for change evolved from the focus group. Inadequate finances to house and care for the children was the primary cause for distress in these families. The major governmental policy that hindered the social workers' ability to assist families pertained to the low financial entitlement for caregivers who are related to the orphaned child. It was noted that unrelated caregivers receive substantially more money for the care of these children than family caregivers receive. Recommendations were made to change this policy and to develop guardianship laws that facilitate families' abilities to provide care to AIDS orphans. Family caregivers of AIDS orphans are bombarded with great demands and limited resources. This analysis of their situation from the social workers' perspective is a positive step toward the improvement of support services for these families. Further research should include individual qualitative interviews assessing the needs of the caregivers and AIDS orphans.

Psychological Distress amongst AIDS-Orphaned Children in Urban South Africa

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Cluver, Lucie; Gardner, Frances; Operario, Don

2007-01-01

Background: South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deficiency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS…

Junior-headed households as a possible strategy for coping with the ...

African Journals Online (AJOL)

Junior-headed households as a possible strategy for coping with the growing orphan crisis in northern Namibia. ... Keywords: child-headed households, coping, extended families, HIV/AIDS, Oshiwambo, socio-economic aspects, southern Africa African Journal of AIDS Research 2008, 7(1): 123–132 ...

Gendered vulnerability to AIDS and its research implications

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Wiegers, E.S.

2008-01-01

According to the various studies, AIDS affects all facets of people’s livelihoods through illness and death and the subsequent care for orphaned children. Much of this literature uses rural households affected by HIV/AIDS as the unit of analysis and do not disaggregate data by hosting orphans,

Using people to cope with the hunger: social networks and food transfers amongst HIV/AIDS afflicted households in KwaZulu-Natal, South Africa.

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Kaschula, Sarah

2011-10-01

Household afflicted by HIV/AIDS are particularly prone to food insecurity. This article explores the role of community networks in meeting household food deficits. One hundred households exhibiting a range (0-5) of HIV/AIDS proxies related to orphan fostering, prime adult chronic illness and mortality were visited at quarterly intervals for a year. At each assessment, donated food types consumed in the past 48 h were recorded, and household food security was monitored through an experiential measure. Factors determining access to donated foods were explored qualitatively by means of participant observation and semi-structured interviews. Poor households with prime adult chronic illness were prone to food insecurity, and used the most donated foods. However, not all households perceived to be afflicted with HIV/AIDS were able to access donated foods due to stigma and social exclusion. Concerted action must be taken by government, non-government and community agents if social food transfer networks are to be transformed into coordinated community action.

The orphaning experience: descriptions from Ugandan youth who have lost parents to HIV/AIDS

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Ssebunnya Joshua

2010-02-01

Full Text Available Abstract The HIV/AIDS epidemic has continued to pose significant challenges to countries in Sub-Saharan Africa. Millions of African children and youth have lost parents to HIV/AIDS leaving a generation of orphans to be cared for within extended family systems and communities. The experiences of youth who have lost parents to the HIV/AIDS epidemic provide an important ingress into this complex, evolving, multi-dimensional phenomenon. A fundamental qualitative descriptive study was conducted to develop a culturally relevant and comprehensive description of the experiences of orphanhood from the perspectives of Ugandan youth. A purposeful sample of 13 youth who had lost one or both parents to HIV/AIDS and who were affiliated with a non-governmental organization providing support to orphans were interviewed. Youth orphaned by HIV/AIDS described the experience of orphanhood beginning with parental illness, not death. Several losses were associated with the death of a parent including lost social capitol, educational opportunities and monetary assets. Unique findings revealed that youth experienced culturally specific stigma and conflict which was distinctly related to their HIV/AIDS orphan status. Exploitation within extended cultural family systems was also reported. Results from this study suggest that there is a pressing need to identify and provide culturally appropriate services for these Ugandan youth prior to and after the loss of a parent(s.

The importance of HIV prevention messaging for orphaned youth in Zimbabwe.

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Haney, Erica; Singh, Kavita

2012-01-01

The AIDS epidemic has contributed to a drastic increase in the number of orphans in Zimbabwe. Female adolescent orphans are particularly in jeopardy of contracting HIV due to disadvantages including extreme poverty, low education, and the absent of parental oversight which can lead to higher risk-taking sexual behaviors. By understanding where girls receive education about HIV and who they rely on for information, organizations can effectively modify existing programs to better target this at-risk population. For this study a household survey was conducted which included 216 orphans and 324 non-orphans (n=540), aged 12-17 years, in the resource-poor setting of Hwange District, Zimbabwe. The aims of this article were to examine the differences between orphans and non-orphans in HIV prevention message exposure, level of motivation for learning about HIV, and communication with caregivers about safe sex. The household survey revealed that younger orphans, aged 12-15 years, were more motivated to learn about HIV and had greater HIV messaging exposure in school than non-orphans. These exposure and differences in the levels of motivation between groups dissipated at older ages. Our research also discovered less caregiver communication among orphans than non-orphans. Our findings suggest that HIV programs targeting orphans need to do a better job at keeping older orphans interested in HIV prevention at a time when it matters most. Furthermore, intervention strategies that provide caregiver support are instrumental in effectively delivering prevention messages to girls at home.

Nutritional status, psychological well-being and the quality of life of AIDS orphans in rural Henan Province, China.

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He, Zhonghu; Ji, Chengye

2007-10-01

To assess the influence of orphanhood due to AIDS on children's nutritional status, psychological well-being and life quality, and to explore appropriate intervention strategies in China. In 2005, 186 children aged 8-15 years (93 AIDS orphans and 93 non-orphans) from a rural area of Henan Province were surveyed in a cross-sectional and matched pairs study on nutritional status, psychological health and life quality. We found no compelling evidence for poorer nutritional status in orphans. The nutritional status of both orphans and non-orphans was extremely poor according to the prevalence of stunting, underweight, wasting and anaemia. Depression, low self-esteem and lower quality of life were more frequent in orphans. These differences mainly existed in boys' groups. No significant differences were found between paternal, maternal and double orphans, or orphans in orphanages or extended families. Regression analysis revealed that orphanhood leads to low self-esteem and more depression which contributes to lower quality of life and mediates the association between orphanhood and quality of life. The high prevalence of poor nutritional status indicates that basic material needs of children, including AIDS orphans, are not met in rural China. Psychological problems were prominent among orphans and had become the most important contributor of lower life quality. Boys were at least as vulnerable as girls. The living conditions of all children in rural China must be improved; school-based care and support are crucial and would be a cost-effective way to improve the overall life quality of AIDS orphans.

The Socioeconomic Impact of HIV/AIDS on Education Outcomes in Uganda: School Enrolment and the Schooling Gap in 2002/2003

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Kasirye, Ibrahim; Hisali, Eria

2010-01-01

Due to high prime-age mortality--a result of the HIV/AIDS scourge, the number of orphans in Uganda continues to rise. Using the 2002/2003 Uganda National Household Survey, this paper investigates how HIV/AIDS orphan status affects schooling enrolment and grade progression. Our results show that HIV/AIDS orphans are not significantly less likely to…

Review The mental health of children orphaned by AIDS: a review of ...

African Journals Online (AJOL)

This paper reviews research on the mental health and psychological outcomes of children who are orphaned by AIDS. Studies are limited, scattered and often unpublished. The review focuses on research which is quantitative and based on primary research with uninfected children who are parentally bereaved by AIDS.

Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform.

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Sun, Jing; Liabsuetrakul, Tippawan; Fan, Yancun; McNeil, Edward

2015-12-01

To compare the incidences of catastrophic health expenditure (CHE) and impoverishment, the risk protection offered by two health financial reforms and to explore factors associated with CHE and impoverishment among patients with cardiovascular diseases (CVDs) in rural Inner Mongolia, China. Cross-sectional study conducted in 2014 in rural Inner Mongolia, China. Patients with CVDs aged over 18 years residing in the sample areas for at least one year were eligible. The definitions of CHE and impoverishment recommended by WHO were adopted. The protection of CHE and impoverishment was compared between the New Cooperative Medical Scheme (NCMS) alone and NCMS plus National Essential Medicines Scheme (NEMS) using the percentage change of incidences for CHE and impoverishment. Logistic regression was used to explore factors associated with CHE and impoverishment. The incidences of CHE and impoverishment under NCMS plus NEMS were 11.26% and 3.30%, respectively, which were lower than those under NCMS alone. The rates of protection were higher among households with patients with CVDs covered by NCMS plus NEMS (25.68% and 34.65%, respectively). NCMS plus NEMS could protect the poor households more from CHE but not impoverishment. NCMS plus NEMS protected more than one-fourth of households from CHE and more than one-third from impoverishment. NCMS plus NEMS was more effective at protecting households with patients with CVDs from CHE and impoverishment than NCMS alone. An integration of NCMS with NEMS should be expanded. However, further strategies to minimise catastrophic health expenditure after this health finance reform are still needed. © 2015 John Wiley & Sons Ltd.

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

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Tharani Loganathan

Full Text Available While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking.We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia.A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur and rural (Kuala Terengganu setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained.Of the 658 stool samples collected at both centers, 248 (38% were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001. The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33% households in Kuala Lumpur to experience catastrophic expenditure and 11 (3% households to incur poverty. However in Kuala Terengganu, only one household (0.5% experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%. The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03 than at Kuala Terengganu (0.24.While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health

Assessing catastrophic and impoverishing effects of health care payments in Uganda.

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Kwesiga, Brendan; Zikusooka, Charlotte M; Ataguba, John E

2015-01-22

Direct out-of-pocket payments for health care are recognised as limiting access to health care services and also endangering the welfare of households. In Uganda, such payments comprise a large portion of total health financing. This study assesses the catastrophic and impoverishing impact of paying for health care out-of-pocket in Uganda. Using data from the Uganda National Household Surveys 2009/10, the catastrophic impact of out-of-pocket health care payments is defined using thresholds that vary with household income. The impoverishing effect of out-of-pocket health care payments is assessed using the Ugandan national poverty line and the World Bank poverty line ($1.25/day). A high level and intensity of both financial catastrophe and impoverishment due to out-of-pocket payments are recorded. Using an initial threshold of 10% of household income, about 23% of Ugandan households face financial ruin. Based on both the $1.25/day and the Ugandan poverty lines, about 4% of the population are further impoverished by such payments. This represents a relative increase in poverty head count of 17.1% and 18.1% respectively. The absence of financial protection in Uganda's health system calls for concerted action. Currently, out-of-pocket payments account for a large share of total health financing and there is no pooled prepayment system available. There is therefore a need to move towards mandatory prepayment. In this way, people could access the needed health services without any associated financial consequence.

Microeconomic loans and health education to families in impoverished communities: implications for the HIV pandemic.

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Sherer, Renslow D; Bronson, John D; Teter, Caroline J; Wykoff, Randolph F

2004-01-01

Poverty is among the root causes of death and poor health worldwide. Project HOPE's Village Health Bank (VHB) program is a public health intervention that combines integrated microcredit lending and health education. Groups of 18 to 25 women receive small loans, and biweekly, one-hour health education sessions. Since 1993, about 50,000 women in 949 VHBs have participated in seven countries in the Americas, Africa, and Southeast Asia, receiving more than US$25 million in loans and 8,445 hours of health education. Members of VHBs are charged modest interest rates that enable them to become self-sufficient (eg, able to cover all operating charges, including the costs of the health education staff, and the necessary loan capital to continue without infusion of outside resources). The VHB program produces substantial economic improvements for individuals and groups, and benefits in health knowledge and behaviors, including increased utilization of healthcare services. Data from Guatemala, Malawi, and Thailand demonstrate that VHBs in countries with high HIV prevalence have been comparably successful in spite of the enormous added burdens of chronic illness, deaths, and orphans in need of support. For example, in 2004, 48 percent of 266 VHB members in Malawi experienced at least one death in their household in the preceding year, and 67 percent housed one or more orphans with an average of two orphans per household. Because of the unique combination of increased household economic stability and improved health knowledge, the VHB program is now being adapted to families of people affected by HIV/AIDS, including orphans.

Peer mentorship program on HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents: an evidence based practice

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Nabunya, Proscovia; Ssewamala, Fred M.; Mukasa, Miriam N.; Byansi, William; Nattabi, Jennifer

2015-01-01

Adolescents and young adults in sub-Saharan Africa (SSA) are particularly vulnerable to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) infection. Adolescents orphaned as a direct result of HIV/AIDS are at an elevated risk of acquiring HIV/AIDS and other sexually transmitted infections. However, limited empirical evidence exists on HIV knowledge and prevention programs, especially those designed to address HIV information gaps among adolescents. This study evaluates the effect of a peer mentorship program provided in addition to other supportive services on HIV/AIDS knowledge, beliefs, and prevention attitudes, among school-going orphaned adolescents in southern Uganda. We utilize data from the Bridges to the Future Study, a 5-year longitudinal randomized experimental study funded by the National Institute of Child Health and Human Development. Out of the 1410 adolescents enrolled in the study (average age = 12.7 at study initiation), 855 of them participated in a nine-session, curriculum based peer mentorship program. We analyzed data collected at baseline and 12-months post intervention initiation. The results from bivariate and regression analysis indicate that, controlling for socioeconomic characteristics, adolescents who participated in a peer mentorship program were more likely than non-participants to report increased scores on HIV/AIDS knowledge(b = .86, 95%CI = .47 – 1.3, p ≤ .001); better scores on desired HIV/AIDS-related beliefs (b = .29, 95%CI = .06 – .52, p ≤ .01); and better scores on HIV/AIDS prevention attitudes (b = .76, 95%CI = .16 – 1.4, p ≤ .01). Overall, the study findings point to the potential role a of peer mentorship program in promoting the much-desired HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents. Future programs and policies that support AIDS-orphaned adolescents in sub-Saharan Africa should consider incorporating peer mentoring programs that provide

Intra-household differences in health seeking behaviour for orphans ...

African Journals Online (AJOL)

Conclusion: There were some differences between orphans and non-orphans within each sub-county and between orphans in the two sub-counties. NGO support is critical in cultivating equity, compassion and non-discrimination. The extended family system in Africa was managing orphan care although it displayed cracks ...

[Basic health care. AIDS and children].

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van de Pasch, T

1994-02-17

The total number of children in Africa who died of AIDS is estimated at 700,000. Based on a 30% rate of maternal transmission of HIV infection to children and an annual birth rate of 40/1000, in urban areas about 120,000 children are born with HIV infection. In rural areas the figure is 240,000. In addition, another 120,000 die because of diminished care, thus it is estimated that a total of 480,000 children die of AIDS per year, 30-40% of child mortality of the continent. In the AIDS-affected areas, 30% of children have become orphans. In Katete, Zambia, with a population of 157,000, there are 20,000 orphans, half of whom lost one or both parents because of AIDS, and 2400 of whom lost both parents. A project was designed with the objective of helping orphans. First they had to be counted, using an interview team of 39 persons who visited 450 households in five villages. There were a total of 311 orphans of whom 148 were AIDS orphans. 62% of the 20,000 orphans in the district of Katete do not go to school. In Lusaka in 1990, orphans made up 10% of all children, but 3 years later in Katete, 23% of all children were orphans. The girls are often kept away from school in order to take of their sick mothers. When the father is also sick, there is no more money for school uniforms or fees. In the plans of the St. Francis Hospital AIDS project for 1994-98, a great deal of attention was given to the care of orphans. This will be carried out by local health workers who have taken a course in the hospital and have solid work experience. They will deliver a package containing the most essential necessities for the orphans: school uniform, books, pens, soap, flour, milk powder, and dried beans. There are more projects in the program, including a women's group that wants to sew school uniforms and a health education plan.

Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India.

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Sharma, Varun; Krishnaswamy, Divya; Mulay, Sanjeevanee

2015-01-01

HIV infection poses a serious threat to the economy of a household. Out of pocket (OOP) health spending can be prohibitive and can drag households below poverty level. Based on the data collected from a cross-sectional survey of 401 households with HIV+ members in Pune city, India, this paper examines the consumption levels and patterns among households, and comments on the economic impoverishment resulting from OOP medical spending. Analysis reveals that households with HIV members spend a major portion of their monthly consumption expenditure on food items. Medical expenditure constitutes a large portion of their total consumption spending. Expenditure on children's education constitutes a minor proportion of total monthly spending. A high proportion of medical expenditure has a bearing on the economic condition of households with HIV members. Poverty increases by 20% among the studied HIV households when OOP health spending is adjusted. It increases 18% among male-headed households and 26% among female-headed households. The results reiterate the need of greater support from the government in terms of accessibility and affordability of health care to save households with HIV members from economic catastrophe.

Willingness to care for children orphaned by HIV/AIDS: a study of ...

African Journals Online (AJOL)

The present study explores adoptive and foster parents' (n = 175) willingness to care for a child orphaned by HIV/AIDS. Although some differences were noted depending on the HIV status of the child and whether the respondent was an adoptive or foster parent, results indicate an overall willingness in these populations to ...

Experts from necessity : agricultural knowledge of children orphaned by AIDS in the Couffo region, Benin

OpenAIRE

Fagbemissi, R.C.

2010-01-01

Chapter 1 sketches the general background of the study. The study tests the hypothesis that HIV and AIDS not only impairs or modifies farmers’ agroecological knowledge base, but also impairs or modifies their strategies to mobilize knowledge and resources. The research mainly aims to understand agricultural knowledge and practices among children orphaned by AIDS, consecutive to widespread interest in and concern about erosion of agricultural knowledge in AIDS-affected communities. Such ...

Psychosocial and health risk outcomes among orphans and non ...

African Journals Online (AJOL)

The study sample comprised 134 children (61 non-orphans, 73 orphans; mean age = 14.64, SD = 1.85) from the Amajuba district in KwaZulu-Natal. Orphans were no worse off in terms of anxiety/depression (p = 0.65), affability (p = 0.11) and resilience (p = 0.29) in comparison to non-orphans in similar type households.

The psychological well-being of children orphaned by AIDS in Cape Town, South Africa

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Cluver Lucie

2006-07-01

Full Text Available Abstract Background An estimated 2 million children are parentally bereaved by AIDS in South Africa. Little is known about mental health outcomes for this group. Methods This study aimed to investigate mental health outcomes for urban children living in deprived settlements in Cape Town. 30 orphaned children and 30 matched controls were compared using standardised questionnaires (SDQ on emotional and behavioural problems, peer and attention difficulties, and prosocial behaviour. The orphan group completed a modified version of a standardised questionnaire (IES-8, measuring Post-Traumatic Stress symptoms. Group differences were tested using t-tests and Pearson's chi-square. Results Both groups scored highly for peer problems, emotional problems and total scores. However, orphans were more likely to view themselves as having no good friends (p = .002, to have marked concentration difficulties (p = .03, and to report frequent somatic symptoms (p = .05, but were less likely to display anger through loss of temper (p = .03. Orphans were more likely to have constant nightmares (p = .01, and 73% scored above the cut-off for Post-Traumatic Stress Disorder. Conclusion Findings suggest important areas for larger-scale research for parentally-bereaved children.

An Analysis of Rural Household Livelihood Change and the Regional Effect in a Western Impoverished Mountainous Area of China

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Chuansheng Wang

2018-05-01

Full Text Available Taking Longnan, in the western Qinling Mountains region of Gansu province, China, as our study area, and using the Sixth National Population Census alongside household survey data, we analyze changes in household livelihoods, and consequent regional effects, following the instigation of the “Grain for Green” program in 1999. Our results show rural livelihood changes with respect to natural assets (e.g., reduction of arable land, planting structure changes, human assets (e.g., labor quality improvement, fluidity of population, financial assets (e.g., income channels widening, income increasing, physical assets (e.g., optimized production tools, and social assets (e.g., information network development, increased outreach opportunities. We suggest that increased household livelihoods play an important role in improving land space utilization efficiency, resource conservation and use, and the ecological environment. However, owing to the natural environment, there are also some problems, such as “hollows” in rural production and living spaces, as well as local environmental degradation. To address these issues, regions such as the western, mountainous, impoverished area of our study should establish a policy of using ecosystems, as well as agriculture, for development in order to improve household livelihoods, build an efficient spatial structure, and providing support for the creation of a resource-saving societal system.

The life experiences of AIDS orphans in Malawi : a case of Area 23, Kalolo and Tsabango village in Lilongwe district

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Chisala, Gloria Lucy

2005-01-01

Mastergradsoppgave i "Comparative social work" - Høgskolen i Bodø, 2005 This thesis reports on qualitative life history interviews of orphaned children who have lost both of their parents due to death by HIV/AIDS in Malawi. The focus is on double orphans who are between the ages of 15 and 17 years. The purpose is to explore and analyse the life experiences of orphans in Lilongwe in order to understand how they construct their social world. Methodologically, the study uses b...

Impact of marriage on HIV/AIDS risk behaviors among impoverished, at-risk couples: A multilevel latent variable approach

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Stein, JA; Nyamathi, A; Ullman, JB; Bentler, PM

2007-01-01

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance us...

Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia.

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Verguet, Stéphane; Memirie, Solomon Tessema; Norheim, Ole Frithjof

2016-10-21

Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty. We used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition. In Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases. We present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.

Impact of marriage on HIV/AIDS risk behaviors among impoverished, at-risk couples: a multilevel latent variable approach.

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Stein, Judith A; Nyamathi, Adeline; Ullman, Jodie B; Bentler, Peter M

2007-01-01

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle-sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle-sharing.

Impact of HIV and AIDS on household food and nutrition security in ...

African Journals Online (AJOL)

The impact of HIV/AIDS on household food and nutrition security in Suba district was studied in a quasi longitudinal study. Households with People Living with HIV/AIDS (Index- 25%) and three surrounding households (control- 75%) were considered for the study. Data were collected on demographic characteristics of the ...

The socio-demographic factors of children orphaned by aids in ...

African Journals Online (AJOL)

Conclusion: The percentage of HIV patients that are orphans in this study is significant. The morbidities in the orphans had deprived them of early childhood education and immunization. Breastfeeding of all the orphans may have compounded the seemingly high mother to child HIV transmission. There is an urgent need for ...

Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

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Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian

2017-02-07

The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local

Assessing catastrophic and impoverishing effects of health care payments in Uganda

OpenAIRE

Kwesiga, Brendan; Zikusooka, Charlotte M; Ataguba, John E

2015-01-01

Background Direct out-of-pocket payments for health care are recognised as limiting access to health care services and also endangering the welfare of households. In Uganda, such payments comprise a large portion of total health financing. This study assesses the catastrophic and impoverishing impact of paying for health care out-of-pocket in Uganda. Methods Using data from the Uganda National Household Surveys 2009/10, the catastrophic impact of out-of-pocket health care payments is defined ...

[The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012].

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Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Wong, Rebeca; Lugo-Palacios, David G; Méndez-Carniado, Oscar

2018-01-01

To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI). It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.

Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana.

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Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di

2017-05-22

There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana's national health insurance scheme. Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen's parade of "dwarfs and a few giants" is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even

Progress on impoverishing health spending in 122 countries: a retrospective observational study.

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Wagstaff, Adam; Flores, Gabriela; Smitz, Marc-François; Hsu, Justine; Chepynoga, Kateryna; Eozenou, Patrick

2018-02-01

The goal of universal health coverage (UHC) requires that families who get needed health care do not suffer financial hardship as a result. This can be measured by instances of impoverishment, when a household's consumption including out-of-pocket spending on health is more than the poverty line but its consumption, excluding out-of-pocket spending, is less than the poverty line. This links UHC directly to the policy goal of reducing poverty. We measure the incidence and depth of impoverishment as the difference in the poverty head count and poverty gap with and without out-of-pocket spending included in household total consumption. We use three poverty lines: the US$1·90 per day and $3·10 per day international poverty lines and a relative poverty line of 50% of median consumption per capita. We estimate impoverishment in 122 countries using 516 surveys between 1984 and 2015. We estimate the global incidence of impoverishment due to out-of-pocket payments by aggregating up from each country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We do not derive global estimates to measure the depth of impoverishment but focus on the median depth for the 122 countries in our sample, accounting for 90% of the world's population. We find impoverishment due to out-of-pocket spending even in countries where the entire population is officially covered by a health insurance scheme or by national or subnational health services. Incidence is negatively correlated with the share of total health spending channelled through social security funds and other government agencies. Across countries, the population-weighted median annual rate of change of impoverishment is negative at the $1·90 per day poverty line but positive at the $3·10 per day and relative poverty lines. We estimate that at the $1·90 per day poverty line, the worldwide incidence of impoverishment decreased between 2000 and 2010, from 131 million

On the Road to HIV/AIDS Competence in the Household: Building a Health-Enabling Environment for People Living with HIV/AIDS

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Caroline Masquillier

2015-03-01

Full Text Available When aiming to provide chronic disease care within the context of human resource shortages, we should not only consider the responsibility of the individual person living with HIV/AIDS (PLWHA but also the capacity of the social environment to actively encourage a lifestyle that fosters health. In this social environment, extensive efforts are thus required to increase HIV/AIDS knowledge, reduce stigma, stimulate HIV testing, improve health care-seeking behavior, and encourage safe sexual practices—described in the literature as the need for AIDS competence. In accordance with socio-ecological theory, one cannot restrict the research focus to communities, as AIDS competence studies should also incorporate the intermediate household level. In responding to this research need, the aim of this article is to conceptualize an “HIV/AIDS competent household” based on qualitative interviews and focus group discussions conducted in a township on the outskirts of Cape Town, South Africa. Our results show that a household’s supportive response to disclosure allows a patient to live openly as HIV positive in the household concerned. This may mark the start of the road to HIV/AIDS competence in the household, meaning the PLWHA receives sustainable support throughout the care continuum and positive living becomes the norm for the PLWHA and his or her household. A feedback loop might also be created in which other household members are encouraged to be tested and to disclose their status, which is an important step towards a sustainable response to HIV/AIDS-related challenges. Despite the fact that this road to HIV/AIDS competence at the household level is fragile and prone to various barriers, this article shows that the household has the potential to be a health-enabling environment for PLWHA.

Child work in households with a person living with HIV/AIDS

African Journals Online (AJOL)

2017-10-02

AIDS (PLWHA) compared to non-PLWHA households using the 2010/2011 ..... clients to participate in the study face to face structured interview. ... contact details for easy contact. .... Note that household religion can also fall under.

Coping with change: Household structure and composition in rural South Africa, 1992 – 20031

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MADHAVAN, SANGEETHA; SCHATZ, ENID J.

2010-01-01

Aim To describe household change over a 10-year period of tremendous social, political, economic and health transformation in South Africa using data from the Agincourt health and demographic surveillance system in the rural northeast of South Africa. Methods Examination of household structure and composition at three points: 1992, 1997, and 2003. These three years loosely represent conditions immediately before the elections (1992), short term post-elections (1997), and longer term (2003), and span a period of notable increase in HIV prevalence. Results Average household size decreased and the proportion headed by females increased. The within-household dependency ratios for children and elders both decreased, as did the proportion of households containing foster children. The proportion with at least one maternal orphan doubled, but was still relatively small at 5.5%. Conclusions This analysis is a starting point for future investigations aimed at explaining how HIV/AIDS and other sociocultural changes post-apartheid have impacted on household organization. The analysis shows both consistency and change in measures of household structure and composition between 1992 and 2003. The changes do not include an increase in various types of “fragile families”, such as child-headed or skipped-generation households that might be expected due to HIV/AIDS. PMID:17676508

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.

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Li, Ye; Wu, Qunhong; Xu, Ling; Legge, David; Hao, Yanhua; Gao, Lijun; Ning, Ning; Wan, Gang

2012-09-01

To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

Development and implementation of a peer-based mental health support programme for adolescents orphaned by HIV/AIDS in South Africa.

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Thupayagale-Tshweneagae, Gloria

2011-12-01

The article describes a framework and the process for the development of the peer-based mental health support programme and its implementation. The development of a peer-based mental health support programme is based on Erikson's theory on the adolescent phase of development, the psycho-educational processes; the peer approach and the orphaned adolescents lived experiences as conceptual framework. A triangulation of five qualitative methods of photography, reflective diaries, focus groups, event history calendar and field notes were used to capture the lived experiences of adolescents orphaned to HIV and AIDS. Analysis of data followed Colaizzi's method of data analysis. The combination of psycho-education, Erikson's stages of development and peer support assisted the participants to gain knowledge and skills to overcome adversity and to assist them to become to more resilient. The peer based mental health support programme if used would enhance the mental health of adolescent orphans.

"They don't care what happens to us." The situation of double orphans heading households in Rakai District, Uganda

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Dalen, Nina; Nakitende, Ann Jacqueline; Musisi, Seggane

2009-01-01

Background This article is based on information collected about the situation of double orphans who are heading households in Rakai District, Uganda. The information will be used as justification and guidance for planning actions to improve the situation of these and similar children. This research is thus the first step in an Action Research approach leading to specific interventions. The aim of this article is to describe the situation of these orphaned children, with an emphasis on the psychosocial challenges they face. Methods The study involved interviews, focus group discussions, observations and narratives. Forty-three heads of sibling-headed households participated. Information derived from informal discussions with local leaders is also included. The responses were analyzed using a modified version of Giorgi's psychological phenomenological method as described by Malterud [1]. Results Factors such as lack of material resources, including food and clothes, limited possibilities to attend school on a regular basis, vast responsibilities and reduced possibilities for social interaction all contribute to causing worries and challenges for the child heads of households. Most of the children claimed that they were stigmatized and, to a great extent, ignored and excluded from their community. The Local Council Secretary ("Chairman") seemed to be the person in the community most responsible and helpful, but some chairmen seemed not to care at all. The children requested counseling for themselves as well as for community members because they experienced lack of understanding from other children and from adult community members. Conclusion The children experienced their situation as a huge and complex problem for themselves as well as for people in their villages. However, the situation might improve if actions focused on practical and psychological issues as well as on sensitization about the children's situation could be initiated. In addition to the fact that

"They don't care what happens to us." The situation of double orphans heading households in Rakai District, Uganda

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Musisi Seggane

2009-09-01

Full Text Available Abstract Background This article is based on information collected about the situation of double orphans who are heading households in Rakai District, Uganda. The information will be used as justification and guidance for planning actions to improve the situation of these and similar children. This research is thus the first step in an Action Research approach leading to specific interventions. The aim of this article is to describe the situation of these orphaned children, with an emphasis on the psychosocial challenges they face. Methods The study involved interviews, focus group discussions, observations and narratives. Forty-three heads of sibling-headed households participated. Information derived from informal discussions with local leaders is also included. The responses were analyzed using a modified version of Giorgi's psychological phenomenological method as described by Malterud 1. Results Factors such as lack of material resources, including food and clothes, limited possibilities to attend school on a regular basis, vast responsibilities and reduced possibilities for social interaction all contribute to causing worries and challenges for the child heads of households. Most of the children claimed that they were stigmatized and, to a great extent, ignored and excluded from their community. The Local Council Secretary ("Chairman" seemed to be the person in the community most responsible and helpful, but some chairmen seemed not to care at all. The children requested counseling for themselves as well as for community members because they experienced lack of understanding from other children and from adult community members. Conclusion The children experienced their situation as a huge and complex problem for themselves as well as for people in their villages. However, the situation might improve if actions focused on practical and psychological issues as well as on sensitization about the children's situation could be initiated. In

Invisible work: Child work in households with a person living with HIV/AIDS in Central Uganda.

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Abimanyi-Ochom, Julie; Inder, Brett; Hollingsworth, Bruce; Lorgelly, Paula

2017-12-01

HIV/AIDS has led to increased mortality and morbidity, negatively impacting adult labour especially in HIV/AIDS burdened Sub-Saharan Africa. There has been some exploration of the effects of HIV/AIDS on paid child labour, but little empirical work on children's non-paid child work. This paper provides quantitative evidence of how child and household-level factors affect children's involvement in both domestic and family farm work for households with a person living with HIV/AIDS (PLWHA) compared to non-PLWHA households using the 2010/2011 Centre for Health Economics Uganda HIV questionnaire Survey. Descriptive analysis and multivariate logistic modelling is used to explore child and household-level factors that affect children's work participation. This research reveals greater demands on the labour of children in PLWHA households in terms of family farm work especially for boys. Results highlight the expected gendered social responsibilities within the household space, with girls and boys engaged more in domestic and family farm work, respectively. Girls shared a greater proportion of household financial burden by working more hours in paid work outside the household than boys. Lastly, the study revealed that a household head's occupation increases children's participation in farm work but had a partial compensatory effect on their involvement in domestic work. Wealth and socio-economic standing is no guarantee to reducing child work. Children from PLWHA households are more vulnerable to child work in family farm work especially boys; and girls are burdened beyond the household space through paid work. Differing perspectives and solutions need to consider the contextual nature of child work.

Psychological distress and its predictors in AIDS orphan ...

African Journals Online (AJOL)

Structured interviewer administered questionnaire and scales including HAD, Rosenberg's and MPSS scales were used to measure the orphans' level of depression, anxiety, self-esteem and their perceived social support. Result: Among the ...

Economic Burden of HIV/AIDS Upon Households in Nepal: A Critical Review

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Newlands, David; Simkhada, Padam

2015-01-01

Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them. PMID:26913211

Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households.

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Nisha Naicker

Full Text Available Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa.Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD study. Logistic regression analysis using the HEAD study data (2006-2011 was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm.A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR 5.72; 95% CI 1.64-19.97; that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39-33.56 and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14-16.47.This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.

Has the Financial Protection Been Materialized in Iranian Health System? Analyzing Household Income and Expenditure Survey 2003-2014.

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Ghiasvand, Hesam; Olyaeemanesh, Alireza; Majdzadeh, Reza; Abdi, Zhaleh; Mobinizadeh, Mohammadreza

2018-01-03

The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.

Orphans and at-risk children in Haiti: vulnerabilities and human rights issues postearthquake.

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Nicholas, Patrice K; George, Erin K; Raymond, Nadia; Lewis-OʼConnor, Annie; Victoria, Stephanie; Lucien, Sergeline; Peters-Lewis, Angelleen; Hickey, Nancy; Corless, Inge B; Tyer-Viola, Lynda; Davis, Sheila M; Barry, Donna; Marcelin, Naomie; Valcourt, Roodeline

2012-01-01

The vulnerability of children in Haiti has increased dramatically since the earthquake in January 2010. Prior to the earthquake, the prevalence of orphans and at-risk children was high but since the earthquake, more than 1 million people-with more than 380,000 children remaining displaced and living in over 1200 displacement sites. These existing conditions leave orphans and at-risk children vulnerable to exploitation, abuse, and increased risk of HIV/AIDS. This article will focus on the complex issues affecting orphans and at-risk children and the intersection with HIV/AIDS and human rights. Specific recommendations by United Nations Children's Fund are discussed. Nursing in Haiti must address the policy-related and population-specific approaches for the care of children living with or affected by HIV/AIDS.

HIV/AIDS Competent Households: Interaction between a Health-Enabling Environment and Community-Based Treatment Adherence Support for People Living with HIV/AIDS in South Africa.

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Masquillier, Caroline; Wouters, Edwin; Mortelmans, Dimitri; van Wyk, Brian; Hausler, Harry; Van Damme, Wim

2016-01-01

In the context of severe human resource shortages in HIV care, task-shifting and especially community-based support are increasingly being cited as potential means of providing durable care to chronic HIV patients. Socio-ecological theory clearly stipulates that-in all social interventions-the interrelatedness and interdependency between individuals and their immediate social contexts should be taken into account. People living with HIV/AIDS (PLWHA) seldom live in isolation, yet community-based interventions for supporting chronic HIV patients have largely ignored the social contexts in which they are implemented. Research is thus required to investigate such community-based support within its context. The aim of this study is to address this research gap by examining the way in which HIV/AIDS competence in the household hampers or facilitates community-based treatment adherence support. The data was analyzed carefully in accordance with the Grounded Theory procedures, using Nvivo 10. More specifically, we analyzed field notes from participatory observations conducted during 48 community-based treatment adherence support sessions in townships on the outskirts of Cape Town, transcripts of 32 audio-recorded in-depth interviews with PLWHA and transcripts of 4 focus group discussions with 36 community health workers (CHWs). Despite the fact that the CHWs try to present themselves as not being openly associated with HIV/AIDS services, results show that the presence of a CHW is often seen as a marker of the disease. Depending on the HIV/AIDS competence in the household, this association can challenge the patient's hybrid identity management and his/her attempt to regulate the interference of the household in the disease management. The results deepen our understanding of how the degree of HIV/AIDS competence present in a PLWHA's household affects the manner in which the CHW can perform his or her job and the associated benefits for the patient and his/her household

HIV/AIDS Competent Households: Interaction between a Health-Enabling Environment and Community-Based Treatment Adherence Support for People Living with HIV/AIDS in South Africa.

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Caroline Masquillier

Full Text Available In the context of severe human resource shortages in HIV care, task-shifting and especially community-based support are increasingly being cited as potential means of providing durable care to chronic HIV patients. Socio-ecological theory clearly stipulates that-in all social interventions-the interrelatedness and interdependency between individuals and their immediate social contexts should be taken into account. People living with HIV/AIDS (PLWHA seldom live in isolation, yet community-based interventions for supporting chronic HIV patients have largely ignored the social contexts in which they are implemented. Research is thus required to investigate such community-based support within its context. The aim of this study is to address this research gap by examining the way in which HIV/AIDS competence in the household hampers or facilitates community-based treatment adherence support. The data was analyzed carefully in accordance with the Grounded Theory procedures, using Nvivo 10. More specifically, we analyzed field notes from participatory observations conducted during 48 community-based treatment adherence support sessions in townships on the outskirts of Cape Town, transcripts of 32 audio-recorded in-depth interviews with PLWHA and transcripts of 4 focus group discussions with 36 community health workers (CHWs. Despite the fact that the CHWs try to present themselves as not being openly associated with HIV/AIDS services, results show that the presence of a CHW is often seen as a marker of the disease. Depending on the HIV/AIDS competence in the household, this association can challenge the patient's hybrid identity management and his/her attempt to regulate the interference of the household in the disease management. The results deepen our understanding of how the degree of HIV/AIDS competence present in a PLWHA's household affects the manner in which the CHW can perform his or her job and the associated benefits for the patient and his

Single parent households and increased child asthma morbidity.

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Moncrief, Terri; Beck, Andrew F; Simmons, Jeffrey M; Huang, Bin; Kahn, Robert S

2014-04-01

To characterize whether single parent households are associated with pediatric asthma-related repeat healthcare utilization and to examine family-level psychosocial variables that may explain this relationship. We analyzed a prospective cohort of 526 children aged 1-16 years hospitalized for asthma or bronchodilator-responsive wheezing whose caregivers self-reported their marital status. Those reporting being "single" were considered the at-risk category. The outcome was repeat asthma-related utilization (emergency room (ER) revisit or hospital readmission) within 12 months. We assessed, a priori, four psychosocial variables (household income, caregiver risk of psychological distress, ratio of in-home children to adults, and regular attendance at childcare or a secondary home). Among all children enrolled in the cohort, 40% returned to the ER or hospital for asthma within 12 months. Of all caregivers, 59% self-identified as single. Single status was significantly associated with each psychosocial variable. Children in households with lower incomes and higher ratios of children to adults were both more likely to return to the ER or hospital than children with higher incomes and lower ratios, respectively (each p asthma from single parent households were more likely to have asthma-related reutilization within 12 months than children from homes with married parents. This was driven, in large part, by underlying differences in household income.

Reconsidering the orphan problem: the emergence of male caregivers in Lesotho.

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Block, Ellen

2016-01-01

Care for AIDS orphans in southern Africa is frequently characterized as a "crisis", where kin-based networks of care are thought to be on the edge of collapse. Yet these care networks, though strained by AIDS, are still the primary mechanisms for orphan care, in large part because of the essential role grandmothers play in responding to the needs of orphans. Ongoing demographic shifts as a result of HIV/AIDS and an increasingly feminized labor market continue to disrupt and alter networks of care for orphans and vulnerable children. This paper examines the emergence of a small but growing number of male caregivers who are responding to the needs of the extended family. While these men are still few in number, the strength of gendered ideologies of female care means that this group of men is socially, if not statistically significant. Men continue to be considered caregivers of last resort, but their care will close a small but growing gap that threatens to undermine kin-based networks of care in Lesotho and across the region. The adaptation of gender roles reinforces the strength and resilience of kinship networks even when working against deeply entrenched ideas about gendered division of domestic labor.

The use of drawings to facilitate interviews with orphaned children in ...

African Journals Online (AJOL)

children orphaned as a result of AIDS also need to cope with the stigma of, ... with the help of the teachers, used purposive sampling – carried out in two ... Researchers (Creswell, 2002; Denzin & Lincoln, 2000) recommend that before seeking ..... of the orphaned children who offered to share their stories had a positive self-.

Illness, death, and macronutrients: adequacy of rural Mozambican household production of macronutrients in the face of HIV/AIDS.

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Donovan, Cynthia; Massingue, Jaquelino

2007-06-01

As the public sector and civil society develop intervention programs to deal with the HIV/ AIDS epidemic, there has been an increasing emphasis on the relationship between nutrition and the disease. Drug interventions may be ineffective, and the progression from HIV infection to full-blown AIDS may be accelerated without adequate nutrition. Mozambique is still fighting an increasing prevalence rate of HIV including in rural areas. Rural households in Mozambique rely heavily on their own agricultural production for the basic macronutrients. To evaluate the extent to which household agricultural production of basic staples meets overall household needs for major macronutrients, comparing households affected and not directly affected by HIV/ AIDS and other major illnesses over two time periods. Methods. This research analyzes nationally representative panel data from rural household surveys conducted in 2002 and 2005 to evaluate whether households that have suffered the chronic illness or illness-related death of prime-age adult members (15 to 49 years of age) are more vulnerable to macronutrient gaps. Households in the South and in the North with a male illness or death in 2002 produced significantly less macronutrients from crops in 2005 than nonaffected households. These households also had significantly lower income per adult equivalent. Mortality or illness from HIV/AIDS affects the ability of agricultural households dependent on own-food production to produce macronutrients. Interventions to improve access to food may be needed for affected households, particularly in light of their inability to recover over time. More analysis is needed to understand income sources, crop diversification, and access to macronutrients through the market.

How do HIV and AIDS impact the use of natural resources by poor rural populations? The case of wild animal products

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Charles M. Shackleton

2012-01-01

Full Text Available As a result of heightened financial and food insecurity, populations adversely affected by HIV and/or AIDS may be more likely to utilise wild natural resources to supplement their diet and livelihoods. Should this effect be pronounced, HIV and AIDS may pose a serious environmental threat. We explored the hypothesis that the presence of factors in the household, such as chronic illness in and recent mortality of individuals in a high HIV-risk age group, as well as the fostering of orphans, are associated with increased utilisation of wild animal products (WAPs at the household level. We randomly surveyed 519 households from four sites in rural South Africa, recording household socio-economic status, the utilisation of wild animal products and health and demographic factors attributed to HIV or AIDS. Binary logistic regressions were used to test if households with markers of HIV and/or AIDS affliction were more likely to have a higher incidence and frequency of WAP utilisation relative to non-afflicted households, after adjusting for socio-economic and demographic variables. We found that, although households with markers of HIV and/or AIDS were generally poorer and had higher dependency ratios, there was no evidence to support the hypothesis that WAP harvesting was associated with either poverty, or markers of HIV and/or AIDS affliction. Our findings suggest that generalisations about a possible interaction between HIV and/or AIDS and the environment may not uniformly apply to all categories of natural resources or to all user groups.

Health and economic impact of HIV/AIDS on South African households: a cohort study

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Booysen Frederick LR

2003-04-01

Full Text Available Abstract Background South African households are severely affected by human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS but health and economic impacts have not been quantified in controlled cohort studies. Methods We compared households with an HIV-infected member, and unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa. Interviews were conducted with one key informant in each household, at baseline and six months later. We studied 1913 members of 404 households, with 94% and 96% follow up, respectively. Household and individual level analyses were done. Results Members of affected households, compared to members of unaffected households, were independently more likely to be continuously ill (adjusted odds ratio (OR 2.1, 95% CI 1.3–3.4 at follow up, and to die (adjusted OR 3.4, 95% CI 1.0–11, mainly due to infectious diseases. Government clinics and hospitals were the main sources of health care. Affected households were poorer than unaffected households at baseline (relative income per person 0.61, 95% CI 0.49–0.76. Over six months expenditure and income decreased more rapidly in affected than in unaffected households (baseline-adjusted relative expenditure 0.86, 95% CI 0.75–0.99 and income 0.89, 95% CI 0.75–1.05. Baseline morbidity was independently associated with lower income and expenditure at baseline but not with changes over six months. Conclusions HIV/AIDS affects the health and wealth of households as well as infected individuals, aggravating pre-existing poverty.

The Work and Family Responsibilities of Black Women Single Parents. Working Paper No. 148.

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Malson, Michelene R.; Woody, Bette

One aspect of the general rise in the number of single parent households is the high proportion of them that are headed by black women. Black families headed by women tend to be larger and are more likely to be impoverished. Contrary to popular belief, many black single mothers considered poor are employed women, not recipients of welfare. An…

Maltreatment of Youth Heads of Households in Rwanda | Ntaganira ...

African Journals Online (AJOL)

Many of these are not only orphans but also youth heads of households (YHH). Orphans and YHH are particularly vulnerable to maltreatment because of marginalization from the community. The objectives of this study were to: (a) determine the prevalence of maltreatment among YHH after a two year follow-up by age and ...

Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya.

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Embleton, Lonnie; Ayuku, David; Kamanda, Allan; Atwoli, Lukoye; Ayaya, Samuel; Vreeman, Rachel; Nyandiko, Winstone; Gisore, Peter; Koech, Julius; Braitstein, Paula

2014-04-01

Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. The Orphaned and Separated Children's Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher's exact test was also used if some cells had expected value of less than 5. Included in this analysis are data from 300 households, 19 Charitable Children's Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI's and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as 'Pure CCI' for those only providing residential care, 'CCI-Plus' for those providing both residential care and community-based supports to orphaned children , and 'CCI-Shelter' which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately

Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico.

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Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

2006-11-18

Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

[Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico].

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Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

2007-01-01

Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

The cost of HIV/AIDS-related morbidity and mortality to households: Preliminary estimates for Soweto

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V Naidu

2014-06-01

Full Text Available This article has two main aims: to provide data on the cost of HIV/AIDS to urban South African households and to contribute to the development of a methodology that could be used in later studies. Data on the costs of HIV/AIDS-related morbidity and mortality were collected from a purposively selected sample of households in Soweto on four occasions between September 2002 and August 2003. The sample comprised 61 affected households, which had at least one member with a CD4 count of 200 or less at the start of the study, and 52 non-affected households. Three types of costs were examined – financial, economic and the present value of lost future earnings. The data suggest that the financial costs of morbidity and mortality were three and two times greater, respectively, for affected households than for those non-affected households that reported disease and/or death. Mortality costs far exceeded morbidity costs. The present value of lost future earnings, where the deceased had previously been an income earner, proved to be the major cost incurred by an affected household.

The Dynamics of Catastrophic and Impoverishing Health Spending in Indonesia: How Well Does the Indonesian Health Care Financing System Perform?

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Aji, Budi; Mohammed, Shafiu; Haque, Md Aminul; Allegri, Manuela De

2017-09-01

Our study examines the incidence and intensity of catastrophic and impoverishing health spending in Indonesia. A panel data set was used from 4 waves of the Indonesian Family Life Surveys 1993, 1997, 2000, and 2007. Catastrophic health expenditure was measured by calculating the ratio of out-of-pocket payments to household income. Then, we calculated poverty indicators as a measure of impoverishing spending in the health care financing system. Head count, overshoot, and mean positive overshoot for each given threshold in 2000 were lower than other surveyed periods; otherwise, fraction headcount in 2007 of households were the higher. Between 1993 and 2007, the percentage of households in poverty decreased, both in gross and net of health payments. However, in each year, the percentages of households in poverty using net health payments were higher than the gross. The estimates of poverty gap, normalized poverty gap, and normalized mean positive gap decreased across the survey periods. The health care financing system performance has shown positive evidence for financial protection offerings. A sound relationship between improvements of health care financing performance and the existing health reform demonstrated a mutual reinforcement, which should be maintained to promote equity and fairness in health care financing in Indonesia.

Parental AIDS Status and Death: Its Impact on Ghanaian Childrens ...

African Journals Online (AJOL)

Methods: In a cross-sectional survey, 4 groups of children (AIDS orphans, orphans of other causes, children living with AIDS parents, and non-orphaned children) aged between 10 and 19 years were interviewed on their hyperactivity, emotional, conduct, and peer problems using the Strength and Difficulties Questionnaire.

World health dilemmas: Orphan and rare diseases, orphan drugs and orphan patients.

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Kontoghiorghe, Christina N; Andreou, Nicholas; Constantinou, Katerina; Kontoghiorghes, George J

2014-09-26

According to global annual estimates hunger/malnutrition is the major cause of death (36 of 62 million). Cardiovascular diseases and cancer (5.44 of 13.43 million) are the major causes of death in developed countries, while lower respiratory tract infections, human immunodeficiency virus infection/acquired immunodeficiency syndrome, diarrhoeal disease, malaria and tuberculosis (10.88 of 27.12 million) are the major causes of death in developing countries with more than 70% of deaths occurring in children. The majority of approximately 800 million people with other rare diseases, including 100000 children born with thalassaemia annually receive no treatment. There are major ethical dilemmas in dealing with global health issues such as poverty and the treatment of orphan and rare diseases. Of approximately 50000 drugs about 10% are orphan drugs, with annual sales of the latter approaching 100 billion USD. In comparison, the annual revenue in 2009 from the top 12 pharmaceutical companies in Western countries was 445 billion USD and the top drug, atorvastatin, reached 100 billion USD. In the same year, the total government expenditure for health in the developing countries was 410 billion USD with only 6%-7% having been received as aid from developed countries. Drugs cost the National Health Service in the United Kingdom more than 20 billion USD or 10% of the annual health budget. Uncontrollable drug prices and marketing policies affect global health budgets, clinical practice, patient safety and survival. Fines of 5.3 billion USD were imposed on two pharmaceutical companies in the United States, the regulatory authority in France was replaced and clinicians were charged with bribery in order to overcome recent illegal practises affecting patient care. High expenditure for drug development is mainly related to marketing costs. However, only 2 million USD was spent developing the drug deferiprone (L1) for thalassaemia up to the stage of multicentre clinical trials. The

World health dilemmas: Orphan and rare diseases, orphan drugs and orphan patients

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Kontoghiorghe, Christina N; Andreou, Nicholas; Constantinou, Katerina; Kontoghiorghes, George J

2014-01-01

According to global annual estimates hunger/malnutrition is the major cause of death (36 of 62 million). Cardiovascular diseases and cancer (5.44 of 13.43 million) are the major causes of death in developed countries, while lower respiratory tract infections, human immunodeficiency virus infection/acquired immunodeficiency syndrome, diarrhoeal disease, malaria and tuberculosis (10.88 of 27.12 million) are the major causes of death in developing countries with more than 70% of deaths occurring in children. The majority of approximately 800 million people with other rare diseases, including 100000 children born with thalassaemia annually receive no treatment. There are major ethical dilemmas in dealing with global health issues such as poverty and the treatment of orphan and rare diseases. Of approximately 50000 drugs about 10% are orphan drugs, with annual sales of the latter approaching 100 billion USD. In comparison, the annual revenue in 2009 from the top 12 pharmaceutical companies in Western countries was 445 billion USD and the top drug, atorvastatin, reached 100 billion USD. In the same year, the total government expenditure for health in the developing countries was 410 billion USD with only 6%-7% having been received as aid from developed countries. Drugs cost the National Health Service in the United Kingdom more than 20 billion USD or 10% of the annual health budget. Uncontrollable drug prices and marketing policies affect global health budgets, clinical practice, patient safety and survival. Fines of 5.3 billion USD were imposed on two pharmaceutical companies in the United States, the regulatory authority in France was replaced and clinicians were charged with bribery in order to overcome recent illegal practises affecting patient care. High expenditure for drug development is mainly related to marketing costs. However, only 2 million USD was spent developing the drug deferiprone (L1) for thalassaemia up to the stage of multicentre clinical trials. The

School performance and school behavior of children affected by AIDS in China

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Tu, Xiaoming; Lv, Yunfei; Li, Xiaoming; Fang, Xiaoyi; Zhao, Guoxiang; Lin, Xiuyun; Hong, Yan; Zhang, Liying; Stanton, Bonita

2009-01-01

It is generally recognized that the AIDS epidemic will have a negative effect on the orphans’ school education. However, few studies have been carried out to examine the school performance and school behavior of AIDS orphans and vulnerable children (children living with HIV-infected parents). Using both self-report and teacher evaluation data of 1625 children from rural central China, we examined the impact of parental HIV/AIDS on children's school performances (academic marks, educational expectation, and student leadership) and school behaviors (e.g., aggression, shy/anxious and assertive social skills). Results indicate that AIDS orphans and vulnerable children had disadvantages in school performances in comparison to their peers from the same community who did not experience AIDS-related death and illness in their family (comparison children). AIDS orphans had the lowest academic marks based on the reports of both children and teachers. Educational expectation was significantly lower among AIDS orphans and vulnerable children than comparison children from teacher's perspective. AIDS orphans were significantly more likely to demonstrate aggressive, impulsive and anxious behaviors than non-orphans. Moreover, orphans have more learning difficulties. Vulnerable children were also at a disadvantage on most measures. The data suggest that a greater attention is needed to the school performance and behavior of children affected by AIDS. The findings also indicate that AIDS relief and assistance program for children should go beyond the school attendance and make efforts to improve their school performance and education aspiration. PMID:20107622

Household expenditures on pneumonia and diarrhoea treatment in Ethiopia: a facility-based study.

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Memirie, Solomon Tessema; Metaferia, Zewdu Sisay; Norheim, Ole F; Levin, Carol E; Verguet, Stéphane; Johansson, Kjell Arne

2017-01-01

Out-of-pocket (OOP) medical payments can lead to catastrophic health expenditure and impoverishment. We quantified household OOP expenditure for treatment of childhood pneumonia and diarrhoea and its impact on poverty for different socioeconomic groups in Ethiopia. This study employs a mix of retrospective and prospective primary household data collection for direct medical and non-medical costs (2013 US$). Data from 345 pneumonia and 341 diarrhoea cases (0-59 months of age) were collected retrospectively through exit interviews from 35 purposively sampled health facilities in Ethiopia. Prospective 2-week follow-up interviews were conducted at the household level using a structured questionnaire. The mean total medical expenditures per outpatient visit were US$8 for pneumonia and US$6 for diarrhoea, while the mean for inpatient visits was US$64 for severe pneumonia and US$79 for severe diarrhoea. The mean associated direct non-medical costs (mainly transport costs) were US$2, US$2, US$13 and US$20 respectively. 7% and 6% of the households with a case of severe pneumonia and severe diarrhoea, respectively, were pushed below the extreme poverty threshold of purchasing power parity (PPP) US$1.25 per day. Wealthier and urban households had higher OOP payments, but poorer and rural households were more likely to be impoverished due to medical payments. Households in Ethiopia incur considerable costs for the treatment of childhood diarrhoea and pneumonia with catastrophic consequences and impoverishment. The present circumstances call for revisiting the existing health financing strategy for high-priority services that places a substantial burden of payment on households at the point of care.

Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya.

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Lukoye Atwoli

Full Text Available The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs and posttraumatic stress disorder (PTSD among orphaned and separated children in Uasin Gishu County, western Kenya.A total of 1565 (55.5% male orphaned and separated adolescents aged 10-18 years (mean 13.8 years, sd 2.2, were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children's Institutions (CCIs, and 73 on the street. Posttraumatic stress symptom (PTSS scores and PTSD were assessed using the Child PTSD Checklist.Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%, then households (15.0% and CCIs (11.5%. PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse.This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households. Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support.

Household Composition among Elders in Sub-Saharan Africa in the Context of HIV/AIDS

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Zimmer, Zachary

2009-01-01

Cross-sectional and repeated surveys from household components of Demographic and Health Surveys in sub-Saharan Africa were examined to determine whether household composition indicators for older adults (N = 52,573), involving offspring and grandchildren, correlated with national levels of AIDS mortality. One in 4 was living with a grandchild…

Are Koreans Prepared for the Rapid Increase of the Single-Household Elderly? Life Satisfaction and Depression of the Single-Household Elderly in Korea

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Mi-Ra Won

2013-01-01

Full Text Available Purpose. In Korea, it has been estimated that the number of the single-household elderly increased 45% from 2005 to 2010. This research was conducted to provide empirical resources for development of a community mental health program by an explorative investigation on depression, coping mechanism, and life satisfaction of a single-household elderly population. Design and Methods. This research applied a descriptive survey research design. Participants were 225 single-household elderlies residing in Seoul, Korea. The geriatric depression scale and the satisfaction with life scale were used to check the level of depression and life satisfaction of the participants. Results. Results showed that 46.3 percent of the participants were categorized as having light-to-severe level of depression, and 80.5 percent of the participants responded that they were dissatisfied with their lives. This research demonstrated that the level of depression and life satisfaction of the Korean single-household elderly is statistically significantly related to age and gender as well as coping resources and human resources. Implications. Current public health services in Korea for the single-household elderly are still lacking and require active support, intervention, and research to provide effective programs and services. Case management, counseling, and various programs based on Korean culture including support from family members and community-based assistance are recommended to help the vulnerable population.

AIDS Myths and Myths about AIDS Myths : A Study about AIDS-related Perceptions in South Africa

OpenAIRE

Sivelä, Jonas

2016-01-01

This doctoral thesis, consisting of four separate articles and a summarizing report, discusses so-called South African AIDS myths also called AIDS beliefs, rumours, misconceptions and legends. AIDS myths have been put forth as an outcome of and a major reason behind the severe HIV/AIDS situation in South Africa. They are proposed to flourish among black South Africans living in impoverished townships and villages. In previous studies, the reasons and mechanisms behind AIDS myths have be...

Issues surrounding orphan disease and orphan drug policies in Europe.

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Denis, Alain; Mergaert, Lut; Fostier, Christel; Cleemput, Irina; Simoens, Steven

2010-01-01

An orphan disease is a disease with a very low prevalence. Although there are 5000-7000 orphan diseases, only 50 orphan drugs (i.e. drugs developed to treat orphan diseases) were marketed in the EU by the end of 2008. In 2000, the EU implemented policies specifically designed to stimulate the development of orphan drugs. While decisions on orphan designation and the marketing authorization of orphan drugs are made at the EU level, decisions on drug reimbursement are made at the member state level. The specific features of orphan diseases and orphan drugs make them a high-priority issue for policy makers. The aim of this article is to identify and discuss several issues surrounding orphan disease and drug policies in Europe. The present system of orphan designation allows for drugs for non-orphan diseases to be designated as orphan drugs. The economic factors underlying orphan designation can be questioned in some cases, as a low prevalence of a certain indication does not equal a low return on investment for the drug across its indications. High-quality evidence about the clinical added value of orphan drugs is rarely available at the time of marketing authorization, due to the low number of patients. A balance must be struck between ethical and economic concerns. To this effect, there is a need to initiate a societal dialogue on this issue, to clarify what society wants and accepts in terms of ethical and economic consequences. The growing budgetary impact of orphan drugs puts pressure on drug expenditure. Indications can be extended for an orphan drug and the total prevalence across indications is not considered. Finally, cooperation needs to be fostered in the EU, particularly through a standardized approach to the creation and use of registries. These issues require further attention from researchers, policy makers, health professionals, patients, pharmaceutical companies and other stakeholders with a view to optimizing orphan disease and drug policies in

Quality of life of middle-aged adults in single households in South Korea.

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Song, Hyun Jin; Park, Susan; Kwon, Jin-Won

2018-04-18

The number of single households has increased worldwide with middle-aged people in such households indicating the highest increase. However, there is a lack of studies on the topic. This study estimated the quality of life (QOL) by household type for middle-aged Korean adults. We used the Korea National Health and Nutrition Examination Survey data from 2007 to 2015. QOL was analyzed using EQ-5D 3-level, and demographic and health-related variables were included as confounders. The households were divided into single household, married couple without child, other one-generation, married couple with child, single parent with child, other two-generation, and three-generation. Logistic regression using level, strata, and sample weight of data was performed based on average QOL. This study included 18,147 responders aged 45-64 years, with single households constituting 5.7%. Single households having average or less QOL were 48.4%, with men and women constituting 40.1 and 53.3%, respectively. After adjusting socioeconomic factors and health-related factors, the odds ratio (OR) of single households was 1.375 (95% CI 1.122-1.684) compared to the three-generation group. According to the sex, the OR of single households with men was higher (OR 1.552, 95% CI 1.121-2.149). However, no significance was found in women. The study results revealed that middle-aged people in single households had low QOL than those in multi-person households. The trend was significantly observable in men than in women. Because middle-aged adults might transform into elderly with low QOL, program development and social support for middle-aged adults in single households should be provided.

Non-evidence-based policy: how effective is China's new cooperative medical scheme in reducing medical impoverishment?

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Yip, Winnie; Hsiao, William C

2009-01-01

In recent years, many lower to middle income countries have looked to insurance as a means to protect their populations from medical impoverishment. In 2003, the Chinese government initiated the New Cooperative Medical System (NCMS), a government-run voluntary insurance program for its rural population. The prevailing model of NCMS combines medical savings accounts with high-deductible catastrophic hospital insurance (MSA/Catastrophic). To assess the effectiveness of this approach in reducing medical impoverishment, we used household survey data from 2006 linked to claims records of health expenditures to simulate the effect of MSA/Catastrophic on reducing the share of individuals falling below the poverty line (headcount), and the amount by which household resources fall short of the poverty line (poverty gap) due to medical expenses. We compared the effects of MSA/Catastrophic to Rural Mutual Health Care (RMHC), an experimental model that provides first dollar coverage for primary care, hospital services and drugs with a similar premium but a lower ceiling. Our results show that RMHC is more effective at reducing medical impoverishment than NCMS. Under the internationally accepted poverty line of US$1.08 per person per day, the MSA/Catastrophic models would reduce the poverty headcount by 3.5-3.9% and the average poverty gap by 11.8-16.4%, compared with reductions of 6.1-6.8% and 15-18.5% under the RMHC model. The primary reason for this is that NCMS does not address a major cause of medical impoverishment: expensive outpatient services for chronic conditions. As such, health policymakers need first to examine the disease profile and health expenditure pattern of a population before they can direct resources to where they will be most effective. As chronic diseases impose a growing share of the burden on the population in developing countries, it is not necessarily true that insurance coverage focusing on expensive hospital care alone is the most effective at

The impact on orchid species abundance of gathering their edible tubers by HIV/AIDS orphans : a case of three villages in the Southern Highlands of Tanzania

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Challe, J.F.X.; Struik, P.C.

2008-01-01

This paper examines the gathering of wild orchids and its effect on orchid species diversity and abundance in rural communities with high prevalence of HIV/AIDS and high numbers of orphans. The study was conducted in three villages in the Makete District of Tanzania. The study used a triangulation

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys.

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Kanamori, Mariano J; Carter-Pokras, Olivia D; Madhavan, Sangeetha; Lee, Sunmin; He, Xin; Feldman, Robert H

2015-08-01

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Crianças órfãs e vulneráveis pelo HIV no Brasil: onde estamos e para onde vamos? Orphans and vulnerable children affected by HIV/AIDS in Brazil: where do we stand and where are we heading?

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Ivan França-Junior

2006-04-01

Full Text Available O objetivo do artigo foi identificar a magnitude e a situação de alguns direitos humanos, conforme expressos na United Nations General Assembly Special Session on HIV/AIDS, de crianças e adolescentes portadores de HIV/Aids, afetados não-órfãos e órfãos por Aids, com base em pesquisa sobre o tema na literatura científica nacional e internacional. Os principais achados não permitiram indicar com segurança quantos seriam as crianças e os adolescentes portadores do HIV e afetados não-órfãos. Há informações sobre o número de portadores de Aids e de órfãos. Estas estimativas, sejam elas oriundas do sistema de vigilância, modelos matemáticos ou inquéritos, são discutidas em suas limitações e possibilidades. Apesar da literatura ainda ser relativamente pequena, há indícios de comprometimento de vários direitos como saúde, educação, moradia, alimentação, não discriminação, integridade física e mental. Verificou-se que o Brasil ainda precisa avançar para responder às necessidades adicionais dos órfãos e outras crianças vulneráveis. A resposta brasileira, até o momento, é limitada à assistência médica para crianças e adolescentes portadores do HIV/Aids, ao combate à transmissão vertical do HIV e ao financiamento da instalação e manutenção de casas de apoio (abrigos pelo Estatuto da Criança e do Adolescente para infectados afetados, órfãos ou não. Essas medidas são insuficientes para garantir um ambiente de apoio para órfãos, crianças e adolescentes infectados ou afetados pelo HIV/Aids. Propõem-se formas do Brasil criar e aprimorar bases de dados para responder a esses desafios.This study aimed at identifying human rights' status and situation, as expressed in the United Nations General Assembly Special Session on HIV/AIDS, of children and adolescents living with HIV/AIDS, non-orphans and orphans affected by AIDS, based on local and international literature review. The main study findings did

Living in single person households and the risk of isolation in later life

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Laura Banks

2009-10-01

Full Text Available Data from the International Social Survey Programme (2001 was used to analyse the social networks of older people and whether living in single person households increased the risk of isolation. When comparing respondents with one or more adult children, there was no significant difference in the likelihood of experiencing familial isolation between people living in single person households and those living in larger households. A majority of those living in single person households had at least regular contact with a sibling, adult child or close friend and participated in a social organisation. Friends compensate to some extent for a lack of support from the family, although in southern and eastern European countries, other relatives appeared to be more important in support networks. People living in single person households were more likely to experience isolation, but this was largely related to advanced age and childlessness. Whilst a very small minority in Japan were living in single person households, they were significantly more likely to be severely isolated than those living in single person households in other countries.

African Journal of AIDS Research - Vol 4, No 1 (2005)

African Journals Online (AJOL)

Developmental vulnerabilities and strengths of children living in childheaded households: a comparison with children in adult-headed households in equivalent impoverished communities · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. David Donald, Glynis Clacherty, 21-28.

Models of care for orphaned and separated children and upholding children’s rights: cross-sectional evidence from western Kenya

Science.gov (United States)

2014-01-01

Background Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children’s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher’s exact test was also used if some cells had expected value of less than 5. Results Included in this analysis are data from 300 households, 19 Charitable Children’s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI’s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as ‘Pure CCI’ for those only providing residential care, ‘CCI-Plus’ for those providing both residential care and community-based supports to orphaned children , and ‘CCI-Shelter’ which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p children and uphold their rights. Family-based care plays an essential role; however

Health promotion needs of Hammanskraal families with adolescents orphaned by HIV/AIDS

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M D Peu

2008-11-01

Full Text Available Health promotion is regarded as the cornerstone of good health. It is the action expected from individuals and families in order to better their own health situation. Health promotion is an art and science (Edelman & Mandle, 2002:16 that is integrated into the primary health care to reduce existing health problems. The purpose of the research on which this article is reporting, was to explore and describe the health promotion needs of families with adolescents orphaned by human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS. The research was located within a qualitative paradigm that is both exploratory and descriptive. Eight families who were purposely selected participated in the research process. Qualitative methods, such as group interviews and field notes were utilised to collect data. The health promotion needs of the families with adolescents orphaned by HIV/AIDS were explored and described. Tesch’s analysis process, which entails a series of steps, was followed (Creswell, 2003:192. Themes, categories and subcategories that form the central focus of health promotion needs emerged during the data analysis. These themes,categories and subcategories are used to develop guidelines for health promotion. Opsomming Die bevordering van gesondheid is die hoeksteen van gesondheid. Dit is die aksie wat van individue en familie verwag word, sodat hulle hul eie gesondheidstoestand kan verbeter. Die bevordering van gesondheid is ‘n kuns en ‘n wetenskap, wat geïntegreer is in primêre gesondheidsorg, om bestaande gesondheidsprobleme te verminder (Edelman & Mandle, 2002:16. Die doel van die navorsing, waarna in hierdie artikel verwys word, was om uit te vind wat die gesondheidsorgbehoeftes van families, met adolessente wat wees gelaat is as gevolg van menslike immunogebrek virus of verworve immuungebrek sindroom (MIV/VIGS, is, en dit te beskryf. Die navorsing was binne die raamwerk van ‘n kwalitatiewe paradigma, wat

The health and living conditions of children in child-headed households in Siteki, Swaziland.

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Earnshaw, S; Njongwe, P Z; English, B; Worku, Z

2009-04-01

The focus of the study reported on here was to determine the health and living conditions of children living in child-headed households (CHHs) in Swaziland, where it is estimated that approximately 10-15 percent of the entire population will be orphans and other vulnerable children (OVC) by 2010 and that one in ten households in the country today are child-headed because of the impact of HIV and AIDS. The population comprised 41 heads of household, caring for 97 siblings among them. Data was collected in a single period between the months of February and April 2007 using the convenience sampling method and employing a semi-structured questionnaire as the data-collection instrument. Children were generally physically healthy, despite not receiving adequate food or balanced diets. Most had access to health facilities or at least to sources of medication. Education assistance exists but is limited and abuse was generally not reported for fear of reprisal. Children generally relied on family and community networks for assistance, but the strain this put on those offering assistance meant that the assistance was not always consistent. Some children also relied on NGOs for food donations, but many of the children were unaware of the services offered by these organisations. There is a dearth of information on adolescents in Swaziland, the primary caregivers in most child-headed households. Children are not actively consulted and encouraged to participate in helping to solve the problems they are affected by. There is a lack of coordination between caregiver organisations, leading to ineffective and inefficient service provision for this particular vulnerable group.

Orphans of the HIV epidemic: the challenges from toddlerhood to adolescence and beyond.

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Lala, Mamatha M

2014-01-01

This presentation focuses on the challenges and practical issues faced each day by orphans of the HIV epidemic and the holistic care that can be provided, as they continue to grow from toddlerhood to adolescence and beyond. An HIV Research Trust Scholarship enabled me to spend quality time in a sub-Saharan African province worst hit by the HIV epidemic and to interact with local experts and learn from mutual clinical experience. It was an immensely useful exercise as the clinical spectra of the diseases are very similar to ours and they have ongoing active research programs very relevant to our setting. India is arguably home to the largest number of orphans of the HIV epidemic. The responsibility of caring for orphaned children overwhelms and pushes many extended families beyond their ability to cope. Many countries are experiencing large increases in the number of families headed by women and grandparents, or even young children. These households are often unable to meet basic needs, and so the number of children living on the streets is rising. Orphaned children are disadvantaged in many devastating ways. In addition to the trauma of witnessing the sickness and death of one or both parents and perhaps siblings, they lack the necessary parental guidance through crucial life-stages of identity formation and transition into adulthood. They are more likely to suffer damage to their cognitive and emotional development and be subjected to; exploitation in terms of labour, social exclusion, extreme economic uncertainty, physical and sexual abuse, illiteracy, malnutrition and illness. Education remains a distant dream. With stigma and discrimination, they lack legal protection, lose inheritance rights, access to essential services available to other community members and professional help from doctors, teachers and lawyers. The implications for these unfortunate children are extraordinarily grave but governments, international agencies, non-governmental organizations

Neglect and perceived stigmatization impact psychological distress of orphans in Tanzania

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Katharin Hermenau

2015-11-01

Full Text Available Background: Research has shown that orphans in sub-Saharan Africa are at increased risk for mental health problems. Exposure to maltreatment and HIV/AIDS-related stigmatization are related to orphans’ psychological distress. Yet, researchers stress the need for more research in low-income countries to identify which factors of being an orphan may lead to psychological distress. Objectives: The present study aims to systematically investigate orphans’ experiences of maltreatment and stigmatization to identify factors that relate to their psychological distress. Methods: In total, 89 Tanzanian children who had lost at least one parent were compared to 89 matched non-orphans (mean age: 11 years; 51% boys. We measured exposure to maltreatment and perceived stigmatization as an orphan. Mental health was assessed using the Strengths and Difficulties Questionnaire, the Children's Depression Inventory, the UCLA PTSD Index for Children, and the Reactive–Proactive Questionnaire. Results: Orphans reported significantly more experiences of neglect, but not of abuse. A group comparison revealed more depressive symptoms, posttraumatic stress symptoms, and aggressive behavior among orphans. Neglect, abuse, and stigmatization correlated with orphans’ internalizing and externalizing problems, yet only neglect and stigmatization were related to orphans’ depression severity. Perceived stigmatization moderated the relationship between neglect and depression. Conclusions: Our findings suggest that orphans in Tanzania are at increased risk of experiencing neglect. Maltreatment and perceived stigmatization may play a role in orphans’ psychological distress. Culturally appropriate and evidence-based interventions may help to prevent maltreatment and stigmatization of orphans.

Role of traditional healers in psychosocial support in caring for the orphans: A case of Dar-es Salaam City, Tanzania

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Massila Mariam

2005-07-01

Full Text Available Abstract Orphans are an increasing problem in developing countries particularly in Africa; due to the HIV/AIDS pandemic; and needs collective effort in intervention processes by including all stakeholders right from the grass roots level. This paper attempts to present the role of traditional healers in psychosocial support for orphan children in Dar-es-Salaam City with special focus on those whose parents have died because of HIV/AIDS. Six traditional healers who were involved in taking care of orphans were visited at their "vilinge" (traditional clinics. In total they had 72 orphans, 31 being boys and 41 being girls with age range from 3 years to 19. It was learned that traditional healers, besides providing remedies for illnesses/diseases of orphans, they also provided other basic needs. Further, they even provided psychosocial support allowing children to cope with orphan hood life with ease. Traditional healers are living within communities at the grass roots level; and appear unnoticed hidden forces, which are involved in taking care of orphans. This role of traditional healers in taking care of orphans needs to be recognised and even scaling it up by empowering them both in financial terms and training in basic skills of psychosocial techniques in how to handle orphans, in order to reduce discrimination and stigmatisation in the communities where they live.

Role of traditional healers in psychosocial support in caring for the orphans: a case of Dar-es Salaam City, Tanzania.

Science.gov (United States)

Kayombo, Edmund J; Mbwambo, Zakaria H; Massila, Mariam

2005-07-29

Orphans are an increasing problem in developing countries particularly in Africa; due to the HIV/AIDS pandemic; and needs collective effort in intervention processes by including all stakeholders right from the grass roots level. This paper attempts to present the role of traditional healers in psychosocial support for orphan children in Dar-es-Salaam City with special focus on those whose parents have died because of HIV/AIDS. Six traditional healers who were involved in taking care of orphans were visited at their "vilinge" (traditional clinics). In total they had 72 orphans, 31 being boys and 41 being girls with age range from 3 years to 19. It was learned that traditional healers, besides providing remedies for illnesses/diseases of orphans, they also provided other basic needs. Further, they even provided psychosocial support allowing children to cope with orphan hood life with ease. Traditional healers are living within communities at the grass roots level; and appear unnoticed hidden forces, which are involved in taking care of orphans. This role of traditional healers in taking care of orphans needs to be recognised and even scaling it up by empowering them both in financial terms and training in basic skills of psychosocial techniques in how to handle orphans, in order to reduce discrimination and stigmatisation in the communities where they live.

Parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China.

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Zhao, Junfeng; Li, Xiaoming; Barnett, Douglas; Lin, Xiuyun; Fang, Xiaoyi; Zhao, Guoxiang; Naar-King, Sylvie; Stanton, Bonita

2011-08-01

The objective of this study was to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. In this study, cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach's α = 0.84) modified from the Trusting Relationship Questionnaire developed by Mustillo et al. in 2005 (Quality of relationships between youth and community service providers: Reliability and validity of the trusting relationship questionnaire. Journal of Child and Family Studies, 14, 577-590). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Group mean comparisons using analysis of variance suggested a significant association (p anxiety and depression. These associations remained significant in General Linear Model analysis, controlling for children's gender, age, family socioeconomic status, orphan status (orphans, vulnerable children, and comparison children), and appropriate interaction terms among factor variables. The findings in the current study support the global literature on the importance of attachment relationship with caregivers in promoting children's psychosocial development. Future prevention intervention efforts to improve AIDS orphans' psychosocial well-being will need to take into consideration the quality of the child's attachment relationships with current caregivers and help their current caregivers to improve the quality of care for these children. Future study is needed to explore the possible reasons for the lack of association between a

Predictors of Mental Health Resilience in Children who Have Been Parentally Bereaved by AIDS in Urban South Africa.

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Collishaw, Stephan; Gardner, Frances; Lawrence Aber, J; Cluver, Lucie

2016-05-01

Children parentally bereaved by AIDS experience high rates of mental health problems. However, there is considerable variability in outcomes, and some show no mental health problems even when followed over time. Primary aims were to identify predictors of resilient adaptation at child, family and community levels within a group of AIDS-orphaned children, and to consider their cumulative influence. A secondary aim was to test whether predictors were of particular influence among children orphaned by AIDS relative to non-orphaned and other-orphaned children. AIDS-orphaned (n = 290), other-orphaned (n = 163) and non-orphaned (n = 202) adolescents living in informal settlements in Cape Town, South Africa were assessed on two occasions 4 years apart (mean age 13.5 years at Time 1, range = 10-19 years). Self-report mental health screens were used to operationalise resilience in AIDS-orphaned children as the absence of clinical-range symptoms of PTSD, anxiety, depression, conduct problems, and suicidality. A quarter of AIDS-orphaned children (24 %) showed no evidence of mental health problems at either wave. Child physical health, better caregiving quality, food security, better peer relationship quality, and lower exposure to community violence, bullying or stigma at baseline predicted sustained resilience. There were cumulative influences across predictors. Associations with mental health showed little variation by child age or gender, or between orphaned and non-orphaned children. Mental health resilience is associated with multiple processes across child, family and community levels of influence. Caution is needed in making causal inferences.

Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings.

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Embleton, Lonnie; Nyandat, Joram; Ayuku, David; Sang, Edwin; Kamanda, Allan; Ayaya, Samuel; Nyandiko, Winstone; Gisore, Peter; Vreeman, Rachel; Atwoli, Lukoye; Galarraga, Omar; Ott, Mary A; Braitstein, Paula

2017-04-01

This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

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Narayana Delampady

2011-01-01

Full Text Available Abstract Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality

Sexual risk behaviors among youth heads of household in Gikongoro, south province of Rwanda

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Ntaganira Joseph

2012-03-01

Full Text Available Abstract Background As a result of the 1994 genocide and AIDS, Rwanda has a crisis of orphans. In 2005, the Ministry of Local Governance and Social Affairs of Rwanda has reported one million vulnerable children. Many of these are not only orphans but also youth heads of households (YHH. The purpose of this study was to: (a identify risk behaviors that expose YHH to HIV infection, (b determine gender-specific high risk profiles and, (c determine predictors of sexual onset. Methods A household survey was conducted among 692 YHH, aged 12-24, all beneficiaries of a World Vision basic needs program in Gikongoro, Rwanda, from January to March 2004. Participants were interviewed using a structured questionnaire. Data was collected on socio-demographic variables, HIV/AIDS prevention knowledge and sexual risk behaviors. Bivariate analyses of the study variables were performed to examine differences between males and females. A logistic regression analysis was conducted to analyze factors that were independently associated with the debut of having sex. Results Forty-one percent of respondents reported sexual onset before age 15. Males were more likely to start earlier than females (50.4% versus 26.7% but females reported more sexual onset with an older partner. Fifty-eight percent of females had their first intercourse with a partner who was four or more years older than themselves. While sexual activity was low (1.75 mean lifetime sexual partner, 0.45 mean sexual partner last twelve months, sexual experience was related to less social connectedness and use of drugs. Having a close friend also appeared to be protective for sexual debut. The analysis also found that although YHH were aware of some prevention measures against HIV/AIDS, there was low (19.8% knowledge of the "ABC" prevention program promoted by the government. In addition, despite 85% of respondents knowing someone who had died of AIDS, only 31% perceived themselves at risk of HIV infection

Endangered edible orchids and vulnerable gatherers in the context of HIV/AIDS in the Southern Highlands of Tanzania

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Price Lisa

2009-12-01

Full Text Available Abstract Background Tanzania is a wild orchid biodiversity hotspot and has a high prevalence of HIV/AIDS. The wild orchids in the study are endemic and protected by the Convention on International Trade in Endangered Species. Every year, however, between 2.2 and 4.1 million orchid plants consumed in Zambia are estimated as originating from Tanzania. This research examines the differences between HIV/AIDS wild edible orchid gatherers and non-HIV/AIDS gatherers with regards to the frequency of gathering, salience in naming the various orchids, gathering knowledge acquisition and perceptions regarding the current state of abundance of the edible species. Methods Data was collected through interviews with 224 individuals in the Makete District of Tanzania close to the boarder of Zambia. Free-listings were conducted and Sutrup's Cultural Significance Index (CSI constructed. The independent t-test was used to compare the differences in gathering frequencies between affected and non-affected gatherers. A multiple comparison of the 4 subgroups (affected adults and children, and non-affected adults and children in gathering frequencies was done with a one way ANOVA test and its post hoc test. To examine the difference between affected and non-affected gatherers difference in source of gathering knowledge, a chi square test was run. Results Forty two vernacular names of gathered orchid species were mentioned corresponding to 7 botanical species belongs to genera Disa, Satyrium, Habenaria, Eulophia and Roeperocharis. Ninety-seven percent of HIV/AIDS affected households state that orchid gathering is their primary economic activity compared to non-HIV/AIDS affected households at 9.7 percent. The HIV/AIDS affected gathered significantly more often than the non-affected. AIDS orphans, however, gathered most frequently. Gatherers perceive a decreasing trend of abundance of 6 of the 7 species. Gathering activities were mainly performed in age based peer groups

Economic burden of chronic conditions among households in Myanmar: the case of angina and asthma.

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Htet, Soe; Alam, Khurshid; Mahal, Ajay

2015-11-01

Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications. Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence). Households with angina (asthma) reported greater OOP spending (angina: range I$1.94-I$4.31; asthma: range I$1.53-I$2.01) (I$1 = 125.09 Myanmar Kyats; I$=International Dollar) almost half of which was spending on medicines; higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6-7%; asthma: range 3-5%); greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12-14%; asthma: range 40-49%); increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption. Myanmar is expanding public

Sex Differences in Parenting Behaviors in Single-Mother and Single-Father Households

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Dufur, Mikaela J.; Howell, Nyssa C.; Downey, Douglas B.; Ainsworth, James W.; Lapray, Alice J.

2010-01-01

Research on family structure has led some to claim that sex-based parenting differences exist. But if such differences exist in single-parent families, the absence of a second parent rather than specific sex-typed parenting might explain them. We examine differences in mothering and fathering behavior in single-parent households, where number of…

Living and care arrangements of non-urban households in KwaZulu-Natal, South Africa, in the context of HIV and AIDS

OpenAIRE

Preez, du, C.J.

2011-01-01

In non-urban KwaZulu-Natal, South Africa, very few households escape the impacts of HIV and AIDS, either the direct impacts as a result of illness and death, or the indirect impacts through providing care and support to family, friends and neighbours. HIV and AIDS becomes part of the context or situation within which households arrange their lives, generate livelihoods and arrange and provide care. The differential impacts of HIV and AIDS on male and female members of different ages within ...

Role of traditional healers in psychosocial support in caring for the orphans:a case of Dar es Salaam city,Tanzania

OpenAIRE

Kayombo, J.Edmund; Mbwambo, H.Zakaria; Massila, Mariam

2005-01-01

Orphans are an increasing problem in developing countries particularly in Africa; due to the HIV/AIDS pandemic; and needs collective effort in intervention processes by including all stakeholders right from the grass roots level. This paper attempts to present the role of traditional healers in psychosocial support for orphan children in Dar-es-Salaam City with special focus on those whose parents have died because of HIV/AIDS. Six traditional healers who were in...

Orphans and political instability.

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Breuning, Marijke; Ishiyama, John

2011-01-01

This study investigates the security implications of growing orphan populations, particularly in Sub-Saharan Africa. Little has been written about the security implications of this especially vulnerable group of children. Are growing orphan populations associated with increases in political instability as has been suggested? Using data from several sources, we employ regression analysis to test whether Sub-Saharan African countries with larger proportions of orphans and those with increasing orphan populations experience higher rates of political instability. We find that the increase in the orphan population is related to an increasing incidence of civil conflict, but do not find a similar relationship for the proportion of orphans. In addition, we find that the causes of orphanhood matter. We conclude that increases in orphan populations (rather than simple proportions) are destabilizing. We suggest possible avenues for mediating the security risks posed by growing orphan populations.

Dynamic Microsimulation Model of Impoverishment among Elderly Women in Japan

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Inagaki, Seiichi

2018-03-01

The increasing poverty rate for elderly women is a growing concern in Japan and is generally due to their lifestyle changes and the public pension system based on the pre-1980s (old) lifestyle. At that time, women were expected to get married and become homemakers. Therefore, the public pension system is generous for married women and widows but not for never-married and divorced women. Using a dynamic microsimulation model, the Integrated Analytical Model for Household Simulation (INAHSIM), previous research has shown that poverty rates for elderly people will increase significantly in the future due to changes in nuptiality behavior after the 1980s. However, this approach is an indirect method, and the mechanism of impoverishment remains unclear. This study uses the same dynamic microsimulation model but attempts a more direct approach to interpret the effects of these behavioral changes on poverty rates for elderly women. Specifically, under the baseline scenario, it makes future projections on key distributions related to poverty by marital status and illustrates how they will face the poverty problem. It shows the future projections of (1) the distribution of pension amounts by gender and marital status, (2) poverty rates for elderly women by marital status, and (3) poverty rates for elderly people by gender. After the 1980s in Japan, the marriage rate decreased and the divorce rate increased significantly. Nevertheless, society still suffers from wage inequality between men and women. As a result, the number of never-married or divorced women will increase and these women will receive poor pension benefits due to an unfavorable public pension system. In addition, they have a higher risk of living in a single-person household because they have no or very few children. In the end, they will face the risk of poverty and raise the overall poverty rate.

Dynamic Microsimulation Model of Impoverishment Among Elderly Women in Japan

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Seiichi Inagaki

2018-03-01

Full Text Available The increasing poverty rate for elderly women is a growing concern in Japan and is generally due to their lifestyle changes and the public pension system based on the pre-1980s (old lifestyle. At that time, women were expected to get married and become homemakers. Therefore, the public pension system is generous for married women and widows but not for never-married and divorced women. Using a dynamic microsimulation model, the Integrated Analytical Model for Household Simulation (INAHSIM, previous research has shown that poverty rates for elderly people will increase significantly in the future due to changes in nuptiality behavior after the 1980s. However, this approach is an indirect method, and the mechanism of impoverishment remains unclear. This study uses the same dynamic microsimulation model but attempts a more direct approach to interpret the effects of these behavioral changes on poverty rates for elderly women. Specifically, under the baseline scenario, it makes future projections on key distributions related to poverty by marital status and illustrates how they will face the poverty problem. It shows the future projections of (1 the distribution of pension amounts by gender and marital status, (2 poverty rates for elderly women by marital status, and (3 poverty rates for elderly people by gender. After the 1980s in Japan, the marriage rate decreased and the divorce rate increased significantly. Nevertheless, society still suffers from wage inequality between men and women. As a result, the number of never-married or divorced women will increase and these women will receive poor pension benefits due to an unfavorable public pension system. In addition, they have a higher risk of living in a single-person household because they have no or very few children. In the end, they will face the risk of poverty and raise the overall poverty rate.

Perceived social support disparities among children affected by HIV/AIDS in Ghana: a cross-sectional survey.

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Doku, Paul Narh; Dotse, John Enoch; Mensah, Kofi Akohene

2015-06-06

The study investigated whether perceived social support varied among children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families (comparison group). This study employed cross-sectional, quantitative survey that involved 291 children aged 10-18 years in the Lower Manya Krobo District of Ghana and examined their social support disparities. Multivariate linear regressions indicate that children living with HIV/AIDS-infected caregivers reported significantly lower levels of social support compared with AIDS-orphaned children, other-orphaned children and non-orphaned children independent of socio-demographic covariates. Children who have lost their parents to other causes and other-orphaned children reported similar levels of social support. In terms of sources of support, all children orphans and vulnerable children were more likely to draw support from friends and significant others rather than from the family. The findings indicate a need to develop interventions that can increase levels of social support for orphaned and vulnerable children within the context of HIV/AIDS in Ghana, particularly networks that include the family.

Macroeconomic and household-level impacts of HIV/AIDS in Botswana.

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Jefferis, Keith; Kinghorn, Anthony; Siphambe, Happy; Thurlow, James

2008-07-01

To measure the impact of HIV/AIDS on economic growth and poverty in Botswana and estimate how providing treatment can mitigate its effects. Demographic and financial projections were combined with economic simulation models, including a macroeconomic growth model and a macro-microeconomic computable general equilibrium and microsimulation model. HIV/AIDS significantly reduces economic growth and increases household poverty. The impact is now severe enough to be affecting the economy as a whole, and threatens to pull some of the uninfected population into poverty. Providing antiretroviral therapy can partly offset this negative effect. Treatment increases health's share of government expenditure only marginally, because it increases economic growth and because withholding treatment raises the cost of other health services. Botswana's treatment programme is appropriate from a macroeconomic perspective. Conducting macroeconomic impact assessments is important in countries where prevalence rates are particularly high.

Orphan sources in Slovenia

International Nuclear Information System (INIS)

Janzekovic, H.; Cesarek, J.

2005-01-01

For decades the international standards and requirements postulate severe control over all lifecycle phases of radioactive sources in order to prevent risks associated with exposure of people and the environment. Despite this fact the orphan sources became a serious problem as a consequence of enlargement of economic transactions in many countries in Europe as well as in the world. The countries as well as international organisations, aware of this emerging problem, are trying to gain control over orphan sources using different approaches. These approaches include control over sources before they could become orphan sources. In addition, countries are also developing action plans in case that an orphan source could be found. The problems related to orphan sources in Slovenia is discussed based on the case studies from the last years. While in the nineties of the last century just a few cases of orphan sources were identified their number has increased substantially since 2003. The paper discusses the general reasons for the phenomena of orphan sources as well as the experience related to regaining control over orphan sources. (author)

Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences.

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Adhikari, Shiva R; Maskay, Nephil M; Sharma, Bishnu P

2009-03-01

Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50% of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17% of annual household income. This expenditure causes more than 20% of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90%. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.

Effects of HIV/AIDS on the livelihood of banana-farming households in Central Kenya

NARCIS (Netherlands)

Nguthi, F.N.; Niehof, A.

2008-01-01

This paper explores the effects of HIV/AIDS on the livelihoods of banana-farming households in Maragua district, Central Kenya. It is based on the results of a field study carried out during 2004-2005. The study applied the sustainable livelihood approach, using both quantitative and qualitative

Value-based reimbursement decisions for orphan drugs: a scoping review and decision framework.

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Paulden, Mike; Stafinski, Tania; Menon, Devidas; McCabe, Christopher

2015-03-01

The rate of development of new orphan drugs continues to grow. As a result, reimbursing orphan drugs on an exceptional basis is increasingly difficult to sustain from a health system perspective. An understanding of the value that societies attach to providing orphan drugs at the expense of other health technologies is now recognised as an important input to policy debates. The aim of this work was to scope the social value arguments that have been advanced relating to the reimbursement of orphan drugs, and to locate these within a coherent decision-making framework to aid reimbursement decisions in the presence of limited healthcare resources. A scoping review of the peer reviewed and grey literature was undertaken, consisting of seven phases: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (4) charting, extracting and tabulating data; (5) analyzing data; (6) consulting relevant experts; and (7) presenting results. The points within decision processes where the identified value arguments would be incorporated were then located. This mapping was used to construct a framework characterising the distinct role of each value in informing decision making. The scoping review identified 19 candidate decision factors, most of which can be characterised as either value-bearing or 'opportunity cost'-determining, and also a number of value propositions and pertinent sources of preference information. We were able to synthesize these into a coherent decision-making framework. Our framework may be used to structure policy discussions and to aid transparency about the values underlying reimbursement decisions for orphan drugs. These values ought to be consistently applied to all technologies and populations affected by the decision.

Parental HIV/AIDS status and death, and children's psychological wellbeing

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Doku Paul

2009-11-01

Full Text Available Abstract Background Ghana has an estimated one million orphans, 250,000 are due to AIDS parental deaths. This is the first study that examined the impact of parental HIV/AIDS status and death on the mental health of children in Ghana. Methods In a cross-sectional survey, 4 groups of 200 children (children whose parents died of AIDS, children whose parents died of causes other than AIDS, children living with parents infected with HIV/AIDS, and non-orphaned children whose parents are not known to be infected with HIV/AIDS aged between 10 and 19 were interviewed on their hyperactivity, emotional, conduct, and peer problems using the Strengths and Difficulties Questionnaire. Results Children whose parents died of AIDS showed very high levels of peer problems [F (3,196 = 7.34, p Conclusion Orphans and children living with parents infected with HIV/AIDS are at heightened risks for emotional and behavioural disorders and that efforts to address problems in children affected by HIV/AIDS must focus on both groups of children. Parallel to this, researchers should see these findings as generated hypotheses (rather than conclusions calling for further exploration of specific causal linkages between HIV/AIDS and children's mental health, using more rigorous research tools and designs.

ORPHANED PROTOSTARS

International Nuclear Information System (INIS)

Reipurth, Bo; Connelley, Michael; Mikkola, Seppo; Valtonen, Mauri

2010-01-01

We explore the origin of a population of distant companions (∼1000-5000 AU) to Class I protostellar sources recently found by Connelley and coworkers, who noted that the companion fraction diminished as the sources evolved. Here, we present N-body simulations of unstable triple systems embedded in dense cloud cores. Many companions are ejected into unbound orbits and quickly escape, but others are ejected with insufficient momentum to climb out of the potential well of the cloud core and associated binary. These loosely bound companions reach distances of many thousands of AU before falling back and eventually being ejected into escapes as the cloud cores gradually disappear. We use the term orphans to denote protostellar objects that are dynamically ejected from their placental cloud cores, either escaping or for a time being tenuously bound at large separations. Half of all triple systems are found to disintegrate during the protostellar stage, so if multiple systems are a frequent outcome of the collapse of a cloud core, then orphans should be common. Bound orphans are associated with embedded close protostellar binaries, but escaping orphans can travel as far as ∼0.2 pc during the protostellar phase. The steep climb out of a potential well ensures that orphans are not kinematically distinct from young stars born with a less violent pre-history. The identification of orphans outside their heavily extincted cloud cores will allow the detailed study of protostars high up on their Hayashi tracks at near-infrared and in some cases even at optical wavelengths.

Child work and labour among orphaned and abandoned children in five low and middle income countries

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Pence Brian

2011-01-01

Full Text Available Abstract Background The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs, yet little is known about rates of child labour among OAC, what child and caregiver characteristics predict child engagement in work and labour, or when such work infers with schooling. This study examines rates and correlates of child labour among OAC and associations of child labour with schooling in a cohort of OAC in 5 LMICs. Methods The Positive Outcomes for Orphans (POFO study employed a two-stage random sampling survey methodology to identify 1480 single and double orphans and children abandoned by both parents ages 6-12 living in family settings in five LMICs: Cambodia, Ethiopia, India, Kenya, and Tanzania. Regression models examined child and caregiver associations with: any work versus no work; and with working Results The majority of OAC (60.7% engaged in work during the past week, and of those who worked, 17.8% (10.5% of the total sample worked 28 or more hours. More than one-fifth (21.9%; 13% of the total sample met UNICEF's child labour definition. Female OAC and those in good health had increased odds of working. OAC living in rural areas, lower household wealth and caregivers not earning an income were associated with increased child labour. Child labour, but not working fewer than 28 hours per week, was associated with decreased school attendance. Conclusions One in seven OAC in this study were reported to be engaged in child labour. Policy makers and social service providers need to pay close attention to the demands being placed on female OAC, particularly in rural areas and poor households with limited income sources. Programs to promote OAC school attendance may need to focus on the needs of families as well as the OAC.

Resource needs to support orphans and vulnerable children in sub-Saharan Africa.

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Stover, John; Bollinger, Lori; Walker, Neff; Monasch, Roland

2007-01-01

In sub-Saharan Africa, 43 million children under the age of 18 have lost one or both parents to AIDS, conflict or other causes. This large number strains systems by which families and communities have traditionally provided care for orphans. Support for some orphans is being provided by a variety of government, community and non-governmental organizations but this assistance reaches only a small percentage of those who need it. This paper estimates the funding required for necessary support to those most in need. We estimate that US$1-4 billion will be required annually by 2010, depending on whether support is provided to all orphans living below the poverty line or just those in most need. This is at least four times current funding and should be a priority topic for donor and national government resource allocation decisions this year.

Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya.

Science.gov (United States)

Barasa, Edwine W; Maina, Thomas; Ravishankar, Nirmala

2017-02-06

Monitoring the incidence and intensity of catastrophic health expenditure, as well as the impoverishing effects of out of pocket costs to access healthcare, is a key part of benchmarking Kenya's progress towards reducing the financial burden that households experience when accessing healthcare. The study relies on data from the nationally-representative Kenya Household Expenditure and Utilization Survey conducted in 2013 (n =33,675). We undertook health equity analysis to estimate the incidence and intensity of catastrophic expenditure. Households were considered to have incurred catastrophic expenditures if their annual out of-pocket health expenditures exceeded 40% of their annual non-food expenditure. We assessed the impoverishing effects of out of pocket payments using the Kenya national poverty line. We distinguished between direct payments for healthcare such as payments for consultation, medicines, medical procedures, and total healthcare expenditure that includes direct healthcare payments and the cost of transportation to and from health facilities. We used logistic regression analysis to explore the factors associated with the incidence of catastrophic expenditures. When only direct payments to healthcare providers were considered, the incidence of catastrophic expenditures was 4.52%. When transport costs are included, the incidence of catastrophic expenditure increased to 6.58%. 453,470 Kenyans are pushed into poverty annually as a result of direct payments for healthcare. When the cost of transport is included, that number increases by more than one third to 619,541. Unemployment of the household head, presence of an elderly person, a person with a chronic ailment, a large household size, lower household social-economic status, and residence in marginalized regions of the country are significantly associated with increased odds of incurring catastrophic expenditures. Kenyan policy makers should prioritize extending pre-payment mechanisms to more

Health of adults caring for orphaned children in an HIV endemic community in South Africa

OpenAIRE

Kuo, Caroline; Operario, Don

2011-01-01

In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic...

The impact and cost of the HIV/AIDS investment framework for adolescents.

Science.gov (United States)

Stover, John; Rosen, Jim; Kasedde, Susan; Idele, Priscilla; McClure, Craig

2014-07-01

In 2005, the resources needed to support orphans and vulnerable children in sub-Saharan Africa were estimated at US$ 1.1-4.1 billion. Approaches to support vulnerable children have changed considerably since then. This study updates previous estimates by including new types of support and information on support costs. We considered 16 types of support categorized as economic strengthening, education support, social care and community outreach, and program support. The estimates combine the number of children in need of each intervention with unit costs derived from the literature and coverage goals based on current coverage and feasible future improvements. The number of children affected by AIDS in low- and middle-income countries varies from 58 million to 315 million depending on the definition of need. The resources required to provide support to children living in poor households will grow from US$ 4.2 billion in 2012 to US$ 5-8 billion by 2020. Almost two-thirds of these resources will be needed for Sub-Saharan Africa. The largest needs are for cash transfers, community care workers, early childhood development, block grants for education, M&E monitoring and evaluation, and direct material support. The results show that we can significantly improve the coverage of services for vulnerable children with only modest increases in resources. This results from stable or declining numbers of orphans and children living with HIV plus economic growth that is moving more households out of poverty. The results also reflect an important shift toward providing support to strengthen families and communities that care for children rather than direct material support. More resources are required to support children affected by AIDS, but new approaches to provide that support will be cost effective and have broad social and economic benefits.

eRepo-ORP: Exploring the Opportunity Space to Combat Orphan Diseases with Existing Drugs.

Science.gov (United States)

Brylinski, Michal; Naderi, Misagh; Govindaraj, Rajiv Gandhi; Lemoine, Jeffrey

2017-12-10

About 7000 rare, or orphan, diseases affect more than 350 million people worldwide. Although these conditions collectively pose significant health care problems, drug companies seldom develop drugs for orphan diseases due to extremely limited individual markets. Consequently, developing new treatments for often life-threatening orphan diseases is primarily contingent on financial incentives from governments, special research grants, and private philanthropy. Computer-aided drug repositioning is a cheaper and faster alternative to traditional drug discovery offering a promising venue for orphan drug research. Here, we present eRepo-ORP, a comprehensive resource constructed by a large-scale repositioning of existing drugs to orphan diseases with a collection of structural bioinformatics tools, including eThread, eFindSite, and eMatchSite. Specifically, a systematic exploration of 320,856 possible links between known drugs in DrugBank and orphan proteins obtained from Orphanet reveals as many as 18,145 candidates for repurposing. In order to illustrate how potential therapeutics for rare diseases can be identified with eRepo-ORP, we discuss the repositioning of a kinase inhibitor for Ras-associated autoimmune leukoproliferative disease. The eRepo-ORP data set is available through the Open Science Framework at https://osf.io/qdjup/. Copyright © 2017. Published by Elsevier Ltd.

Orphan drugs, orphan diseases. The first decade of orphan drug legislation in the EU.

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Joppi, Roberta; Bertele', Vittorio; Garattini, Silvio

2013-04-01

To assess the methodological quality of Orphan Medicinal Product (OMP) dossiers and discuss possible reasons for the small number of products licensed. Information about orphan drug designation, approval, refusal or withdrawal was obtained from the website of the European Medicines Agency and from the European Public Assessment Reports. From 2000 up to 2010, 80.9 % of the 845 candidate orphan drug designations received a positive opinion from the European Medicines Agency (EMA)'s Committee on Orphan Medicinal Products. Of the 108 OMP marketing authorizations applied for, 63 were granted. Randomised clinical trials were done for 38 OMPs and placebo was used as comparator for nearly half the licensed drugs. One third of the OMPs were tested in trials involving fewer than 100 patients and more than half in trials with 100-200 cases. The clinical trials lasted less than one year for 42.9 % of the approved OMPs. Although there may have been some small improvements over time in the methods for developing OMPs, in our opinion, the number of patients studied, the use of placebo as control, the type of outcome measure and the follow-up have often been inadequate. The present system should be changed to find better ways of fostering the development of effective and sustainable treatments for patients with orphan diseases. Public funds supporting independent clinical research on OMPs could bridge the gap between designation and approval. More stringent criteria to assess OMPs' efficacy and cost/effectiveness would improve the clinical value and the affordability of products allowed onto the market.

[Orphan drugs].

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Golocorbin Kon, Svetlana; Vojinović, Aleksandra; Lalić-Popović, Mladena; Pavlović, Nebojsa; Mikov, Momir

2013-01-01

Drugs used for treatment of rare diseases are known worldwide under the term of orphan drugs because pharmaceutical companies have not been interested in "adopting" them, that is in investing in research, developing and producing these drugs. This kind of policy has been justified by the fact that these drugs are targeted for small markets, that only a small number of patients is available for clinical trials, and that large investments are required for the development of drugs meant to treat diseases whose pathogenesis has not yet been clarified in majority of cases. The aim of this paper is to present previous and present status of orphan drugs in Serbia and other countries. THE BEGINNING OF ORPHAN DRUGS DEVELOPMENT: This problem was first recognized by Congress of the United States of America in January 1983, and when the "Orphan Drug Act" was passed, it was a turning point in the development of orphan drugs. This law provides pharmaceutical companies with a series of reliefs, both financial ones that allow them to regain funds invested into the research and development and regulatory ones. Seven years of marketing exclusivity, as a type of patent monopoly, is the most important relief that enables companies to make large profits. There are no sufficient funds and institutions to give financial support to the patients. It is therefore necessary to make health professionals much more aware of rare diseases in order to avoid time loss in making the right diagnosis and thus to gain more time to treat rare diseases. The importance of discovery, development and production of orphan drugs lies in the number of patients whose life quality can be improved significantly by administration of these drugs as well as in the number of potential survivals resulting from the treatment with these drugs.

Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India

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Bhojani Upendra

2012-11-01

Full Text Available Abstract Background The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. Methods A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. Results The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2 of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4 of their total income. Overall, 16% (95%CI=14.8-17.3 of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe. The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances, and sold or mortgaged their assets (0.4% instances. Conclusions This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the

Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India.

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Bhojani, Upendra; Thriveni, Bs; Devadasan, Roopa; Munegowda, Cm; Devadasan, Narayanan; Kolsteren, Patrick; Criel, Bart

2012-11-16

The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe.The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important

[Agro-household livelihood vulnerability and influence factors of ethnic villages under different geomorphology backgrounds.

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Han, Wen Wen; Liu, Xiao Peng; Pei, Yin Bao; An, Qiong; Li, Yong Hong

2016-04-22

The vulnerability and influence factors of agro-household livelihood in Haiyuan County, Ningxia were empirically analyzed utilizing set pair analysis and obstacle degree model, based on field survey data of impoverished agro-households in 2014. Results showed that vulnerability of agro-household livelihood in Haiyuan County was high in general while it exhibited geomorphological and ethnical differences. Vulnerability of agro-households livelihood in plain areas, valleys and intermountain depression areas were lower than that in earth-rock areas, loess ridge areas and moderately high mountain landform areas. Moreover, vulnerability of agro-household livelihood was higher in mixed Hui and Han ethnic villages than in mono Hui or Han ethnic villages. The villagers' lacking of necessities and the stress of sensitive external geographical environment were considered to be the fundamental reasons of vulnerability of agro-household livelihood. The unreasonable livelihood structure and the unvariant livelihood strategy caused the long-term accumulation of livelihood vulnerabi-lity. The nature of the local environment, which was not easy to change, decreased the accessibility of poverty alleviation resources. Building a clear village water rights allocation system, the implementation of counterpart-assistance to educate impoverished families, increasing investment in improving the diversities of means of living, developing the chains of comprehensive commodity market among villages, were necessary to improve the response capability of agro-household livelihood. The management of vulnerability of agro-household livelihood should put the 'Extending Roads to Every Village Project' on a more prominent position in the 'Extending Radio and TV Broadcasting Coverage to Every Village Project'. Furthermore, the combination of meteorological disaster prevention and insurance enterprise disaster reduction should be sought, and the agricultural production insurance system should be

Profiling the orphan enzymes

Science.gov (United States)

2014-01-01

The emergence of Next Generation Sequencing generates an incredible amount of sequence and great potential for new enzyme discovery. Despite this huge amount of data and the profusion of bioinformatic methods for function prediction, a large part of known enzyme activities is still lacking an associated protein sequence. These particular activities are called “orphan enzymes”. The present review proposes an update of previous surveys on orphan enzymes by mining the current content of public databases. While the percentage of orphan enzyme activities has decreased from 38% to 22% in ten years, there are still more than 1,000 orphans among the 5,000 entries of the Enzyme Commission (EC) classification. Taking into account all the reactions present in metabolic databases, this proportion dramatically increases to reach nearly 50% of orphans and many of them are not associated to a known pathway. We extended our survey to “local orphan enzymes” that are activities which have no representative sequence in a given clade, but have at least one in organisms belonging to other clades. We observe an important bias in Archaea and find that in general more than 30% of the EC activities have incomplete sequence information in at least one superkingdom. To estimate if candidate proteins for local orphans could be retrieved by homology search, we applied a simple strategy based on the PRIAM software and noticed that candidates may be proposed for an important fraction of local orphan enzymes. Finally, by studying relation between protein domains and catalyzed activities, it appears that newly discovered enzymes are mostly associated with already known enzyme domains. Thus, the exploration of the promiscuity and the multifunctional aspect of known enzyme families may solve part of the orphan enzyme issue. We conclude this review with a presentation of recent initiatives in finding proteins for orphan enzymes and in extending the enzyme world by the discovery of new

Promoting food security and well-being among poor and HIV/AIDS affected households: lessons from an interactive and integrated approach.

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Swaans, Kees; Broerse, Jacqueline; Meincke, Maylin; Mudhara, Maxwell; Bunders, Joske

2009-02-01

Participatory and interdisciplinary approaches have been suggested to develop appropriate agricultural innovations as an alternative strategy to improve food security and well-being among HIV/AIDS affected households. However, sustainable implementation of such interactive approaches is far from easy and straight forward. This study reports of the Interactive Learning and Action (ILA) approach, a methodology for agricultural innovation which has been adapted to the context of HIV/AIDS. Role players in agriculture and health were brought together to stimulate and sustain innovation among three support groups for poor and affected households in a rural high HIV/AIDS prevalence area in South Africa. The effectiveness of the approach was evaluated using both outcome and process criteria. The results indicate that an interactive approach in which service providers/researchers engage themselves as actors to explore the livelihood system and develop appropriate solutions in joint collaboration with resource users has potential. However, it also revealed that cooperation among participants and stakeholders at the interface of agriculture and HIV/AIDS is complicated and sensitive to erosion. Of particular concern was the difficulty of mobilizing members from poor and affected households to participate and to overcome stigma and discrimination. Lessons and potential applications for the further development of interactive approaches are discussed.

Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date.

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Heuveline, Patrick

2004-06-01

HIV is contracted most frequently at birth and during early adulthood. The epidemic may thus impact the demographic structure and the household structure of affected populations. This paper reviews earlier evidence of such an impact, uses demographic theory to anticipate its changes over time, and reviews the most recent evidence for indications of these changes. Modest increases in the male : female ratio are beginning to show within certain age groups only (approximately 15% among 25-34 year olds). Similarly sized increases in the proportion of 15-29 year olds relative to 30-54 year olds are observed in some age pyramids. These 'youth bulges' are expected to fade out, whereas an aging effect phases in with the fertility impact of the epidemic. In the longer run, the size of all age groups will be reduced, but relatively less so for middle-aged adults. Proportions of orphans and widows have increased in the most affected countries. Fewer remarriage probabilities for widows were observed. Resulting increases in the proportion of female-headed households should only be temporary, as female mortality is catching up with male mortality. The number of double orphans is beginning to increase, but overall, orphans continue to live predominantly with a family member, most often the grandparents if not with the surviving parent. To date, the epidemic's impact on the population and household structure has been limited by demographic (aging) and social (adaptive movements of kin across households) processes that contribute to diffuse the epidemic throughout the entire population and all households.

Orphan drugs: the regulatory environment.

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Franco, Pedro

2013-02-01

The definition of a rare disease is not universal and depends on the legislation and policies adopted by each region or country. The main objective of this article is to describe and discuss the legal framework and the regulatory environment of orphan drugs worldwide. Some reflections and discussions on the need for specific orphan drug legislation or policies are described at length. Furthermore, some aspects of the history of each region in respect of the orphan drug legislation evolution are outlined. This article describes and compares the orphan drug legislation or policies of the following countries or regions: United Sates of America (US), European Union (EU), Japan, Australia, Singapore, Taiwan and Canada. The incentives described in the orphan drug legislations or policies, the criteria for designation of orphan status and the authorisation process of an orphan drug are also described and compared. The legislations and policies are to some extent similar but not the same. It is important to understand the main differences among all available legislative systems to improve the international collaboration in the field of orphan drugs and rare diseases. Copyright © 2012 Elsevier Ltd. All rights reserved.

Needs of children affected by HIV and AIDS: Mangaung in the Free State

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R.M. Chakalane-Mpeli

2007-09-01

Full Text Available The terminal illness or death of a parent due to HIV and AIDS has a disastrous effect on the surviving children. The purpose of this study was to explore and describe the needs of HIV and AIDS orphans and pre-orphans. A qualitative method using indepth interviews with 10 children affected by their parent’s illness or death was carried out. Results indicate that there was a marked reduction in financial capital paving the way for basic physical needs such as food, clothing, fuel and shelter. Lack of school fees, uniforms and transport money together with biased teachers and rigid school policies were affecting school attendance and performance. On the psychosocial level needs expressed were for family and community support, friendship, acceptance by the group as well as love and belonging. It seems as if stigmatisation and resulting ostracism by important-others is a drawback at all levels of interaction for AIDS orphans and pre-orphans.

[The economic consequences of AIDS in Africa].

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Ilinigumugabo, A

1996-12-01

The economic and social consequences of the AIDS epidemic in Africa are enormous because of the prevalence of the disease and the age structure of patients. AIDS has caused a rise in early childhood and adult mortality, leading to a younger age distribution and a less favorable dependency ratio. All epidemiological studies have shown a strong seroprevalence in urban areas, and some show higher infection rates among the educated. The consequences of AIDS at the household level begin with the appearance of symptoms and often continue past the death of the patient. Expenditures for medical care, treatment of opportunistic infections, loss of income of the patient (who frequently is the main breadwinner), depletion of savings, funeral expenses, and care for others who may have become infected create an enormous burden for most households. Widows with no inheritance rights are left destitute with their children, who may be taken out of school to reduce expenses. UNICEF estimates that some 5.5 million children in East and Central Africa will be orphaned by AIDS by the year 2000. Many such children end up in the streets, prime targets for prostitution and HIV infection. The coping mechanisms of poor communities with high prevalence rates are soon overwhelmed by demands for assistance. Businesses are affected by health care costs, lessened productivity, and absenteeism. Costs of training increase for jobs requiring skilled workers. AIDS tends to reduce agricultural productivity, especially in areas with little rainfall and high seasonal manpower needs. Cash crops, which frequently depend on advanced technology, are more vulnerable than is subsistence agriculture. Agronomists may be hard to replace, and large unskilled migratory labor forces living apart from families may develop habits of promiscuity that allow HIV to spread rapidly. The few studies done on direct health costs of AIDS show that they vary tremendously depending on the country's level of development and

Children in Single-Parent Families Living in Poverty Have Fewer Supports after Welfare Reform. IWPR Research in Brief.

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Lyter, Deanna M.; Sills, Melissa; Oh, Gi-Taik

Since the 1996 passage of the Personal Responsibility and Work Opportunity Act (welfare reform), impoverished children in single-parent families receive less aid than under the previous system, and the most disadvantaged of these children have slipped deeper into poverty. This research brief summarizes a study that explored the economic well-being…

A generalizable pre-clinical research approach for orphan disease therapy

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Beaulieu Chandree L

2012-06-01

Full Text Available Abstract With the advent of next-generation DNA sequencing, the pace of inherited orphan disease gene identification has increased dramatically, a situation that will continue for at least the next several years. At present, the numbers of such identified disease genes significantly outstrips the number of laboratories available to investigate a given disorder, an asymmetry that will only increase over time. The hope for any genetic disorder is, where possible and in addition to accurate diagnostic test formulation, the development of therapeutic approaches. To this end, we propose here the development of a strategic toolbox and preclinical research pathway for inherited orphan disease. Taking much of what has been learned from rare genetic disease research over the past two decades, we propose generalizable methods utilizing transcriptomic, system-wide chemical biology datasets combined with chemical informatics and, where possible, repurposing of FDA approved drugs for pre-clinical orphan disease therapies. It is hoped that this approach may be of utility for the broader orphan disease research community and provide funding organizations and patient advocacy groups with suggestions for the optimal path forward. In addition to enabling academic pre-clinical research, strategies such as this may also aid in seeding startup companies, as well as further engaging the pharmaceutical industry in the treatment of rare genetic disease.

THE CONTRIBUTION OF SOCIAL ENTREPRENEURSHIP IN MEETING THE NEEDS OF ORPHANS IN THE MBERENGWA DISTRICT, ZIMBABWE

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Katungu, Wisdom

2016-08-01

Full Text Available Since the turn of the millennium Zimbabwe has witnessed a raft of socio-economic and political challenges, exacerbated by the devastating effects of the HIV and Aids pandemic. This diminished the government’s ability to provide safety nets to vulnerable groups. The responsibility for orphan care has been shifted to the community, which has become the core focus of intervention initiatives by devising local-level coping mechanisms to deal with the orphan care crisis. The study explored the contribution of social entrepreneurship in meeting the needs of orphans in the Mberengwa district. The study concludes that the income-generating projects based on social entrepreneurship principles in Mberengwa play an important role in poverty alleviation and social protection, and particularly in meeting the needs of orphans. However, this cannot be achieved without the supportive role of government in promoting private-public partnerships.

Health of adults caring for orphaned children in an HIV-endemic community in South Africa.

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Kuo, Caroline; Operario, Don

2011-09-01

In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV-endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic Studies-Depression scale), anxiety (using Kessler-10 scale), and post-traumatic stress (using the Harvard Trauma Questionnaire) among a representative community sample of adults caring for children in Umlazi Township, an HIV-endemic community in South Africa. Of 1599 respondents, 33% (n=530) were carers of orphaned children. Results showed that, overall, carers reported poor general health and functioning and elevated levels of depression, anxiety, and post-traumatic stress. Carers of orphaned children reported significantly poorer general health and functioning and higher rates of depression and post-traumatic stress compared with carers of non-orphaned children. In multivariate analyses, orphan carer and non-orphan carer differences in general health were accounted for by age, gender, education, economic assets, and source of income, but differences in depression were independent of these cofactors. Interventions are needed to address physical and mental health of carers in general. Greater health problems among orphan carers appeared to be fully explained by socioeconomic characteristics, which offer opportunities for targeting of programs. More research is needed to understand determinants of mental health disparities among orphan carers, which were not explained by socioeconomic characteristics.

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

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Loganathan, Tharani; Lee, Way-Seah; Lee, Kok-Foo; Jit, Mark; Ng, Chiu-Wan

2015-01-01

While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; pMalaysia.

Stigma, marginalization and psychosocial well-being of orphans in Rwanda: exploring the mediation role of social support.

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Caserta, Tehetna Alemu; Pirttilä-Backman, Anna-Maija; Punamäki, Raija-Leena

2016-01-01

Stigma and marginalization are one of the major challenges orphans face in their daily lives, particularly in developing countries, but little is known about their impacts on mental health. This study examines how orphan-related characteristics, stigma and marginalization are associated with psychosocial well-being. It further analyses the role of social support in mediating between stigma and marginalization and mental health, indicated by emotional well-being and mental distress. The participants in this study were 430 Rwandan orphans who were 10-25 years of age, and of whom 179 were females and 251 were males. Results showed that high levels of stigma and marginalization were associated with a lower level of emotional well-being and higher levels of mental distress. A mediation analysis indicated that low level of social support due to stigma and marginalization contributed significantly to low level of emotional well-being. Once stigma, marginalization and social support were fully accounted for, AIDS orphans exhibited higher levels of mental distress than those who were orphaned by genocide or other causes. Future interventions designed to reduce stigma and marginalization for orphans and actions that facilitate social support can significantly improve emotional well-being and reduce mental distress among orphans.

Education and nutritional status of orphans and children of HIV-infected parents in Kenya.

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Mishra, Vinod; Arnold, Fred; Otieno, Fredrick; Cross, Anne; Hong, Rathavuth

2007-10-01

We examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. We analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate logistic regression. Results indicate that orphans, fostered children, and children of HIV-infected parents are significantly less likely to attend school than non-orphaned/non-fostered children of HIV-negative parents. Children of HIV-infected parents are more likely to be underweight and wasted, and less likely to receive medical care for ARI and diarrhea. Children of HIV-negative single mothers are also disadvantaged on most indicators. The findings highlight the need to expand child welfare programs to include not only orphans but also fostered children, children of single mothers, and children of HIV-infected parents, who tend to be equally, if not more, disadvantaged.

Exploring impacts of multi-year, community-based care programs for orphans and vulnerable children: a case study from Kenya.

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Larson, Bruce A; Wambua, Nancy; Masila, Juliana; Wangai, Susan; Rohr, Julia; Brooks, Mohamad; Bryant, Malcolm

2013-01-01

The Community-Based Care for Orphans and Vulnerable Children (CBCO) program operated in Kenya during 2006-2010. In Eastern Province, the program provided support to approximately 3000 orphans and vulnerable children (OVC) living in 1500 households. A primary focus of the program was to support savings and loan associations composed of OVC caregivers (typically elderly women) to improve household and OVC welfare. Cross-sectional data were collected in 2011 from 1500 randomly selected households from 3 populations: program participants (CBCO group, n=500), households in the same villages as program participants but not in the program (the local-community-group = Group L, n=300), and households living in nearby villages where the program did not operate (the adjacent-community-group, Group A, n=700). Primary welfare outcomes evaluated are household food security, as measured by the Household Food Insecurity Access instrument, and OVC educational attainment. We compared outcomes between the CBCO and the subset of Group L not meeting program eligibility criteria (L-N) to investigate disparities within local communities. We compared outcomes between the CBCO group and the subset of Group A meeting eligibility criteria (A-E) to consider program impact. We compared outcomes between households not eligible for the program in the local and adjacent community groups (L-N and A-N) to consider if the adjacent communities are similar to the local communities. In May-June 2011, at the end of the OVC program, the majority of CBCO households continued to be severely food insecure, with rates similar to other households living in nearby communities. Participation rates in primary school are high, reflecting free primary education. Among the 18-22 year olds who were "children" during the program years, relatively few children completed secondary school across all study groups. Although the CBCO program likely provided useful services and benefits to program participants, disparities

Quantitative assessment of protein activity in orphan tissues and single cells using the metaVIPER algorithm. | Office of Cancer Genomics

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We and others have shown that transition and maintenance of biological states is controlled by master regulator proteins, which can be inferred by interrogating tissue-specific regulatory models (interactomes) with transcriptional signatures, using the VIPER algorithm. Yet, some tissues may lack molecular profiles necessary for interactome inference (orphan tissues), or, as for single cells isolated from heterogeneous samples, their tissue context may be undetermined.

Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002-2010.

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Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke

2013-11-01

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.

Orphans' household circumstances and access to education in a ...

African Journals Online (AJOL)

The over-representation in rural areas could reflect urban-rural migration around the time of death of the parent due to loss of income and the high cost of living in towns. Over-representation in female-, elderly- and adolescent-headed households reflects the predisposition of men to seek employment in towns, estates and ...

Demand Side Management for the European Supergrid: Occupancy variances of European single-person households

International Nuclear Information System (INIS)

Torriti, Jacopo

2012-01-01

The prospect of a European Supergrid calls for research on aggregate electricity peak demand and Europe-wide Demand Side Management. No attempt has been made as yet to represent a time-related demand curve of residential electricity consumption at the European level. This article assesses how active occupancy levels of single-person households vary in single-person household in 15 European countries. It makes use of occupancy time-series data from the Harmonised European Time Use Survey database to build European occupancy curves; identify peak occupancy periods; construct time-related electricity demand curves for TV and video watching activities and assess occupancy variances of single-person households. - Highlights: ► Morning peak occupancies of European single households tale place between 7h30 and 7h40. ► Evening peaks take place between 20h10 and 20h20. ► TV and video activities during evening peaks make up about 3.1 GWh of European peak electricity load. ► Baseline and peak occupancy variances vary across countries. ► Baseline and peak occupancy variances can be used as input for Demand Side Management choices.

Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE.

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Kumar, Kaushalendra; Singh, Ashish; Kumar, Santosh; Ram, Faujdar; Singh, Abhishek; Ram, Usha; Negin, Joel; Kowal, Paul R

2015-01-01

The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.

Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE

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Kumar, Kaushalendra; Singh, Ashish; Kumar, Santosh; Ram, Faujdar; Singh, Abhishek; Ram, Usha; Negin, Joel; Kowal, Paul R.

2015-01-01

Background and Objectives The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. Data and Methods The paper uses data from the World Health Organisation’s Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Results and Conclusions Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India. PMID:26270049

Orphan/vulnerable child caregiving moderates the association between women's autonomy and their BMI in three African countries.

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Kanamori, Mariano; Carter-Pokras, Olivia; Madhavan, Sangeetha; Feldman, Robert; He, Xin; Lee, Sunmin

2014-01-01

Enhancement of women's autonomy is a key factor for improving women's health and nutrition. With nearly 12 million orphan and vulnerable children (OVC) in Africa due to HIV/AIDS, the study of OVC primary caregivers' nutrition is fundamental. We investigated the association between married women's autonomy and their nutritional status; explored whether this relationship was modified by OVC primary caregiving; and analyzed whether decision-making autonomy mediated the association between household wealth and body mass index (BMI). This cross-sectional study used the data from Demographic Health Surveys collected during 2006-2007 from 20- to 49-year-old women in Namibia (n = 2633), Swaziland (n = 1395), and Zambia (n = 2920). Analyses included logistic regression, Sobel, and Goodman tests. Our results indicated that women's educational attainment increased the odds for being overweight (Swaziland and Zambia) and decreased the odds for being underweight (Namibia). In Zambia, having at least primary education increased the odds for being overweight only among child primary caregivers regardless of the OVC status of the child, and having autonomy for buying everyday household items increased the odds for being overweight only among OVC primary caregivers. Decision-making autonomy mediated the association between household wealth and OVC primary caregivers' BMI in Zambia (Z = 2.13, p value = 0.03). We concluded that depending on each country's contextual characteristics, having education can decrease the odds for being an underweight woman or increase the odds for being an overweight woman. Further studies should explore why in Namibia education has an effect on women's overweight status only among women who are caring for a child.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

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Ssewamala, Fred M; Ismayilova, Leyla; McKay, Mary; Sperber, Elizabeth; Bannon, William; Alicea, Stacey

2010-04-01

This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms. Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

Outcome of anti-retroviral treatment in HIV-infected orphans and non-orphans at an ART centre in North India.

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Bhattacharya, Malobika; Saxena, Romit

2012-01-01

Few Indian studies have reported the long-term efficacy of anti-retroviral treatment (ART) in children and in orphaned, HIV-infected children in particular. To study differences in outcome of ART in HIV-infected orphans compared with non-orphans. A retrospective study of 87 HIV-infected children who commenced ART in the period January 2006 to August 2007. The main measures were orphan status, absolute CD4 count and weight-for-height (WHZ) and height-for-age (HAZ) Z-scores. Median follow-up was 33 months. Forty (45·9%) children were orphaned. Orphans and non-orphans had similar baseline median WHZ and HAZ (-2·48 vs -2·63, P = 0·65 and -2·78 vs -2·91, P = 0·77, respectively). The two groups were similar in terms of WHO clinical stage and frequency of severe immunosuppression at presentation (P = 0·88 and 0·25, respectively). After ART initiation, the median absolute CD4 count increased progressively in both groups. Median WHZ and HAZ increased throughout the study period in the orphans and reached -1 at 27 and 39 months of ART, respectively. In the non-orphans, WHZ remained below that of the orphan group, the difference becoming statistically significant from 18 months of ART. The increment in HAZ in the non-orphan group was at par with the orphan group until 12 months of follow-up, after which it fell between 18 and 30 months. Subsequently, HAZ rose but remained below that of the orphan group. Both WHZ and HAZ failed to reach -1 in the non-orphan group. In both groups, 85% reported 100% adherence to ART. The outcome of ART is not affected by orphan status with the extended family adequately supporting orphaned children. Growth of children whose parents are HIV-infected may be constrained despite ART if there is inadequate family support.

Orphan drug: Development trends and strategies

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Aarti Sharma

2010-01-01

Full Text Available The growth of pharma industries has slowed in recent years because of various reasons such as patent expiries, generic competition, drying pipelines, and increasingly stringent regulatory guidelines. Many blockbuster drugs will loose their exclusivity in next 5 years. Therefore, the current economic situation plus the huge generic competition shifted the focus of pharmaceutical companies from the essential medicines to the new business model - niche busters, also called orphan drugs. Orphan drugs may help pharma companies to reduce the impact of revenue loss caused by patent expiries of blockbuster drugs. The new business model of orphan drugs could offer an integrated healthcare solution that enables pharma companies to develop newer areas of therapeutics, diagnosis, treatment, monitoring, and patient support. Incentives for drug development provided by governments, as well as support from the FDA and EU Commission in special protocols, are a further boost for the companies developing orphan drugs. Although there may still be challenges ahead for the pharmaceutical industry, orphan drugs seem to offer the key to recovery and stability within the market. In our study, we have compared the policies and orphan drug incentives worldwide alongwith the challenges faced by the pharmaceutical companies. Recent developments are seen in orphan drug approval, the various drugs in orphan drug pipeline, and the future prospectives for orphan drugs and diseases.

Principals Learning from Veteran Teachers Serving Impoverished Students: Social Justice Implications for Professors of Educational Administration

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Rosine, Dale

2013-01-01

This qualitative study of ten elementary veteran teachers used Hargrove's single, double, and triple-loop thinking to understand their perceptions regarding knowledge new principals need to be social justice leaders working in impoverished schools. Findings in three categories revealed the importance of principals learning to identify their…

Child-headed households in Rakai District, Uganda: a mixed-methods study.

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Collins, Lisa; Ellis, Matthew; Pritchard, Edward W J; Jenkins, Christopher; Hoeritzauer, Ingrid; Farquhar, Adam; Laverty, Orla; Murray, Vincent; Nelson, Brett D

2016-02-01

An important but neglected consequence of the AIDS pandemic that continues across sub-Saharan Africa is the phenomenon of child-headed households (CHH). This study aims to describe the challenges to health and well-being for young people living in child-headed households. A mixed-methods research approach linked common themes using qualitative and quantitative instruments to provide a broad picture of the location and challenges of CHH in Kabira, Kyotera and Kamuganja in the Rakai District of southern Uganda. Local knowledge was used to locate CHH. 163 children living in 40 CHH were traced: 42·5% of the household heads were double orphans caring for younger siblings, and 43% were also caring for chronically ill or disabled grandparents who were economically unproductive and largely dependent on the eldest child for survival. It was found that those heading households were more likely not to attend school than children living at home with a parent. Their immediate needs ranged from food and shelter to health-care and education. Fear was a major theme: 38% of those interviewed reported fear of 'violence'. Children as young as 13 were responsible for navigating through complex decision-making processes from everyday basic necessities to decisions on the health care of younger siblings and grandparents. Children and young people living in CHH are a largely invisible and highly vulnerable population. Clear, officially accepted definitions of CHH are a first step in recognising this vulnerable group for whom safeguards will be necessary as social work develops in lower- and middle-income countries (LMICs). The precise numbers of CHH are unknown and further examination of this undocumented group is needed.

Living and care arrangements of non-urban households in KwaZulu-Natal, South Africa, in the context of HIV and AIDS

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Preez, du C.J.

2011-01-01

The psychosocial well-being of orphans in Southern Africa: the perception of orphans and teachers

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M W de Witt

2010-03-01

Full Text Available The escalation in numbers of orphans in Sub-Saharan Africa has become a human catastrophe. If governments do not deal with this phenomenon as a priority it might spiral beyond control. Very few studies have been done to investigate the psychosocial impact of orphanhood on children and communities in developing countries. Very little is known about the life world of orphans in developing countries and even less is known about factors in these children’s lives which can affect their mental health. The researchers decided to undertake research in three areas in Southern Africa to investigate the psychosocial well-being of orphans and to compare the findings with existing research findings. A survey was done in three rural areas to determine the perceptions of orphans regarding their own personal experiences and emotional feelings which may reflect on psychosocial well-being, as well as the perceptions of teachers working with these orphans. Except for depression, the findings with regard to most of the psychosocial aspects were in accordance with the literature. The most important findings were that bereavement practices and approaches fit for developed communities might be of little value in developing settings. We are, however, more than aware that orphans from developed counties or even urban settings might differ from those of developing or deep rural areas. Keywords: Orphans; psychosocial well-being; bereavement; poverty; stigmatisation

Impact of orphan drugs on Latvian budget.

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Logviss, Konstantins; Krievins, Dainis; Purvina, Santa

2016-05-11

Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia. Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries. Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure. Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.

Household energy demand in Kenya: An application of the linear approximate almost ideal demand system (LA-AIDS)

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Ngui, Dianah; Mutua, John; Osiolo, Hellen; Aligula, Eric

2011-01-01

This paper estimates price and fuel expenditure elasticities of demand by applying the linear Approximate Almost Ideal Demand system (LA-AIDS) to 3665 households sampled across Kenya in 2009. The results indicate that motor spirit premium (MSP), automotive gas oil (AGO) and lubricants are price elastic while fuel wood, kerosene, charcoal, liquefied petroleum gas (LPG) and electricity are price inelastic. Kerosene is income elastic while fuel wood, charcoal, LPG, electricity, MSP and AGO are income inelastic. The results also reveal fuel stack behaviour, that is, multiple fuel use among the households. Main policy implications of the results include increasing the penetration of alternative fuels as well as provision of more fiscal incentives to increase usage of cleaner fuels. This not withstanding however, the household income should be increased beyond a certain point for the household to completely shift and use a new fuel. - Highlights: → Fuel wood, kerosene, charcoal, LPG and electricity are price inelastic. → Kerosene is income elastic. → Fuel wood, charcoal, electricity, LPG, MSP and AGO are income inelastic. → Results reveal fuel stack behaviour among the households. → Income should be increased beyond a certain point to facilitate fuel switch.

Household energy demand in Kenya: An application of the linear approximate almost ideal demand system (LA-AIDS)

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Ngui, Dianah, E-mail: ngui.diana@ku.ac.ke [Kenyatta University, P.O. Box 43844-00100, Nairobi (Kenya); Kenya Institute for Public Policy Research and Analysis, P.O. Box, 56445-00200, Nairobi (Kenya); Mutua, John [Energy Regulatory Commission, P.O. Box 42681-00100, Nairobi (Kenya); Osiolo, Hellen; Aligula, Eric [Kenya Institute for Public Policy Research and Analysis, P.O. Box, 56445-00200, Nairobi (Kenya)

2011-11-15

This paper estimates price and fuel expenditure elasticities of demand by applying the linear Approximate Almost Ideal Demand system (LA-AIDS) to 3665 households sampled across Kenya in 2009. The results indicate that motor spirit premium (MSP), automotive gas oil (AGO) and lubricants are price elastic while fuel wood, kerosene, charcoal, liquefied petroleum gas (LPG) and electricity are price inelastic. Kerosene is income elastic while fuel wood, charcoal, LPG, electricity, MSP and AGO are income inelastic. The results also reveal fuel stack behaviour, that is, multiple fuel use among the households. Main policy implications of the results include increasing the penetration of alternative fuels as well as provision of more fiscal incentives to increase usage of cleaner fuels. This not withstanding however, the household income should be increased beyond a certain point for the household to completely shift and use a new fuel. - Highlights: > Fuel wood, kerosene, charcoal, LPG and electricity are price inelastic. > Kerosene is income elastic. > Fuel wood, charcoal, electricity, LPG, MSP and AGO are income inelastic. > Results reveal fuel stack behaviour among the households. > Income should be increased beyond a certain point to facilitate fuel switch.

Psychosocial support and parents' social life determine the self-esteem of orphan children.

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Erango, Markos Abiso; Ayka, Zikie Ataro

2015-01-01

Parental death affects the life of children in many ways, one of which is self-esteem problems. Providing psychosocial support and equipping orphans play a vital role in their lifes. A cross-sectional study was conducted on 7-18-year-old orphans at 17 local districts of Gamo Gofa Zone, Southern Regional State of Ethiopia. From a total of 48,270 orphans in these areas, 4,368 were selected using stratified simple random sampling technique. Data were collected with a designed questionnaire based on the Rosenberg's rating scale to measure their self-esteem levels. Self-esteem with a score less than or equal to an average score was considered to be low self-esteem in the analysis. Binary logistic regression model was used to analyze the data using the SPSS software. The results of the study revealed that the probability of orphans suffering from low self-esteem was 0.59. Several risk factors were found to be significant at the level of 5%. Psychosocial support (good guidance, counseling and treatment, physical protection and amount of love shared, financial and material support, and fellowship with other children), parents living together before death, strong relationship between parents before death, high average monthly income, voluntary support, and consideration from the society are some of the factors that decrease the risk of being low in self-esteem. There are many orphans with low self-esteem in the study areas. The factors negatively affecting the self-esteem of orphans include the lack of psychosocial support, poor social life of parents, and death of parents due to AIDS. Society and parents should be aware of the consequences of these factors which can influence their children's future self-esteem.

The Household Economy Approach. Managing the impact of climate change on poverty and food security in developing countries

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John A. Seaman

2014-01-01

Full Text Available Climate change is expected to have severe effects on the populations of developing countries because many of these depend heavily on agriculture for income, have large impoverished rural populations which rely on agriculture for subsistence, and are financially and technically least equipped to adapt to changing conditions. Planning to target measures to support adaptation to reduce the impact of climate change on poverty and food insecurity requires methods of identifying vulnerable households. This paper describes an established approach to vulnerability assessment, the ‘Household Economy Approach’ (HEA and its potential application to the management of climate change in developing countries. The HEA is widely used by Governments and others, chiefly in Africa, for the assessment of household vulnerability to poverty and food security. HEA uses a model based on Amartya Sen’s entitlement theory and detailed social and economic data to simulate the impact of weather related, price, policy and other shocks on household income and food access, to provide information for decision making. In developing countries climate change will be experienced in terms of increased climate variability and an increased frequency of extreme events. HEA provides a way of managing the effects of year to year shocks to prevent impoverishment and the erosion of household resilience. It also provides the information needed to develop scenarios to support the design of policies to support longer term adaptation. HEA data has already been collected for large areas of Africa.

Psychosocial support and parents' social life determine the self-esteem of orphan children

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Erango MA

2015-10-01

Full Text Available Markos Abiso Erango,1 Zikie Ataro Ayka2 1School of Mathematical and Statistical Sciences, Department of Applied Statistics, Hawassa University, Hawassa, 2Department of Biology, Arba Minch University, Arba Minch, Ethiopia Abstract: Parental death affects the life of children in many ways, one of which is self-esteem problems. Providing psychosocial support and equipping orphans play a vital role in their lifes. A cross-sectional study was conducted on 7–18-year-old orphans at 17 local districts of Gamo Gofa Zone, Southern Regional State of Ethiopia. From a total of 48,270 orphans in these areas, 4,368 were selected using stratified simple random sampling technique. Data were collected with a designed questionnaire based on the Rosenberg's rating scale to measure their self-esteem levels. Self-esteem with a score less than or equal to an average score was considered to be low self-esteem in the analysis. Binary logistic regression model was used to analyze the data using the SPSS software. The results of the study revealed that the probability of orphans suffering from low self-esteem was 0.59. Several risk factors were found to be significant at the level of 5%. Psychosocial support (good guidance, counseling and treatment, physical protection and amount of love shared, financial and material support, and fellowship with other children, parents living together before death, strong relationship between parents before death, high average monthly income, voluntary support, and consideration from the society are some of the factors that decrease the risk of being low in self-esteem. There are many orphans with low self-esteem in the study areas. The factors negatively affecting the self-esteem of orphans include the lack of psychosocial support, poor social life of parents, and death of parents due to AIDS. Society and parents should be aware of the consequences of these factors which can influence their children's future self

Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa.

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Short, Susan E; Goldberg, Rachel E

2015-01-01

In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children. Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households. The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent. Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.

Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa.

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Susan E Short

Full Text Available In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children.Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households.The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent.Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these

Compassionate use of orphan drugs.

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Hyry, Hanna I; Manuel, Jeremy; Cox, Timothy M; Roos, Jonathan C P

2015-08-21

EU regulation 726/2004 authorises manufacturers to provide drugs to patients on a temporary basis when marketing authorisation sought centrally for the entire EU is still pending. Individual Member States retain the right to approve and implement such 'compassionate use' programmes which companies will usually provide for free. Nevertheless some companies have opted not to partake in such programmes, in effect restricting access to drugs for patients in need. Here we survey the state of compassionate use programmes in the EU with particular reference to the rare disease field, and provide legal and ethical arguments to encourage their increased compassionate use in the EU and beyond. We contend that if enacted, these recommendations will be mutually beneficial to companies as well as patients. Requests for information from the European Medicines Agency were made under the UK Freedom of Information Act 2000. Legal, ethical and economic/pragmatic analysis identified means by which provision of therapy in compassionate use programmes might be increased. More than 50 notifications of compassionate use programmes have been submitted to the EMA by Member States since 2006. About 40 % relate to orphan drugs. As there is a compulsory register of programmes but not of outcomes, their success is difficult to evaluate but, for example, the French programme expedited treatment for more than 20,000 (orphan and non-orphan) patients over a period of three years. Compelling self-interested, legal and ethical arguments can be mounted to encourage manufacturers to offer therapies on a compassionate use basis and these are often equally applicable to provision on a humanitarian aid basis. The EU's compassionate use programmes are instrumental in ensuring continuity of access to drugs until approval and reimbursement decisions are finalised. We propose the creation of a registry of drugs offered on a compassionate use basis; further transparency would allow such programmes to be

Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?

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Sylvia Shangani

Full Text Available Orphaned and vulnerable adolescents (OVA in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA.Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing.We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs.The mean age was 14.0 (SD 2.4 years and 329 (50.2% of the participants were female while 190 (29.0% were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99, less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78, and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89. We did not find statistically significant differences in odds of depression by CT group.OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households.

Legal assessment of current situation on orphan patients in Lithuania.

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Spokiene, Indre

2008-01-01

After Lithuania joined the European Union, the Regulation (EC) No. 141/2000 on orphan medicinal products and Commission Regulation (EC) No. 847/2000 came into force as part of national legislation. Member States must adopt specific measures to increase knowledge on rare diseases and to improve their detection, diagnosis, and treatment. The aim of this article was to present and to assess the current legal situation on orphan patients and their treatment in Lithuania, to identify legislation gaps, and to propose some ideas how to facilitate the solution of the existing problems in this field. For this purpose, European Union and Lithuanian legal documents on rare medicinal products are examined using a comparative method. With reference to inventory of Member States' incentives for rare diseases in national level, the most important issues, which orphan patients face to in Lithuania, are singled out. In Lithuania, the situation of orphan patients in terms of protection of patient rights is insufficiently determined. The access to effective health care services or approved therapies in some cases is restricted. Working relationships between genetic services and various clinical specialists as well as with those in primary care are not legally determined; the number of clinical trials aimed at orphan medicinal products is low. These results suggest a need for awareness raising among Lithuanian Government, health care specialists, patient organizations about the importance to improve practical implementation of European Union legislation and progressive experience of some European countries in this field.

Some Numbers behind Canada's Decision to Adopt an Orphan Drug Policy: US Orphan Drug Approvals in Canada, 1997-2012.

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Herder, Matthew; Krahn, Timothy Mark

2016-05-01

We examined whether access to US-approved orphan drugs in Canada has changed between 1997 (when Canada chose not to adopt an orphan drug policy) and 2012 (when Canada reversed its policy decision). Specifically, we looked at two dimensions of access to US-approved orphan drugs in Canada: (1) regulatory access; and (2) temporal access. Whereas only 63% of US-approved orphan drugs were granted regulatory approval in 1997, we found that regulatory access to US-approved orphan drugs in Canada increased to 74% between 1997 and 2012. However, temporal access to orphan drugs is slower in Canada: in a head-on comparison of 40 matched drugs, only two were submitted and four were approved first in Canada; moreover, the mean review time in Canada (423 days) was longer than that in the US (mean = 341 days), a statistically significant difference (t[39] = 2.04, p = 0.048). These results raise questions about what motivated Canada's apparent shift in orphan drug policy. Copyright © 2016 Longwoods Publishing.

Economic impacts of health shocks on households in low and middle income countries: a review of the literature.

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Alam, Khurshid; Mahal, Ajay

2014-04-03

Poor health is a source of impoverishment among households in low -and middle- income countries (LMICs) and a subject of voluminous literature in recent years. This paper reviews recent empirical literature on measuring the economic impacts of health shocks on households. Key inclusion criteria were studies that explored household level economic outcomes (burden of out-of-pocket (OOP) health spending, labour supply responses and non-medical consumption) of health shocks and sought to correct for the likely endogeneity of health shocks, in addition to studies that measured catastrophic and impoverishment effects of ill health. The review only considered literature in the English language and excluded studies published before 2000 since these have been included in previous reviews. We identified 105 relevant articles, reports, and books. Our review confirmed the major conclusion of earlier reviews based on the pre-2000 literature--that households in LMICs bear a high but variable burden of OOP health expenditure. Households use a range of sources such as income, savings, borrowing, using loans or mortgages, and selling assets and livestock to meet OOP health spending. Health shocks also cause significant reductions in labour supply among households in LMICs, and households (particularly low-income ones) are unable to fully smooth income losses from moderate and severe health shocks. Available evidence rejects the hypothesis of full consumption insurance in the face of major health shocks. Our review suggests additional research on measuring and harmonizing indicators of health shocks and economic outcomes, measuring economic implications of non-communicable diseases for households and analyses based on longitudinal data. Policymakers need to include non-health system interventions, including access to credit and disability insurance in addition to support formal insurance programs to ameliorate the economic impacts of health shocks.

Transformation of the Housing Market in Tokyo since the Late 1990s: Housing Purchases by Single-person Households

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Tomoko Kubo

2011-12-01

Full Text Available This study aims to clarify the correlation between the transformation of the Japanese housing market and the increasing number of single-person households in Japan, with a special focus on the supply of compact condominiums. In order to achieve the abovementioned purpose, the changes in the Japanese housing market and diversification of the Japanese household structure are described. Finally, the features of the supply strategies of condominium suppliers, which reflect the diversification of the household structure and increasing need for condominiums by single-person households in central Tokyo, are examined.

Promoting food security and well-being among poor and HIV/AIDS affected households: Lessons from an interactive and integrated approach

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Swaans, K.; Broerse, J.E.W.; Meincke, M.; Mudhara, M.; Bunders, J.

2009-01-01

Participatory and interdisciplinary approaches have been suggested to develop appropriate agricultural innovations as an alternative strategy to improve food security and well-being among HIV/AIDS affected households. However, sustainable implementation of such interactive approaches is far from

Orphan/vulnerable child caregiving moderates the association between women’s autonomy and their BMI in three African countries

Science.gov (United States)

Carter-Pokras, Olivia; Madhavan, Sangeetha; Feldman, Robert; He, Xin; Lee, Sunmin

2014-01-01

Enhancement of women’s autonomy is a key factor for improving women’s health and nutrition. With nearly 12 million orphan and vulnerable children (OVC) in Africa due to HIV/AIDS, the study of OVC primary caregivers’ nutrition is fundamental. We investigated the association between married women’s autonomy and their nutritional status; explored whether this relationship was modified by OVC primary caregiving; and, analyzed whether decision-making autonomy mediated the association between household wealth and body mass index (BMI). This cross-sectional study used data from Demographic Health Surveys collected during 2006–2007 from 20–49 year old women in Namibia (n=2,633), Swaziland (n=1,395), and Zambia (n=2,920). Analyses included logistic regression, Sobel and Goodman tests. Our results indicated that women’s educational attainment increased the odds for being overweight (Swaziland and Zambia) and decreased the odds for being underweight (Namibia). In Zambia, having at least primary education increased the odds for being overweight only among child primary caregivers regardless of the OVC status of the child, and having autonomy for buying everyday household items increased the odds for being overweight only among OVC primary caregivers. Decision-making autonomy mediated the association between household wealth and OVC primary caregivers’ BMI in Zambia (Z=2.13, p-value0.03). We concluded that depending on each country’s contextual characteristics, having education can decrease the odds for being an underweight woman or increase the odds for being an overweight woman. Further studies should explore why in Namibia, education has an effect on women’s overweight status only among women who are caring for a child. PMID:24888977

Estimating household food waste in Denmark:case study of single family households

DEFF Research Database (Denmark)

Edjabou, Vincent Maklawe Essonanawe; Petersen, C.; Scheutz, Charlotte

and determine potential improvements. In Denmark, although many sorting campaigns involving household waste has been conducted, little attention has been placed on food waste. Comparison of recent studies made for examples in Austria, and the UK suggests that quantity and material composition of food waste vary...... waste and non-avoidable vegetable food waste. Furthermore, avoidable vegetable and animal food waste were the primary source of household food waste. Statistical analysis found a positive linear relationship between household size and the amount of the household food waste suggesting the amount...

Role of governmental and non-governmental organizations in mitigation of stigma and discrimination among HIV/AIDS persons in Kibera, Kenya.

Science.gov (United States)

Odindo, Margaret A; Mwanthi, Mutuku A

2008-04-01

This study assessed the role of governmental and non-governmental organizations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. This was a descriptive cross-sectional study and used a multi stage stratified sampling method. The study was conducted in Kibera, an informal settlement with a population of over one million people which makes it the largest slum not only in Kenya but in sub-Saharan Africa. The study targeted infected individuals, non-infected community members, managers of the organizations implementing HIV/AIDS programmes and service providers. In the process 1331 households were interviewed using qualitative and quantitative data collection instruments. Statistical Package for Social Sciences (SPSS) and Nudist 4 packages were used to analyze the quantitative and qualitative data respectively. More than 61% of the respondents had patients in their households. Fifty five percent (55%) of the households received assistance from governmental and non-governmental organizations in taking care of the sick. Services provided included awareness, outreach, counseling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counseling services and formation of post counseling support groups to combat stigma and discrimination to be helpful. Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatization and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. Approximately 43% of the study population experienced

Optimised management of orphan wastes in the UK

International Nuclear Information System (INIS)

Doudou, Slimane; McTeer, Jennifer; Wickham, Stephen; Thied, Rob; Woodcock, Richard; Turner, Tom; Hamblin, Clive; Buckley, Matthew; Walsh, Ciara

2013-01-01

Orphan wastes have properties preventing them from being managed according to existing or currently planned management routes, or lack characterisation so that their management is uncertain. The identification of new management opportunities for orphan wastes could realise significant benefits by reducing the number of processing facilities required, reducing waste volumes, reducing hazard or leading to the development of centres of excellence for the processing of certain types of orphan wastes. Information on the characteristics of orphan waste existing at nuclear licensed sites across the UK has been collated and a database developed to act as a repository for the information gathered. The database provides a capability to analyse the data and to explore possible treatment technologies for each orphan waste type. Thirty five distinct orphan waste types have been defined and possible treatment options considered. Treatment technologies (including chemical, high temperature, immobilisation and physical technologies) that could be applied to one or more of the generic orphan waste streams have been identified. Wiring diagrams have been used to highlight the waste treatment / lifecycle management options that are available for each of the generic orphan groups as well as identifying areas for further research and development. This work has identified the potential for optimising the management of orphan wastes in a number of areas, and many potential opportunities were identified. Such opportunities could be investigated by waste managers at waste producing nuclear sites, to facilitate the development of new management routes for orphan wastes. (authors)

Contextualising the emergence and impacts of the AIDS epidemic on rural livelihoods and household food security in Masaka, Uganda

NARCIS (Netherlands)

Tumwine, Jackson

2018-01-01

This thesis aims to contribute to current debates on the impact of the AIDS epidemic on the livelihoods and food and nutrition security of rural households in sub-Saharan Africa. Over the last 20 years, numerous studies have been conducted on this subject. Although these studies have generated a

1997/98 Orphan Well Fund annual report

International Nuclear Information System (INIS)

1999-04-01

Alberta's Orphan Well Fund (previously referred as the Abandonment Fund) is funded by the oil and gas industry with provincial government support and approval. It was created to enforce and improve regulations regarding orphan wells. 1997/98 marked the year in which Orphan Well Fund activities included pipeline abandonments, facility decommissioning, and well site reclamation. The first part of this report includes the annual report of the Orphan Fund, while the second part includes the report on the Energy and Utilities Board's (EUB's) Liability Management activities which are an important part of enforcing and improving provincial regulations in the prevention of orphan wells. The fund allows liability management to be done with industry's dollars rather than taxpayer's dollars. Highlights for the year include the successful completion on eleven downhole and surface wells. Expanded activities also included the abandonment of eleven pipelines, and facilities decommissioning work at five locations. The report also includes a financial review, and a summary of the future goals of the program. The EUB enforcement activities and operations, as well as the EUB orphan prevention activities are also reviewed. tabs

On the periphery of HIV and AIDS: Reflections on stress as ...

African Journals Online (AJOL)

Few researchers have investigated how female caregivers of institutionalised children, especially those affected by HIV and AIDS, experience stress. The role played by caregivers cannot be overemphasised; yet caregivers who work in institutions caring for orphaned and/or abandoned children affected by HIV and AIDS, ...

Orphans in the Dead Sea Scrolls

Directory of Open Access Journals (Sweden)

Gideon R. Kotzé

2016-08-01

Full Text Available This study investigates the literary references to orphans in writings amongst the Qumran texts that were written in Hebrew and can be associated with the sectarian Qumran movement. The study focuses on passages where forms of the word יתום are used. These include the Damascus Document (CD 6:16–17, Hodayot (1QHa 13:22 and Barkhi Nafshia (4Q434 1 i 2. The investigation concludes that the references to orphans in these passages do not have the same rhetorical functions. In CD 6, the wordings of authoritative scriptures are adapted to portray orphans and widows as the victims of wrongdoing. In 1QHa and 4Q434, however, orphans are mentioned in hymns that praise the Lord’s positive treatment of needy people

Child-headed households because of the trauma surrounding HIV ...

African Journals Online (AJOL)

Misinformation, ignorance and prejudice concerning HIV/AIDS limit the willingness of a community to provide for the orphans who have been affected by the disease. This article aims to address the question why this is also the case in South Africa and why the African philosophy of “ubuntu” (humaneness), does not seem to ...

AIDS and Rural Livelihoods. Dynamics and Diversity in Sub-Saharan Africa

NARCIS (Netherlands)

Niehof, Anke; Rugalema, G.; Gillespie, S.

2010-01-01

HIV and AIDS continue to devastate the livelihoods of millions of Africans and represent the major public health challenge in many countries. More people die of AIDS each day than from wars, famine and floods combined, while an orphaned generation of children must be provided for. Yet despite

Depressive symptoms among older caregivers raising children impacted by HIV/AIDS in the Omusati Region of Namibia.

Science.gov (United States)

Kalomo, Eveline; Lee, Kyoung Hag; Besthorn, Fred

2017-12-01

The study of depressive symptoms among caregivers raising HIV/AIDS-orphans is emerging as an important area of research. However, it has not been explored at length in generational and cultural contexts. In this study, the authors explore the role of financial strain, raising a HIV-infected and/or impacted child, and caregiver knowledge on the depressive symptoms of 89-older caregivers raising HIV/AIDS-orphans in Namibia, Africa. In this study, we found elevated levels of depressive symptoms among this population. Using hierarchical regression, a significant positive association between financial strain and depressive symptoms was found. A significant negative association between caring for an HIV-infected orphan and depression was shown. Our work suggests the need for economic assistance programs and psychosocial interventions for older caregivers.

Orphan immunotherapies for allergic diseases.

Science.gov (United States)

Ridolo, Erminia; Montagni, Marcello; Incorvaia, Cristoforo; Senna, Gianenrico; Passalacqua, Giovanni

2016-03-01

As confirmed by systematic reviews and meta-analyses, allergen immunotherapy is clinically effective in the treatment of allergic diseases. In particular, subcutaneous immunotherapy is a pivotal treatment in patients with severe reactions to Hymenoptera venom, whereas subcutaneous immunotherapy and sublingual immunotherapy are indicated in the treatment of allergic rhinitis and asthma by inhalant allergens. Other allergies related to animal dander (other than cat, which is the most studied), such as dog, molds, occupational allergens, and insects, have also been recognized. For these allergens, immunotherapy is poorly studied and often unavailable. Thus, use of the term orphan immunotherapies is appropriate. We used MEDLINE to search the medical literature for English-language articles. Randomized, controlled, masked studies for orphan immunotherapies were selected. In the remaining cases, the available reports were described. The literature on food desensitization is abundant, but for other orphan allergens, such as mosquito, Argas reflexus, dog, or occupational allergens, there are only a few studies, and most are small studies or case reports. Orphan immunotherapy is associated with insufficient evidence of efficacy from controlled trials, an erroneous belief of the limited importance of some allergen sources, and the unlikelihood for producers to have a profit in making commercially available extracts (with an expensive process for registration) to be used in few patients. It should be taken into consideration that adequate preparations should be available also for orphan allergens. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Impact of HIV/AIDS mortality on South Africa's life expectancy and ...

African Journals Online (AJOL)

kemrilib

from HIV/AIDS by the time they reach age 75 from a hypothetical cohort of 100,000 live births, assuming ... This condition is likely to impoverish the elderly population. Everything ..... abstaining from sex, are a person's best choice and the only ...

The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries.

Science.gov (United States)

Chang, Angela Y; Riumallo-Herl, Carlos; Perales, Nicole A; Clark, Samantha; Clark, Andrew; Constenla, Dagna; Garske, Tini; Jackson, Michael L; Jean, Kévin; Jit, Mark; Jones, Edward O; Li, Xi; Suraratdecha, Chutima; Bullock, Olivia; Johnson, Hope; Brenzel, Logan; Verguet, Stéphane

2018-02-01

With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.

Cultural practices and sexual risk behaviour among adolescent orphans and non-orphans: a qualitative study on perceptions from a community in Western Kenya.

Science.gov (United States)

Juma, Milka; Askew, Ian; Alaii, Jane; Bartholomew, L Kay; van den Borne, Bart

2014-01-27

This study explored community perceptions of cultural beliefs and practices that may increase sexual risk behaviour of adolescents, to understand more about meaning they hold within the culture and how they expose adolescent orphans and non-orphans to higher risks in a high HIV and teenage pregnancy prevalence context. Using a qualitative descriptive cross-sectional design 14 focus group discussions were conducted with 78 adolescents and 68 parents/guardians purposively selected to represent their communities. Thirteen key informant interviews were also conducted with community leaders, health care and child welfare workers, and adolescents who were also selected purposively. The two methods were used to explore how cultural beliefs and practices predispose adolescent orphans and non- orphans to risky sexual behaviours. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes. Identified cultural practices that predisposed adolescents orphans and non-orphans to risky sexual behaviours included: adolescent sleeping arrangements, funeral ceremonies, replacing a deceased married daughter with her younger sister in marriage, widow inheritance among boys, early marriage among girls, and preference for boys/sons. Cultural risks perceived to equally affect both orphans and non-orphans were sleeping arrangements, funeral ceremonies, and sister replacement. Factors associated more with orphans than non-orphans were widow inheritance among boys and a preference for boy over girl children. Adolescent sexual risk reduction programs should be developed considering the specific cultural context, using strategies that empower communities to challenge the widely accepted cultural norms that may predispose young people in general to sexual risks while targeting those that unequally influence orphans.

78 FR 35117 - Orphan Drug Regulations

Science.gov (United States)

2013-06-12

..., ``This [framework] affects the plasma protein therapeutics industry significantly because various drugs... orphan designated.'' Because many plasma protein therapies lack orphan-drug designation, they are... change in delivery system from intravenous (IV) to oral may, in some cases and for some drugs, constitute...

Affordable orphan drugs: a role for not-for-profit organizations.

Science.gov (United States)

Davies, Elin H; Fulton, Emma; Brook, Daniel; Hughes, Dyfrig A

2017-07-01

The success of the Regulation on Orphan Medicinal Products in the European Union is evidenced by the 127 orphan drugs that have had market authorization since 2000. However, the incentives aimed at stimulating research and development have had the unintended consequence of increasing drug cost, resulting in many orphan drugs not being cost-effective. Orphan drugs command an increasing share of the pharmaceutical market and account for a disproportionate amount of healthcare expenditure. Orphan drug ownership by socially motivated, not-for-profit organizations may facilitate access to more affordable orphan drugs, for the benefit of patients and healthcare systems alike. This study aims to describe opportunities for such organizations to become orphan drug Market Authorization Holders. We reviewed data on the ownership of EMA designated and approved orphan drugs, identified funding opportunities and business models for not-for-profit organizations, and summarised relevant legal and policy documents concerning intellectual property rights and drug regulation. Using repurposed drugs as a paradigm, this narrative review navigates the regulatory hurdles, describes the legal context and identifies funding opportunities, in a bid to facilitate and encourage not-for-profit organizations to lead on the development of affordable orphan drugs. Although the regulatory steps required to obtain an MA for an orphan drug are numerous and challenging, they are not insurmountable and can be achieved by not-for-profit organizations that are socially motivated to reduce the costs of orphan drugs to the payers of healthcare. Opportunities for orphan drug development resulting in affordable products lie mainly with repurposed drugs. © 2017 The British Pharmacological Society.

Health Care Expenditure of Rural Households in Pondicherry, India

Directory of Open Access Journals (Sweden)

Poornima Varadarajan

2013-11-01

Full Text Available Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005 estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16. Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%.Conclusion There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.

Incentives for orphan drug research and development in the United States.

Science.gov (United States)

Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa; Szeinbach, Sheryl L; Visaria, Jay

2008-12-16

The Orphan Drug Act (1983) established several incentives to encourage the development of orphan drugs (ODs) to treat rare diseases and conditions. This study analyzed the characteristics of OD designations, approvals, sponsors, and evaluated the effective patent and market exclusivity life of orphan new molecular entities (NMEs) approved in the US between 1983 and 2007. Primary data sources were the FDA Orange Book, the FDA Office of Orphan Drugs Development, and the US Patent and Trademark Office. Data included all orphan designations and approvals listed by the FDA and all NMEs approved by the FDA during the study period. The FDA listed 1,793 orphan designations and 322 approvals between 1983 and 2007. Cancer was the main group of diseases targeted for orphan approvals. Eighty-three companies concentrated 67.7% of the total orphan NMEs approvals. The average time from orphan designation to FDA approval was 4.0 +/- 3.3 years (mean +/- standard deviation). The average maximum effective patent and market exclusivity life was 11.7 +/- 5.0 years for orphan NME. OD market exclusivity increased the average maximum effective patent and market exclusivity life of ODs by 0.8 years. Public programs, federal regulations, and policies support orphan drugs R&D. Grants, research design support, FDA fee waivers, tax incentives, and orphan drug market exclusivity are the main incentives for orphan drug R&D. Although the 7-year orphan drug market exclusivity provision had a positive yet relatively modest overall effect on effective patent and market exclusivity life, economic incentives and public support mechanisms provide a platform for continued orphan drug development for a highly specialized market.

Understanding orphan and non-orphan adolescents' sexual risks in the context of poverty: a qualitative study in Nyanza Province, Kenya.

Science.gov (United States)

Juma, Milka; Alaii, Jane; Bartholomew, L Kay; Askew, Ian; Van den Born, Bart

2013-07-25

Some studies show orphanhood to be associated with increased sexual risk-taking while others have not established this relationship, but have found factors other than orphanhood as predictors of sexual risk behaviours and outcomes among adolescents. This study examines community members' perceptions of how poverty influences adolescent sexual behaviour and outcomes in four districts of Nyanza Province, Kenya. Eight study sites within the four districts were randomly selected. Focus group discussions were conducted with a purposive sample of adolescents, parents and caregivers. Key informant interviews were undertaken with a purposive sample of community leaders, child welfare and healthcare workers, and adolescents. The two methods elicited information on factors perceived to predispose adolescent orphans and non-orphans to sexual risks. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes. Participants included 147 adolescents and parents/caregivers in 14 focus groups and 13 key informants. Poverty emerged as a key predisposing factor to sexual risk behaviour among orphans and non-orphans. Poverty was associated with lack of food, poor housing, school dropout, and engaging in income generating activities, all of which increase their vulnerability to transactional sex, early marriage, sexual experimentation, and the eventual consequences of increased risk of unintended pregnancies and STI/HIV. Poverty was perceived to contribute to increasing sexual risks among orphan and non-orphan adolescents through survival strategies adopted to be able to meet their basic needs. Policies for prevention and intervention that target adolescents in a generalized poverty and HIV epidemic should integrate economic empowerment for caregivers and life skills for adolescents to reduce vulnerabilities of orphan and non-orphan adolescents to sexual risk behaviour.

Shining a light in the black box of orphan drug pricing

Science.gov (United States)

2014-01-01

Background The pricing mechanism of orphan drugs appears arbitrary and has been referred to as a “black box”. Therefore, the aim of this study is to investigate how drug- and disease-specific variables relate to orphan drug prices. Additionally, we aim to explore if certain country-specific pricing and reimbursement policies affect the price level of orphan drugs. Methods Annual treatment costs per indication per patient were calculated for 59 orphan drugs with a publicly available price in Belgium, the Netherlands, Czech Republic, France, Italy and the United Kingdom. A multiple linear regression model was built with 14 drug- and disease-specific variables. A Mann-Whitney U test was used to explore whether there is a correlation between annual treatment costs of orphan drugs across countries with different pricing and reimbursement policies. Results Repurposed orphan drugs, orally administered orphan drugs or orphan drugs for which an alternative treatment is available are associated with lower annual treatment costs. Orphan drugs with multiple orphan indications, for chronic treatments or for which an improvement in overall survival or quality-of-life has been demonstrated, are associated with higher annual treatment costs. No association was found between annual treatments cost of orphan drugs across countries and the different pricing and reimbursement systems. Conclusions This study has shown that prices of orphan drugs are influenced by factors such as the availability of an alternative drug treatment, repurposing, etc. Current debate about the affordability of orphan drugs highlights the need for more transparency in orphan drug price setting. PMID:24767472

Radiation Safety and Orphan Sources

International Nuclear Information System (INIS)

Janzekovic, H.; Krizman, M.

2006-01-01

The wide spread use of radioactive and particularly of nuclear materials which started in the last century very quickly also demonstrated negative sides. The external exposure and radiotoxicity of these materials could be easily used in a malevolent act. Due to the fact that these materials could not be detected without special equipment designed for that purpose, severe control over their use in all phases of a life cycle is required. An orphan source is a radioactive source which is not under regulatory control, either because it has never been under regulatory or because it has been abandoned, lost, misplaced, stolen or transferred without proper authorization. In the last ten years a few international conferences were dedicated to the improvement of the safety and security of radioactive sources. Three main tasks are focused, the maintenance of data bases related to events with orphan sources and the publications of such events, the preparation of recommendations and guidelines to national regulatory bodies in order to prevent and detect the events related to orphan sources as well as to develop the response strategies to radiological or nuclear emergency, appraisals of the national strategies of radioactive sources control. Concerning Slovenia, strengthening control over orphan sources in Slovenia started after the adoption of new legislation in 2002. It was carried out through several tasks with the aim to prevent orphan sources, as well as to identify the sources which could be potentially orphan sources. The comprehensive methodology was developed by the Slovenian nuclear safety administration (S.N.S.A.) based on international guidelines as well as on the study of national lesson learned cases. The methodology was developed and used in close cooperation with all parties involved, namely other regulatory authorities, police, customs, agency for radioactive waste management (A.R.A.O.), technical support organisations (T.S.O.), users of source, authorised

Radiation Safety and Orphan Sources

Energy Technology Data Exchange (ETDEWEB)

Janzekovic, H.; Krizman, M. [Slovenian Nuclear Safety Administration, Ljubljana (Slovenia)

2006-07-01

The wide spread use of radioactive and particularly of nuclear materials which started in the last century very quickly also demonstrated negative sides. The external exposure and radiotoxicity of these materials could be easily used in a malevolent act. Due to the fact that these materials could not be detected without special equipment designed for that purpose, severe control over their use in all phases of a life cycle is required. An orphan source is a radioactive source which is not under regulatory control, either because it has never been under regulatory or because it has been abandoned, lost, misplaced, stolen or transferred without proper authorization. In the last ten years a few international conferences were dedicated to the improvement of the safety and security of radioactive sources. Three main tasks are focused, the maintenance of data bases related to events with orphan sources and the publications of such events, the preparation of recommendations and guidelines to national regulatory bodies in order to prevent and detect the events related to orphan sources as well as to develop the response strategies to radiological or nuclear emergency, appraisals of the national strategies of radioactive sources control. Concerning Slovenia, strengthening control over orphan sources in Slovenia started after the adoption of new legislation in 2002. It was carried out through several tasks with the aim to prevent orphan sources, as well as to identify the sources which could be potentially orphan sources. The comprehensive methodology was developed by the Slovenian nuclear safety administration (S.N.S.A.) based on international guidelines as well as on the study of national lesson learned cases. The methodology was developed and used in close cooperation with all parties involved, namely other regulatory authorities, police, customs, agency for radioactive waste management (A.R.A.O.), technical support organisations (T.S.O.), users of source, authorised

Orphan Well Association 2007-08 annual report

International Nuclear Information System (INIS)

2008-06-01

The Alberta Oil and Gas Orphan Abandonment and Reclamation Association or Orphan Well Association (OWA) is a not for profit organization which operates as a separate, financially independent organization under the legal authority delegated by the Alberta Energy Resources Conservation Board (ERCB). The OWA was established in January 2002 as a joint initiative between the upstream oil and gas industry and the provincial government. The Alberta government supports the initiative to deal with upstream oil and gas orphan wells through the ERCB and Alberta Environment (AENV). The ERCB collects funds from industry through an annual orphan fund levy and other fees which are then contributed directly to the OWA to cover the expenditures on orphan well abandonment and reclamation activities. The OWA prepares a yearly annual budget which determines the amount of the orphan fund levy. This budget is then approved by its four member organizations, notably the Canadian Association of Petroleum Producers (CAPP), Small Explorers and Producers Association of Canada, ERCB and AENV. This annual report for the OWA for 2007-2008 presented a historical summary of funding; a historical summary of expenditures; and a discussion of operating and financial highlights. These operating highlights included well abandonment; pipeline abandonment; facility decommissioning; and site reclamation. Financial statements for the OWA were also provided. It was concluded that the OWA had a year of responsible and productive operations. 8 tabs., 6 figs

Food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County, Kenya.

Science.gov (United States)

Chege, Peter M; Ndungu, Zipporah W; Gitonga, Betty M

2016-07-22

HIV and AIDS affect most the productive people, leading to reduced capacity to either produce food or generate income. Children under-fives are the most vulnerable group in the affected households. There exists minimal information on food security status and its effect on nutritional status of children under-fives in households affected by HIV and AIDS. The aim of this study was to assess food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County. A cross-sectional analytical design was used. A formula by Fisher was used to calculate the desired sample size of 286. Systematic random sampling was used to select the children from a list of identified households affected by HIV. A questionnaire was used to collect data. Focus group discussion (FGD) guides were used to collect qualitative data. Nutri-survey software was used for analysis of nutrient intake while ENA for SMART software for nutritional status. Data were analyzed using SPSS computer software for frequency and means. Qualitative data was coded and summarized to capture the emerging themes Results show that HIV affected the occupation of people with majority being casual laborers (37.3 %), thus affecting the engagement in high income generating activities. Pearson correlation coefficient showed a significant relationship between dietary diversity score and energy intake (r = 0.54 p = 0.044) and intake of vitamin A, iron, and zinc (p poor nutritional status noted by a prevalence of 9.9 % in wasting. Stunting and underweight was 17.5 and 5.5 %, respectively. Qualitative data shows that the stigma due to HIV affected the occupation and ability to earn income. The research recommends a food-based intervention program among the already malnourished children.

Gender differentiation in community responses to AIDS in rural Uganda.

Science.gov (United States)

Kanyamurwa, J M; Ampek, G T

2007-01-01

AIDS has been reported in Africa to push households into poverty and chronic food insecurity. At the same time there are reports of significant household resilience to AIDS. This study explored how a mature epidemic in rural Uganda has affected rural farming households. It focused on gender differences in the experience of AIDS and, in particular, household capabilities to sustain livelihoods. The study compared the vulnerability of male- and female-headed households in relation to their ability to mitigate human resource losses, as well as their access to natural and physical resources, to social networks and to finance capital for production. The findings suggest that when rural households are affected by AIDS, depleting productive resources and directing resources towards immediate needs, there are gender differences in responses to, and in impacts of, the epidemic due to the different resources available to male- and female- headed households. Female-headed households were found to be more vulnerable to AIDS than male-headed counterparts. Women's remarriage opportunities were lower than men's, they faced greater risk of losing control over land and livestock and they accessed less state and private sector support. Women-headed households were more dependent on livelihood support from non-governmental organizations, which were found to provide both welfare and credit support to female-headed households affected by AIDS. Women were found to play an important role in social networks and resources at community level but themselves received little support from many formal community networks and services.

Estimating the budget impact of orphan medicines in Europe: 2010 - 2020

Directory of Open Access Journals (Sweden)

Milanova Tsveta

2011-09-01

Full Text Available Abstract Background Orphan drugs are a growing issue of importance to European healthcare policy makers. The success of orphan drug legislation in Europe has resulted in an increasing number of licensed medicines for rare diseases, and many more yet unlicensed products have received orphan drug designation. Increasingly the concerns amongst policy makers relate to issues of patient access and affordability, yet few studies have sought to estimate the future budget impact of orphan drugs. The aim of this study was to predict the total cost of orphan medicines in Europe between 2010 and 2020 as a percentage of total European pharmaceutical expenditure. Methods A disease-based epidemiological model was created based upon trends in the designation and approval of new orphan medicines, prevalence estimates for orphan diseases, and historical price and sales data for orphan drugs in Europe (defined as Eurozone + UK. The analysis incorporated two stages: 1 Predicting the number of diseases for which new orphan drugs will be approved over the next decade, based on an analysis of trends from the EU registry of orphan medicines; 2 Estimating the average ex-factory drug cost across an orphan disease life cycle, from the year in which the first orphan medicine is launched to the point where the first medicine loses marketing exclusivity. The two sets of information were combined to quantify the annual cost of orphan drugs from 2010 through 2020. Results The results from the model predicted a steady increase in the cumulative number of diseases for which an orphan drug is approved, averaging just over 5 new diseases per year over the next 10 years. The annual per patient cost of existing orphan drugs was seen to vary between €1,251 and €407,631, with the median cost being €32,242 per year. The share of the total pharmaceutical market represented by orphan drugs is predicted to increase from 3.3% in 2010 to a peak of 4.6% in 2016 after which it is

Factors associated with internalising problems in orphans and their ...

African Journals Online (AJOL)

Objectives: To compare internalising problems reported by orphans and their caregivers with that of non-orphans and their caregivers. Design: Case control study. Setting: Cahora-Bassa District of Tete, Mozambique Subjects: Seventy-six maternal or double orphans (aged 10-14 years) and their caregivers were compared ...

Advancements in therapeutically-targeting orphan GPCRs

Directory of Open Access Journals (Sweden)

Jennifer eStockert

2015-05-01

Full Text Available G-protein coupled receptors (GPCRs are popular biological targets for drug discovery and development. To date there are more than 140 orphan GPCRs, i.e. receptors whose endogenous ligands are unknown. Traditionally orphan GPCRs have been difficult to study and the development of therapeutic compounds targeting these receptors has been extremely slow although these GPCRs are considered important targets based on their distribution and behavioral phenotype revealed by animals lacking the receptor. Recent advances in several methods used to study orphan receptors, including protein crystallography and homology modeling are likely to be useful in the identification of therapeutics targeting these receptors. In the past 13 years, over a dozen different Class A GPCRs have been crystallized; this trend is exciting, since homology modeling of GPCRs has previously been limited by the availability of solved structures. As the number of solved GPCR structures continues to grow so does the number of templates that can be used to generate increasingly accurate models of phylogenetically-related orphan GPCRs. The availability of solved structures along with the advances in using multiple templates to build models (in combination with molecular dynamics simulations that reveal structural information not provided by crystallographic data and methods for modeling hard-to-predict flexible loop regions have improved the quality of GPCR homology models. This, in turn, has improved the success rates of virtual ligand screens that use homology models to identify potential receptor binding compounds. Experimental testing of the predicted hits and validation using traditional GPCR pharmacological approaches can be used to drive ligand-based efforts to probe orphan receptor biology as well as to define the chemotypes and chemical scaffolds important for binding. As a result of these advances, orphan GPCRs are emerging from relative obscurity as a new class of drug

Orphan diseases: state of the drug discovery art.

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Volmar, Claude-Henry; Wahlestedt, Claes; Brothers, Shaun P

2017-06-01

Since 1983 more than 300 drugs have been developed and approved for orphan diseases. However, considering the development of novel diagnosis tools, the number of rare diseases vastly outpaces therapeutic discovery. Academic centers and nonprofit institutes are now at the forefront of rare disease R&D, partnering with pharmaceutical companies when academic researchers discover novel drugs or targets for specific diseases, thus reducing the failure risk and cost for pharmaceutical companies. Considerable progress has occurred in the art of orphan drug discovery, and a symbiotic relationship now exists between pharmaceutical industry, academia, and philanthropists that provides a useful framework for orphan disease therapeutic discovery. Here, the current state-of-the-art of drug discovery for orphan diseases is reviewed. Current technological approaches and challenges for drug discovery are considered, some of which can present somewhat unique challenges and opportunities in orphan diseases, including the potential for personalized medicine, gene therapy, and phenotypic screening.

Pioneering efforts to control AIDS. Review: IHO.

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Chatterji, A; Sehgal, K

1995-01-01

The Indian Health Organisation (IHO) is a nongovernmental organization based in Bombay with more than 12 years experience in HIV/AIDS prevention and control efforts. It has attacked ignorance and prejudice via communication efforts. IHO has created a bond with some hospital systems of Bombay. IHO disseminated information about HIV/AIDS in Bombay's red light districts and has bridged the gap between the city's medical establishment and the community most in need. IHO's aggressive street-level fighting in a sector replete with sensitive issues has somewhat isolated it from mainstream national NGOs involved in HIV/AIDS education and control as well as from the medical establishment and potential partners. IHO funds have been reduced, forcing IHO to reduce intervention programs and responses to field demands. It suffers from a high rate of turnover among middle management staff. IHO's chief advantage is its confidence gained over the past 12 years. IHO has clearly delineated the direction it wants to go: care and support programs for persons affected by HIV/AIDS and for commercial sex workers to allow them to quit prostitution, orphan care, and development of training institutions for the education and motivation of medical personnel on HIV/AIDS care and prevention. It plans to build a hospice for AIDS patients and orphans and a training center. Training activities will vary from one-week orientation programs to three-month certificate courses for medical workers, NGOs, and managers from the commercial sector. IHO is prepared to share its experiences in combating HIV/AIDS in Bombay in a team effort. As official and bilateral funding has been decreasing, IHO has targeted industry for funding. Industry has responded, which enables IHO to sustain its core programs and approaches. IHO observations show a decrease in the number of men visiting red-light districts. IHO enjoys a positive relationship with Bombay's media reporting on AIDS.

Perspectives about family meals from single-headed and dual-headed households: a qualitative analysis.

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Berge, Jerica M; Hoppmann, Caroline; Hanson, Carrie; Neumark-Sztainer, Dianne

2013-12-01

Cross-sectional and longitudinal research has shown that family meals are protective for adolescent healthful eating behaviors. However, little is known about what parents think of these findings and whether parents from single- vs dual-headed households have differing perspectives about the findings. In addition, parents' perspectives regarding barriers to applying the findings on family meals in their own homes and suggestions for more widespread adoption of the findings are unknown. The current study aimed to identify single- and dual-headed household parents' perspectives regarding the research findings on family meals, barriers to applying the findings in their own homes, and suggestions for helping families have more family meals. The current qualitative study included 59 parents who participated in substudy of two linked multilevel studies-EAT 2010 (Eating and Activity in Teens) and Families and Eating and Activity in Teens (F-EAT). Parents (91.5% female) were racially/ethnically and socioeconomically diverse. Data were analyzed using a grounded theory approach. Results from the current study suggest that parents from both single- and dual-headed households have similar perspectives regarding why family meals are protective for healthful eating habits for adolescents (eg, provides structure/routine, opportunities for communication, connection), but provide similar and different reasons for barriers to family meals (eg, single-headed=cost vs dual-headed=lack of creativity) and ideas and suggestions for how to increase the frequency of family meals (eg, single-headed=give fewer options vs dual-headed=include children in the meal preparation). Findings can help inform public health intervention researchers and providers who work with adolescents and their families to understand how to approach discussions regarding reasons for having family meals, barriers to carrying out family meals, and ways to increase family meals depending on family structure. Copyright �

Orphan drugs: trends and issues in drug development.

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Rana, Proteesh; Chawla, Shalini

2018-04-12

Research in rare diseases has contributed substantially toward the current understanding in the pathophysiology of the common diseases. However, medical needs of patients with rare diseases have always been neglected by the society and pharmaceutical industries based on their small numbers and unprofitability. The Orphan Drug Act (1983) was the first serious attempt to address the unmet medical needs for patients with rare diseases and to provide impetus for the pharmaceutical industry to promote orphan drug development. The process of drug development for rare diseases is no different from common diseases but involves significant cost and infrastructure. Further, certain aspect of drug research may not be feasible for the rare diseases. The drug-approving authority must exercise their scientific judgment and ensure due flexibility while evaluating data at various stages of orphan drug development. The emergence of patent cliff combined with the government incentives led the pharmaceutical industry to realize the good commercial prospects in developing an orphan drug despite the small market size. Indeed, many drugs that were given orphan designation ended up being blockbusters. The orphan drug market is projected to reach $178 billion by 2020, and the prospects of research and development in rare diseases appears to be quite promising and rewarding.

Priority setting for orphan drugs: an international comparison.

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Rosenberg-Yunger, Zahava R S; Daar, Abdallah S; Thorsteinsdóttir, Halla; Martin, Douglas K

2011-04-01

To describe the process of priority setting for two orphan drugs - Cerezyme and Fabrazyme - in Canada, Australia and Israel, in order to understand and improve the process based on stakeholder perspectives. We conducted qualitative case studies of how three independent drug advisory committees made decisions relating to the funding of Cerezyme and Fabrazyme. Interviews were conducted with 22 informants, including committee members, patient groups and industry representatives. (1) DESCRIPTION: Orphan drugs reimbursement recommendations by expert panels were based on clinical evidence, cost and cost-effectiveness analysis. (2) EVALUATION: Committee members expressed an overall preference for the current drug review process used by their own committee, but were concerned with the fairness of the process particularly for orphan drugs. Other informants suggested the inclusion of other relevant values (e.g. lack of alternative treatments) in order to improve the priority setting process. Some patient groups suggested the use of an alternative funding mechanism for orphan drugs. Priority setting for drugs is not solely a technical process (involving cost-effective analysis, evidence-based medicine, etc.). Understanding the process by which reimbursement decisions are made for orphan drugs may help improve the system for future orphan drugs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Recent trend in family households in Beijing.

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Guo, Z; Guo, L

1997-01-01

This study examined trends in household size and age structure in Beijing, China, in 1995. Data were reliably obtained from the 1% sample survey of China. Findings indicate that the average size of a family household was 3.15 persons, that is, 0.050 persons fewer than the 3.20 from the 1990 Census. Children aged 0-14 years in each household averaged 0.04 fewer children during 1990-95. 80% of the decline in household size was due to decreases in the number of children. The percentage of single-family and single-person households declined. Three-person households were the only size group that increased (23.2-40.7%). The household headship (HH) rate for males increased dramatically between the ages of 20 and 30 years and stabilized after 35 years. The HH rate for women grew slowly and continuously until age 50 years and then stabilized. The gender gap in HH appeared at an early age and remained thereafter. The HH rate declined at older ages. The HH rate in Beijing, compared to the national rate, suggests relative gender equity in Beijing. As a child ages, the percentage of three-generation households declines and the percentage of two-generation households rises. As a child becomes an adult, the percentages of single-person households and single-couple households increase. Single-couple households decreased among the middle-aged. 67.4% of the elderly lived in two- or three-generation households. 31.4% of elderly lived in single-person/couple households. The percentage of elderly living with their children declined by 2 points during 1990-95.

Pricing and reimbursement of orphan drugs: the need for more transparency

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Simoens Steven

2011-06-01

Full Text Available Abstract Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a orphan drugs benefit from a period of marketing exclusivity; b few alternative health technologies are available; c third-party payers and patients have limited negotiating power; d manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness

Pricing and reimbursement of orphan drugs: the need for more transparency.

Science.gov (United States)

Simoens, Steven

2011-06-17

Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and

Labor, social exclusion, and chronic muscular illness: the case of mid-impoverished sectors in a peripheral neighborhood in Madrid, Spain.

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Betrisey, Débora

2009-01-01

This study analyzes the combination of different and differing representations and care practices that social groups belonging to a mid-impoverished sector of Madrid use to alleviate chronic muscular pain, as well as the consequences that this has for both domestic and work life. I collected empirical evidence in a peripheral neighborhood of Madrid during 2004 using a number of anthropological methods such as participant observation, in-depth interviews, and life-history interviews. The following results can be singled out from the completed investigation: in the context of social impoverishment there are macrostructural factors that are transformed into health-destructive processes that influence the development and incidence of chronic muscular illness. This requires the different social groups that are suffering from this to establish a number of care practices mainly based on the use of Western medicine as well as other medical traditions of self-care. These practices relate to economic, educational, sociocultural, and ideological factors that characterize the lives of these individuals. This essay focuses on perceptions of illness and care practices beyond the biomedical context, as it addresses those representations and practices that these impoverished social groups display in accordance with their way of life and in relation to their ailments.

Single photon emission computed tomography in AIDS dementia complex

International Nuclear Information System (INIS)

Pohl, P.; Vogl, G.; Fill, H.; Roessler, H.Z.; Zangerle, R.; Gerstenbrand, F.

1988-01-01

Single photon emission computed tomography (SPECT) studies were performed in AIDS dementia complex using IMP in 12 patients (and HM-PAO in four of these same patients). In all patients, SPECT revealed either multiple or focal uptake defects, the latter corresponding with focal signs or symptoms in all but one case. Computerized tomography showed a diffuse cerebral atrophy in eight of 12 patients, magnetic resonance imaging exhibited changes like atrophy and/or leukoencephalopathy in two of five cases. Our data indicate that both disturbance of cerebral amine metabolism and alteration of local perfusion share in the pathogenesis of AIDS dementia complex. SPECT is an important aid in the diagnosis of AIDS dementia complex and contributes to the understanding of the pathophysiological mechanisms of this disorder

Activation-induced deoxycytidine deaminase (AID) co-transcriptional scanning at single-molecule resolution

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Senavirathne, Gayan; Bertram, Jeffrey G.; Jaszczur, Malgorzata; Chaurasiya, Kathy R.; Pham, Phuong; Mak, Chi H.; Goodman, Myron F.; Rueda, David

2015-12-01

Activation-induced deoxycytidine deaminase (AID) generates antibody diversity in B cells by initiating somatic hypermutation (SHM) and class-switch recombination (CSR) during transcription of immunoglobulin variable (IgV) and switch region (IgS) DNA. Using single-molecule FRET, we show that AID binds to transcribed dsDNA and translocates unidirectionally in concert with RNA polymerase (RNAP) on moving transcription bubbles, while increasing the fraction of stalled bubbles. AID scans randomly when constrained in an 8 nt model bubble. When unconstrained on single-stranded (ss) DNA, AID moves in random bidirectional short slides/hops over the entire molecule while remaining bound for ~5 min. Our analysis distinguishes dynamic scanning from static ssDNA creasing. That AID alone can track along with RNAP during transcription and scan within stalled transcription bubbles suggests a mechanism by which AID can initiate SHM and CSR when properly regulated, yet when unregulated can access non-Ig genes and cause cancer.

Orphan drugs expenditure in the Netherlands in the period 2006–2012

OpenAIRE

Kanters, Tim A; Steenhoek, Adri; Hakkaart, Leona

2014-01-01

textabstractBackground: The relatively low budget impact of orphan drugs is often used as an argument in reimbursement decisions. However, overall, the budget impact of orphan drugs can still be substantial. In this study, we assess the uptake and budget impact of orphan drugs in the Netherlands.Methods. We examined the number of orphan drugs, the number of patients and budget impact of orphan drugs in the Netherlands in the period 2006 to 2012, both for inpatient and outpatient orphan drugs....

Narratives of Resilience among Learners in a Rural Primary School in Swaziland

Science.gov (United States)

Motsa, Ncamsile Daphne; Morojele, Pholoho Justice

2017-01-01

Drawing from the concepts of social constructionism, the article provides insights on how six purposively sampled Grade 6 vulnerable children, aged between 11-15, from poverty-stricken families, child-headed households and those allegedly orphaned by AIDS, resiliently navigated their schooling spaces and places in one rural, primary school in…

Needs and challenges of lay community health workers in a palliative care environment for orphans and vulnerable children

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Bonita Bernice Visagie

2017-12-01

Full Text Available Introduction: The escalation of HIV/AIDS infections in the last decade has increased the need for palliative care community organizations to care for orphans and vulnerable children, who are in dire need of support. Many of these organizations depend on the services of lay community health workers to provide constant care to those in need of it in their local communities. The focus of this study is to explore the role of lay health workers in a community organization located in rural Bronkhorstspruit, Gauteng Province of South Africa. That provides palliative care for orphans and vulnerable children diagnosed with HIV/AIDS. Their roles were analysed critically through a job-demands and job-resources theoretical framework. Methods: A descriptive phenomenological case study design was employed to collect data through twenty five individual interviews, two separate focus groups consisting of ten participants in one group and eleven participants in the other group, observations and document analysis. Data were processed through a rigorous thematic analysis. Results: The findings pointed out specific knowledge and skills these lay community health workers needed in order to be satisfied with, and successful in, their administration of palliative care to orphans and vulnerable children. Participants identified the following organizational challenges that were deemed to be impacting negatively on their work experiences: the lack of career pathing processes; sufficient career guidance; and inadequate employment processes, such as staff retention, succession planning, and promotion. Conclusion: Through the findings, a framework for enhancing the work experiences of the lay community health workers was developed. The uniqueness of this framework is that the focus is on improving the work lives of the lay community health workers, who have serious skills-resourcing needs. There were specific concrete strategies that the organization could adopt to support

Financing drug discovery for orphan diseases.

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Fagnan, David E; Gromatzky, Austin A; Stein, Roger M; Fernandez, Jose-Maria; Lo, Andrew W

2014-05-01

Recently proposed 'megafund' financing methods for funding translational medicine and drug development require billions of dollars in capital per megafund to de-risk the drug discovery process enough to issue long-term bonds. Here, we demonstrate that the same financing methods can be applied to orphan drug development but, because of the unique nature of orphan diseases and therapeutics (lower development costs, faster FDA approval times, lower failure rates and lower correlation of failures among disease targets) the amount of capital needed to de-risk such portfolios is much lower in this field. Numerical simulations suggest that an orphan disease megafund of only US$575 million can yield double-digit expected rates of return with only 10-20 projects in the portfolio. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

The availability and affordability of orphan drugs for rare diseases in China.

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Gong, Shiwei; Wang, Yingxiao; Pan, Xiaoyun; Zhang, Liang; Huang, Rui; Chen, Xin; Hu, Juanjuan; Xu, Yi; Jin, Si

2016-02-27

Orphan drugs are intended to treat, prevent or diagnose rare diseases. In recent years, China healthcare policy makers and patients have become increasingly concerned about orphan drug issues. However, very few studies have assessed the availability and affordability of orphan drugs for rare diseases in China. The aim of this study was to provide an overview of the availability and affordability of orphan drugs in China and to make suggestions to improve patient access to orphan drugs. Two components of the availability of orphan drugs were examined. Market availability was assessed by the extent to which orphan drugs were marketed in China with a comparison to orphan drugs in international markets, such as the U.S., EU and Japan. We conducted surveys and collected data from 24 tertiary public hospitals in China to measure hospital-level availability of orphan drugs. The affordability of orphan drugs was calculated using hospital dispensary prices and was expressed as days of average daily income required for the cost of a course of treatment. Affordability was also analyzed under the Chinese basic medical insurance system. Orphan drugs approved in the U.S., EU and Japan had 37.8%, 24.6% and 52.4% market availability in China, respectively. Median availability of 31 orphan drugs surveyed at the 24 tertiary public hospitals was 20.8% (very low). Within a periodic treatment course, the average treatment cost of 23 orphan drugs is approximately 4, 843. 5 USD, which equates to 505.6 days of per capita net income for an urban resident with a middle income (187.4 days for a high-income urban resident) or 1,582.8 days's income for a rural resident with a middle income (657.2 days for a high-income rural resident). Except for homoharringtonine, 22 orphan drugs for 14 rare diseases were unaffordable for the most of residents in China. With 5% out-of-pocket expenses, only three generics could be afforded by middle-income residents, whereas seven drugs for high-income urban

The economic burden of angina on households in South Asia.

Science.gov (United States)

Alam, Khurshid; Mahal, Ajay

2014-02-19

Globally, an estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. Despite the increasing burden of cardiovascular disease (CVD) in South Asia, there is no evidence of an economic burden of angina on households in this region. We investigated the economic burden of angina on households in South Asia. We applied a novel propensity score matching approach to assess the economic burden of angina on household out-of-pocket (OOP) health spending, borrowing or selling assets, non-medical consumption expenditure, and employment status of angina-affected individual using nationally representative World Health Survey data from Bangladesh, India, Nepal and Sri Lanka collected during 2002-2003. We used multiple matching methods to match households where the respondent reported symptomatic or diagnosed angina with control households with similar propensity scores. Angina-affected households had significantly higher OOP health spending per person in the four weeks preceding the survey than matched controls, in Bangladesh (I$1.94, p = 0.04), in Nepal (I$4.68, p = 0.03) and in Sri Lanka (I$1.99, p finance OOP health expenses in Bangladesh (6%, p = 0.03), India (8.20%, p < 0.01) and Sri Lanka (7.80%, p = 0.01). However, impoverishment, non-medical consumption expenditure and employment status of the angina-affected individual remained mostly unaffected. We adjusted our estimates for comorbidities, but limitations on comorbidity data in the WHS mean that our results may be upwardly biased. Households that had the respondent reporting angina in South Asia face an economic burden of OOP health expenses (primarily on drugs and other outpatient expenses), and tend to rely on borrowing or selling assets. Our analysis underscores the need to protect South Asian households from the financial burden of CVD.

The Use of Social Media in Orphan Drug Development.

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Milne, Christopher-Paul; Ni, Wendi

2017-11-01

Social media has transformed how people interact with one another through the Internet, and it has the potential to do the same for orphan drug development. Currently, social media influences the orphan drug development process in the following three ways: assisting the study of orphan diseases, increasing the awareness of orphan disease, and playing a vital role in clinical trials. However, there are some caveats to the utilization of social media, such as the need to protect patient privacy by adequately de-identifying personal health information, assuring consistent quality and representativeness of the data, and preventing the unblinding of patient group assignments. Social media has both potential for improving orphan drug development and pitfalls, but with proper oversight on the part of companies, support and participation of patients and their advocacy groups, and timely guidance from regulatory authorities, the positives outweigh the negatives for this powerful and patient-centric tool. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

African Journal of AIDS Research - Vol 8, No 1 (2009)

African Journals Online (AJOL)

Conceptions of mental health among Ugandan youth orphaned by AIDS · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD ... TEXT DOWNLOAD FULL TEXT. Kathleen McDavid Harrison, Johanna Claass, Paul B Spiegel, Judith Bamuturaki, Njogu Patterson, Michael Muyonga, Lillian Tatwebwa ...

Risk and protective factors for bullying victimization among AIDS-affected and vulnerable children in South Africa.

Science.gov (United States)

Cluver, Lucie; Bowes, Lucy; Gardner, Frances

2010-10-01

To examine whether bullying is a risk factor for psychological distress among children in poor, urban South Africa. To determine risk and protective factors for bullying victimization. One thousand and fifty children were interviewed in deprived neighborhoods, including orphans, AIDS-affected children, streetchildren, and child-headed households. Using standardized scales, children reported on bullying victimization, psychological problems, and potential risk and protective factors at individual, peer, family, and community levels. 34% of children reported bullying victimization. Bullied children showed higher levels of anxiety, depression, suicidal ideation, and post-traumatic stress, as well as higher levels of clinical-level disorder. Risk factors for being bullied were being a victim of physical or sexual abuse or domestic violence at home, living in a high-violence community, and experiencing AIDS-related stigma (independent of sociodemographic cofactors and child psychological disorder). Protective factors were sibling support and support from friends, although findings suggest that friendship groups may also be sources of bullying for AIDS-affected children. Bullying is an independent and important risk factor in child psychological distress in South Africa. Children victimized at home or in the community are more likely to be bullied, suggesting a cycle of violence. Those working with children in Southern Africa should be alert to risk of bullying, especially among abused or AIDS-affected children. Interventions combating community violence and AIDS-related stigma may have additional positive impacts on bullying, and promotion of peer and sibling support may reduce bullying victimization among high-risk children. Copyright © 2010 Elsevier Ltd. All rights reserved.

Financing drug discovery for orphan diseases

OpenAIRE

Fagnan, David Erik; Gromatzky, Austin A.; Stein, Roger Mark; Fernandez, Jose-Maria; Lo, Andrew W.

2014-01-01

Recently proposed ‘megafund’ financing methods for funding translational medicine and drug development require billions of dollars in capital per megafund to de-risk the drug discovery process enough to issue long-term bonds. Here, we demonstrate that the same financing methods can be applied to orphan drug development but, because of the unique nature of orphan diseases and therapeutics (lower development costs, faster FDA approval times, lower failure rates and lower correlation of failures...

The CanOE strategy: integrating genomic and metabolic contexts across multiple prokaryote genomes to find candidate genes for orphan enzymes.

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Adam Alexander Thil Smith

2012-05-01

Full Text Available Of all biochemically characterized metabolic reactions formalized by the IUBMB, over one out of four have yet to be associated with a nucleic or protein sequence, i.e. are sequence-orphan enzymatic activities. Few bioinformatics annotation tools are able to propose candidate genes for such activities by exploiting context-dependent rather than sequence-dependent data, and none are readily accessible and propose result integration across multiple genomes. Here, we present CanOE (Candidate genes for Orphan Enzymes, a four-step bioinformatics strategy that proposes ranked candidate genes for sequence-orphan enzymatic activities (or orphan enzymes for short. The first step locates "genomic metabolons", i.e. groups of co-localized genes coding proteins catalyzing reactions linked by shared metabolites, in one genome at a time. These metabolons can be particularly helpful for aiding bioanalysts to visualize relevant metabolic data. In the second step, they are used to generate candidate associations between un-annotated genes and gene-less reactions. The third step integrates these gene-reaction associations over several genomes using gene families, and summarizes the strength of family-reaction associations by several scores. In the final step, these scores are used to rank members of gene families which are proposed for metabolic reactions. These associations are of particular interest when the metabolic reaction is a sequence-orphan enzymatic activity. Our strategy found over 60,000 genomic metabolons in more than 1,000 prokaryote organisms from the MicroScope platform, generating candidate genes for many metabolic reactions, of which more than 70 distinct orphan reactions. A computational validation of the approach is discussed. Finally, we present a case study on the anaerobic allantoin degradation pathway in Escherichia coli K-12.

THE ORBIT OF THE ORPHAN STREAM

International Nuclear Information System (INIS)

Newberg, Heidi Jo; Willett, Benjamin A.; Yanny, Brian; Xu Yan

2010-01-01

We use recent Sloan Extension for Galactic Understanding and Exploration (SEGUE) spectroscopy and the Sloan Digital Sky Survey (SDSS) and SEGUE imaging data to measure the sky position, distance, and radial velocities of stars in the tidal debris stream that is commonly referred to as the 'Orphan Stream'. We fit orbital parameters to the data and find a prograde orbit with an apogalacticon, perigalacticon, and eccentricity of 90 kpc, 16.4 kpc, and e = 0.7, respectively. Neither the dwarf galaxy UMa II nor the Complex A gas cloud has velocities consistent with a kinematic association with the Orphan Stream. It is possible that Segue-1 is associated with the Orphan Stream, but no other known Galactic clusters or dwarf galaxies in the Milky Way lie along its orbit. The detected portion of the stream ranges from 19 to 47 kpc from the Sun and is an indicator of the mass interior to these distances. There is a marked increase in the density of Orphan Stream stars near (l, b) = (253 0 , 49 0 ), which could indicate the presence of the progenitor at the edge of the SDSS data. If this is the progenitor, then the detected portion of the Orphan Stream is a leading tidal tail. We find blue horizontal branch (BHB) stars and F turnoff stars associated with the Orphan Stream. The turnoff color is (g - r) 0 = 0.22. The BHB stars have a low metallicity of [Fe/H] WBG = -2.1. The orbit is best fit to a halo potential with a halo plus disk mass of about 2.6 x 10 11 M sun , integrated to 60 kpc from the Galactic center. Our fits are done to orbits rather than full N-body simulations; we show that if N-body simulations are used, the inferred mass of the galaxy would be slightly smaller. Our best fit is found with a logarithmic halo speed of v halo = 73 ± 24 km s -1 , a disk+bulge mass of M(R 11 M sun , and a halo mass of M(R 11 M sun . However, we can find similar fits to the data that use a Navarro-Frenk-White halo profile or that have smaller disk masses and correspondingly larger

Gender Differences in Maladaptive Cognitive Schema in Orphans in Dakahlia, Egypt

Directory of Open Access Journals (Sweden)

Abdel-Hady El-Gilany

2013-01-01

Full Text Available The objective of this study was to assess the gender differences of maladaptive cognitive schema among orphans in Dakahlia governorate orphanages. A cross-sectional comparative study included 152 orphan boys and 48 orphan girls in all orphanages homes in Dakahlia governorate, Egypt. Data collection tools included a structured interview questionnaire for personal data; early maladaptive schema questionnaire-short form (EMSQ-SF. The mean score of the total YSQ and all the subscales, except self-sacrifice and unrelenting standards, are significantly higher among females than males. Attention should be given to the psychological care of the orphans especially security, trust, confidence, and autonomy with more attention to orphan girls.

Assessing the feasibility of a web-based registry for multiple orphan lung diseases: the Australasian Registry Network for Orphan Lung Disease (ARNOLD) experience

OpenAIRE

Casamento, K.; Laverty, A.; Wilsher, M.; Twiss, J.; Gabbay, E.; Glaspole, I.; Jaffe, A.

2016-01-01

Background We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand. Methods A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were s...

Household economic and food security after the 2010 Pakistan floods.

Science.gov (United States)

Doocy, Shannon; Leidman, Eva; Aung, Tricia; Kirsch, Thomas

2013-03-01

The 2010 floods inundated one-fifth of Pakistan and affected more than 20 million people. To characterize the impact of the floods and subsequent humanitarian response on household economy and food security. A cross-sectional 80 x 20 cluster survey (n = 1,569 households) was conducted using probability proportional to size sampling in the four most flood-affected provinces 6 months after the floods. Analysis included both descriptive statistics and regression models, with receipt of food aid (in the first month), dietary quality, and household income at 6 months postflood as outcomes. Need for food aid was nearly ubiquitous (98.9%); however, only half of the study population ever received food aid. Displacement was not a significant predictor of food aid receipt (OR, 1.28; 95% CI, 0.83 to 1.98); however urban location (OR, 2.78; 95% CI, 2.00 to 3.86) and damage to the home (OR, 2.73; 95% CI, 1.34 to 5.60) were significantly associated. Some of the hardest-hit groups, including both farmers and day laborers, were significantly less likely to receive food aid (p floods was relatively low, and many of the most affected populations were less likely to receive aid, suggesting that targeting should be improved in future responses.

A roadmap for breeding orphan leafy vegetable species

NARCIS (Netherlands)

Sogbohossou, E.O.D.; Achigan-Dako, Enoch G.; Maundu, Patrick; Solberg, Svein; Deguenon, Edgar M.S.; Mumm, Rita H.; Hale, Iago; Deynze, van Allen; Schranz, M.E.

2018-01-01

Despite an increasing awareness of the potential of "orphan" or unimproved crops to contribute to food security and enhanced livelihoods for farmers, coordinated research agendas to facilitate production and use of orphan crops by local communities are generally lacking. We provide an overview of

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Science.gov (United States)

Etiaba, Enyi; Onwujekwe, Obinna; Torpey, Kwasi; Uzochukwu, Benjamin; Chiegil, Robert

2016-01-01

A gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART) programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services. An exit survey of adults (18+years) attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra). In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities' during out-and in-patient visits. The levels of catastrophic health expenditure (CHE) were computed and disaggregated by state, socio-economic status (SES) and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE) in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits) as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively. The average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (ptravel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable and high cost burden of ART services. Full inclusion of ART services within the benefit package of the National Health Insurance Scheme should be considered.

Young Adults from Single versus Two-Parent Households: Attitudes toward Maternal Employment and Quality of Current Relationships with Parents.

Science.gov (United States)

Farrell, Debi; Thomas, Amy; Johnson, Lisa; Arena, Jordan; Weiner, Stacie; Nyce, Susan; Lang, Allison; Alvazian, Casey; Szuchyt, Jamie; Cane, Susan; Gelband, Amy; Zohe, Dorothy; Chambliss, Catherine

To identify the attitudes towards maternal employment of undergraduates reared in single-parent families compared to those in dual-parent households, 717 undergraduates were surveyed. Subjects were divided into two groups based on number of household parents. Between group t-tests revealed a significant effect on the Beliefs about the Consequences…

Orphan Strontium-87 in Abyssal Peridotites: Daddy Was a Granite

Science.gov (United States)

Snow, Jonathan E.; Hart, Stanley R.; Dick, Henry J. B.

1993-12-01

The 87Sr/86Sr ratios in some bulk abyssal and alpine peridotites are too high to be binary mixtures of depleted mantle and seawater components. The apparent excess, or "orphan," 87Sr appears to be separated from its radioactive parent. Such observations were widely held to be analytical artifacts. Study of several occurrences of orphan 87Sr shows that the orphan component in abyssal peridotite is located in the alteration products of olivine and enstatite in the peridotite. The orphan 87Sr is most likely introduced by infiltration of low-temperature (<200^circC) seawater bearing suspended detrital particulates. These particulates include grains of detrital clay that are partly derived from continental (that is, granitic) sources and thus are highly radiogenic. Orphan 87Sr and other radiogenic isotopes may provide a tracer for low-temperature seawater penetrating into the oceanic crust.

Health Technology Assessment Of Orphan Drugs : The example of Pompe disease

NARCIS (Netherlands)

T.A. Kanters (Tim A.)

2016-01-01

markdownabstractIn recent decades, the development of orphan drugs, i.e. drugs for rare diseases, is stimulated by regulations in various countries. However, the generally high prices of orphan drugs confront policy makers with difficult reimbursement decisions. The orphan disease investigated in

Enriching Orphans' Potentials through Interpersonal and Intrapersonal Intelligence Enrichment Activities

Science.gov (United States)

Azid, Nurulwahida Hj; Yaacob, Aizan

2016-01-01

Orphans are considered a minority and they should be given a greater emphasis so that they do not feel left out and can build their own lives without a sense of humility. This does not mean that the orphans should be pampered instead they should be given the confidence and motivation to strive for success in later life. Humility among orphans can…

The Orphan Problem in Selected African Countries | Lalthapersad ...

African Journals Online (AJOL)

becoming more widespread in response to the emerging orphan crisis. Orphans themselves are in a diffi cult position, having to contend with conditions that are fi nancially, socially and emotionally dislocating, and experiencing hunger, homelessness, forced migration, limited or no access to healthcare and social services, ...

Orphan drugs expenditure in the Netherlands in the period 2006-2012

NARCIS (Netherlands)

T.A. Kanters (Tim A.); A. Steenhoek (Adri); L. van Hakkaart-van Roijen (Leona)

2014-01-01

textabstractBackground: The relatively low budget impact of orphan drugs is often used as an argument in reimbursement decisions. However, overall, the budget impact of orphan drugs can still be substantial. In this study, we assess the uptake and budget impact of orphan drugs in the

The use of rites of passage in strengthening the psychosocial wellbeing of orphaned children in Botswana.

Science.gov (United States)

Thamuku, Masego; Daniel, Marguerite

2012-10-01

Children who have been bereaved in the context of AIDS may experience many challenges to their psychosocial wellbeing. Programmes to help orphaned children are usually anchored in child rights. As the individual focus of rights-based approaches is inept in African collectivist culture, NGOs tend to make use of group approaches in psychosocial support programmes. One orphan-strengthening programme in Botswana, called the Ark for Children, uses rites of passage and rites of affirmation as part of a therapeutic retreat. This study explored how rites of passage and rites of affirmation contribute to psychosocial strengthening of orphaned children in Botswana. Ten orphaned children were involved in five rounds of data collection during a 16-day therapeutic retreat; and eight social workers answered questions on the effectiveness of the therapy. A supplementary document analysis was also completed, which included retreat reports since 2001 and correspondence from community-based support workers and graduates of the programme. Participants reported that the rites used during the retreat helped them to commit to therapeutic transformation. During a retreat, all the participants witness and support each individual going through each rite - a process reported to foster and strengthen group formation. It was documented that the symbols used as part of the themed rites of affirmation are used by participants for years afterwards as reminders of their transformation and commitment to the group. We conclude that rites of passage can provide a powerful tool to help children commit to therapeutic transformation, build the supportive group, and enable the community to recognise and affirm that the children return as changed individuals and members of the group.

Effect of HIV/AIDS on Children's Attitudes toward Learning: Voices of Teachers and Caregivers in Western Kenya

Science.gov (United States)

Jepkemboi, Grace; Aldridge, Jerry

2014-01-01

The well-being of children orphaned by HIV/AIDS is often significantly compromised, as they are prone to discrimination, victimization, and exclusion from social and familial structures. The present study examines the effect of HIV/AIDS on children's attitudes toward learning, as perceived by teachers and caregivers. Teachers and caregivers from…

Unique characteristics of regulatory approval and pivotal studies of orphan anticancer drugs in Japan.

Science.gov (United States)

Nakayama, Hiroki; Tsukamoto, Katsura

2018-04-17

The approval of orphan anticancer drugs has increased, with the number exceeding that of non-orphan drugs in Japan in recent years. Although orphan anticancer drugs may have unique characteristics due to their rarity, these have not been fully characterized. We investigated anticancer drugs approved in Japan between April 2004 and November 2017 to reveal the characteristics of regulatory approval and pivotal studies on orphan anticancer drugs compared to non-orphan drugs. The median regulatory review time and number of patients in pivotal studies on orphan anticancer drugs (281.0 days [interquartile range, 263.3-336.0]; 222.5 patients [66.0-454.3]) were significantly lower than those on non-orphan drugs (353.0 days [277.0-535.5]; 521.0 patients [303.5-814.5], respectively) (P < 0.001). Phase II, non-randomized and non-controlled designs were more frequently used in pivotal studies on orphan anticancer drugs (45.9%, 41.9% and 43.2%) than non-orphan drugs (17.2%, 14.1% and 14.1%, respectively). Response rate was more commonly used as a primary endpoint in pivotal studies on orphan anticancer drugs (48.6%) than non-orphan drugs (17.2%). Indications limited by molecular features, second or later treatment line, and accelerated approval in the United States were associated with the use of response rate in orphan anticancer drug studies. In conclusion, we demonstrated that orphan anticancer drugs in Japan have unique characteristics compared to non-orphan drugs: shorter regulatory review and pivotal studies frequently using phase II, non-randomized, or non-controlled designs and response rate as a primary endpoint, with fewer patients.

Let's Stop Trying to Quantify Household Vulnerability: The Problem With Simple Scales for Targeting and Evaluating Economic Strengthening Programs.

Science.gov (United States)

Moret, Whitney M

2018-03-21

Economic strengthening practitioners are increasingly seeking data collection tools that will help them target households vulnerable to HIV and poor child well-being outcomes, match households to appropriate interventions, monitor their status, and determine readiness for graduation from project support. This article discusses efforts in 3 countries to develop simple, valid tools to quantify and classify economic vulnerability status. In Côte d'Ivoire, we conducted a cross-sectional survey with 3,749 households to develop a scale based on the definition of HIV-related economic vulnerability from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) for the purpose of targeting vulnerable households for PEPFAR-funded programs for orphans and vulnerable children. The vulnerability measures examined did not cluster in ways that would allow for the creation of a small number of composite measures, and thus we were unable to develop a scale. In Uganda, we assessed the validity of a vulnerability index developed to classify households according to donor classifications of economic status by measuring its association with a validated poverty measure, finding only a modest correlation. In South Africa, we developed monitoring and evaluation tools to assess economic status of individual adolescent girls and their households. We found no significant correlation with our validation measures, which included a validated measure of girls' vulnerability to HIV, a validated poverty measure, and subjective classifications generated by the community, data collector, and respondent. Overall, none of the measures of economic vulnerability used in the 3 countries varied significantly with their proposed validation items. Our findings suggest that broad constructs of economic vulnerability cannot be readily captured using simple scales to classify households and individuals in a way that accounts for a substantial amount of variance at locally defined vulnerability levels. We

Insurance companies' perspectives on the orphan drug pipeline.

Science.gov (United States)

Handfield, Robert; Feldstein, Josh

2013-11-01

Rare diseases are of increasing concern to private and public healthcare insurance plans. Largely neglected by manufacturers before the 1983 passing of the Orphan Drug Act (ODA), orphan drugs have become a commercialization target of steadily increasing importance to the healthcare industry. The ODA mandates the coverage of rare diseases, which are defined in research communities as diseases that are so infrequent that there is no reasonable expectation of a drugmaker recovering the cost of developing that drug. To determine the views of leading commercial US payers regarding providing access to and coverage for orphan drugs; to assess whether and to what degree cost-effectiveness analysis (CEA) is viewed by payers as relevant to rare disease coverage. The study sample was identified through a call for action sent by America's Health Insurance Plans to its members, resulting in 4 interviews conducted and 3 completed surveys from a total of 7 companies. These 7 US health insurance companies represent approximately 75% of the US private insurance market by revenue and include approximately 157 million covered lives (using self-reported data from insurance companies). Representatives of 3 companies responded to the survey, and representatives of 4 companies were interviewed via the phone. The interviews were conducted with subject matter experts at each company and included 2 senior vice presidents of a pharmacy program, 1 chief medical director, and 1 head of pharmacoeconomics. The surveys were completed by 1 vice president of clinical pharmacy strategy, 1 chief pharmacy director, and 1 medical director. Based on the responses in this study, approximately 67% of US private insurance companies are concerned about orphan drugs, but only approximately 17% have developed meaningful strategies for addressing the cost of orphan drugs. Of the companies who do have such a strategy, 100% are unsure how to determine the best economic assessment tools to control orphan drug

Orphans in the Dead Sea Scrolls | Kotzé | HTS Teologiese Studies ...

African Journals Online (AJOL)

The investigation concludes that the references to orphans in these passages do not have the same rhetorical functions. In CD 6, the wordings of authoritative scriptures are adapted to portray orphans and widows as the victims of wrongdoing. In 1QHa and 4Q434, however, orphans are mentioned in hymns that praise the ...

Orphan caribou, Rangifer tarandus, calves: A re-evaluation of overwinter survival data

Science.gov (United States)

Joly, Kyle

2000-01-01

Low sample size and high variation within populations reduce power of statistical tests. These aspects of statistical power appear to have affected an analysis comparing overwinter survival rates of non-orphan and orphan Caribou (Rangifer tarandus) calves by an earlier study for the Porcupine Caribou Herd. A re-evaluation of the data revealed that conclusions about a lack of significant difference in the overwinter survival rates between orphan and non-orphan calves were premature.

Characterization of household food waste in Denmark

DEFF Research Database (Denmark)

Edjabou, Vincent Maklawe Essonanawe; Petersen, C.; Scheutz, Charlotte

This paper presents a methodology and the results of compositional analysis of food waste from Danish families living in single-family houses. Residual household waste was sampled and manually sorted from 211 single-family houses in the suburb of Copenhagen. The main fractions contributing...... to the household food waste were avoidable vegetable food waste and non-avoidable vegetable food waste. Statistical analysis found a positive linear relationship between household size and the amount of the household food waste....

Correlating Orphaned Windows Registry Data Structures

Directory of Open Access Journals (Sweden)

Damir Kahved

2009-06-01

Full Text Available Recently, it has been shown that deleted entries of the Microsoft Windows registry (keys may still reside in the system files once the entries have been deleted from the active database. Investigating the complete keys in context may be extremely important from both a Forensic Investigation point of view and a legal point of view where a lack of context can bring doubt to an argument. In this paper we formalise the registry behaviour and show how a retrieved value may not maintain a relation to the part of the registry it belonged to and hence lose that context. We define registry orphans and elaborate on how they can be created inadvertently during software uninstallation and other system processes. We analyse the orphans and attempt to reconstruct them automatically. We adopt a data mining approach and introduce a set of attributes that can be applied by the forensic investigator to match values to their parents. The heuristics are encoded in a Decision Tree that can discriminate between keys and select those which most likely owned a particular orphan value.

Multiple transitions and HIV risk among orphaned Kenyan schoolgirls.

Science.gov (United States)

Mojola, Sanyu A

2011-03-01

Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.

Tackling the growing number of suspended and orphan wells

International Nuclear Information System (INIS)

Cornford, A.

1996-01-01

The number of suspended and potentially orphaned wells in the three oil producing Western provinces has grown substantially in recent years. There are currently some 38,000 wells in Alberta, 2,000 in B.C., and some 5,000 in Saskatchewan that have been inactive for at least one year. Governments are now looking at proposals to deal with the issue which, if implemented, will have far reaching implications for the oil and gas and reclamation industry in Western Canada. Proposals to date have not dealt with the potential liability for sulphur-recovery gas plants and oil and gas transmission pipelines and associated facilities. It is estimated that to pay for the expanded orphaned well program in Alberta, the current Orphan Well Program would have to be increased from $2 million to $5 million in the first four years. The recommendation is to levy an annual fee on all inactive wells and facilities. This would put the burden of paying for orphan wells on those who have facilities most in risk of becoming orphans. Informed opinion is that while the cost of addressing the problem is admittedly high, however, preventing it from getting worse is much less than the alternative

FOOD DEMAND PATTERNS IN GHANAIAN URBAN HOUSEHOLDS

Directory of Open Access Journals (Sweden)

Bernard SAKYIAMAH

2018-03-01

Full Text Available This paper analysed food consumption patterns in Ghanaian urban households by comparing food commodity budget shares and estimating price and expenditure elasticities for eleven food commodity groups across different income groups. The Linear Approximation Almost Ideal Demand System (LA/AIDS was applied to the data. Demand for most of the food commodity groups was found to be elastic. The study concluded that generally, across income groups, food commodities respond negatively to changes in food prices and that cereals/bread, roots/tubers, vegetables, meat and fish will remain an important component of urban household food expenditure. Generally, household demographic characteristics such as age, gender and household size had significant effects on urban food demand patterns.

Extending the moral economy beyond households: Gendered livelihood strategies of single migrant women in Accra, Ghana

NARCIS (Netherlands)

Tufuor, T.; Niehof, A.; Sato, C.; Horst, van der H.M.

2015-01-01

This article highlights how single migrant women (SMW) from rural northern Ghana generate livelihoods through the adoption of both market and non-market based strategies by extending and then prioritising moral obligations to community members beyond their immediate households instead of focusing on

The impact of the global economic crisis on HIV and AIDS ...

African Journals Online (AJOL)

This investigation sought to ascertain the extent to which the global economic crisis of 2008–2009 affected the delivery of HIV/AIDS-related services directed at pregnant and lactating mothers, children living with HIV and children orphaned through HIV in Zambia. Using a combined macroeconomic analysis and a multiple ...

Hereditary Angioedema: The Economics of Treatment of an Orphan Disease.

Science.gov (United States)

Lumry, William Raymond

2018-01-01

This review will discuss the cost burden of hereditary angioedema on patients, healthcare systems, and society. The impact of availability of and access to novel and specific therapies on morbidity, mortality, and the overall burden of disease will be explored along with potential changes in treatment paradigms to improve effectiveness and reduce cost of treatment. The prevalence of orphan diseases, legislative incentives to encourage development of orphan disease therapies and the impact of orphan disease treatment on healthcare payment systems will be discussed.

Orphan drugs

OpenAIRE

Goločorbin-Kon, Svetlana; Vojinović, Aleksandra; Lalić-Popović, Mladena; Pavlović, Nebojša; Mikov, Momir

2013-01-01

Introduction. Drugs used for treatment of rare diseases are known worldwide under the term of orphan drugs because pharmaceutical companies have not been interested in ”adopting” them, that is in investing in research, developing and producing these drugs. This kind of policy has been justified by the fact that these drugs are targeted for small markets, that only a small number of patients is available for clinical trials, and that large investments are required for the development of ...

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

Directory of Open Access Journals (Sweden)

Enyi Etiaba

Full Text Available A gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services.An exit survey of adults (18+years attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra. In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities' during out-and in-patient visits. The levels of catastrophic health expenditure (CHE were computed and disaggregated by state, socio-economic status (SES and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively.The average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (p<0.0001. Rural dwellers incurred more CHE for all categories of costs compared to urban dwellers, but the costs were statistically significant for only outpatient costs.ART subsidization is not enough to eliminate economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable

Care and support of orphaned and vulnerable children at school: helping teachers to respond

Directory of Open Access Journals (Sweden)

Lesley Wood

2011-01-01

Full Text Available It is acknowledged that teacher training programmes around HIV in most of sub-Saharan Africa appear not to have been very effective in assisting teachers to respond to the demands placed on them by the pandemic. In response to the need identified by international development agencies, for research into teacher education and HIV in sub-Saharan Africa, this study investigated teacher perceptions of the effectiveness of training programmes offered in a specific school district in South Africa to equip them to deal with issues arising from having orphans and vulnerable children in their classrooms. A qualitative research design was followed to purposively select teachers who had attended the departmental training to participate in focus groups to explore the phenomenon of teaching orphaned and vulnerable children. The findings that emerged from the thematic data analysis provided supporting evidence that current teacher education approaches in this regard are not perceived to be effective. The results are used to suggest guidelines for an alternative approach to the current forms of HIV and AIDS training for teachers that is more likely to be sustainable, culturally appropriate and suited to the context.

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries.

Science.gov (United States)

Gammie, Todd; Lu, Christine Y; Babar, Zaheer Ud-Din

2015-01-01

To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country's legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country's pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases.

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries.

Directory of Open Access Journals (Sweden)

Todd Gammie

Full Text Available To review existing regulations and policies utilised by countries to enable patient access to orphan drugs.A review of the literature (1998 to 2014 was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country.Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country's legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35 had in place orphan drug legislation. Access to orphan drugs depends on individual country's pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access.Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases.

Intertwining lives and logics: Household and informal economies in Cape Town

Directory of Open Access Journals (Sweden)

Sophie Oldfield

2014-07-01

Full Text Available Enabling households to make ends meet, the practices of small, informal businesses are not simple, but bound up in the struggles of households and the social and economic relationships that weave local economies together. This paper draws on stories of local businesses in an impoverished Cape Town township to situate these diverse logics and strategies, the histories and aspirations that shape small business success and struggle. Drawing on interviews and mapping every informal sector business in the neighbourhood, I reflect on the specific difficulties of running a business in the context of poverty, including unreliable and inadequate incomes, difficulties of credit, as well as the challenges of operating business on a small scale. This material demonstrates the community-based, as well as livelihood, logics that motivate local business owners as well as sustain their livelihoods. The paper concludes with an argument that the neighbourhood economy, instead of a vehicle driven primarily to maximize profit, forms an intimate part of peoples’ lives. This more multifaceted and embedded analysis stretches overly narrow notions of the informal economy, its limits and logics.

Implementation of oral health education to orphan children

International Nuclear Information System (INIS)

Malik, N.

2015-01-01

To determine the knowledge and oral hygiene status of orphange children in apune and a changes in them after health education. Study Design: Interventional study. Place and Duration of Study: Centers for Orphan Children in Pune, India, from April to June 2014. Methodology: A specially designed questionnaire was used to assess the dental problems and existing oral hygiene maintenance practice among children between 5 - 12 years of age (n=100) in an orphanage center. Pre- and post interventional intra-oral examination was carried out to check their oral hygiene status which included DMFS (Decayed Missing Filled Tooth Surfaces index (for permanent teeth)), OHIS (Simplified Oral Hygiene Index) and gingival indices. Intervention was in the form of oral health education, demonstration of correct brushing technique, diet counselling and maintenance of overall oral hygiene. Results: Present study shows that the orphans had multiple dental problems along with improper oral hygiene practices and careless attitude towards oral health. Pre- and post-interventional DMFS was compared using Wilcoxon sign rank test, which was not significant; while OHIS and gingival indices were compared by using repeat measures ANOVA(p < 0.001) which was significant for each, respectively. Conclusion: There was considerable improvement in the oral hygiene status of orphans due to educational intervention. Oral health education at right age can help to cultivate healthy oral hygiene practices in orphans which will benefit them for lifelong. Caretakers should be educated and trained about oral hygiene practices so that they can implement it and supervise the orphan children. (author)

Challenges to orphan drugs access in Eastern Europe: the case of Bulgaria.

Science.gov (United States)

Iskrov, Georgi; Miteva-Katrandzhieva, Tsonka; Stefanov, Rumen

2012-11-01

This article explores how an Eastern European country could deal with orphan drugs access, combining EU policies with its own national settings. The cross-sectional observational study takes the total number of orphan drugs (61) available on EU level by March 2011, and then consecutively filters it through the requirements and criteria of relevant Bulgarian legislation on registration, pricing and reimbursement of medicinal products, obtaining the final number of accessible orphan drugs (16) in Bulgaria. The study further evaluates the average time period from market authorisation to positive reimbursement decision by Bulgarian health authorities (43±29.1 months). Access to orphan drugs should be provided on a reasonable and justified basis. Having in mind the limited availability of resources, it is not a question whether to prioritise rarity, but to create legitimate mechanisms for properly assessing orphan drugs' value and optimally using this value, according to the society's needs and views. The analysis identifies four important challenges to orphan drugs' access in Eastern Europe: (1) elaboration of new orphan drugs pricing approaches, (2) further interaction of cost-effectiveness analysis with medical criteria, (3) active introduction of epidemiological registries for rare diseases, and (4) research of societal preferences and raising public awareness. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Food security and HIV/AIDS

African Journals Online (AJOL)

households in Homa Bay, Kenya. The paper argues that once patients are stable, they can effectively be engaged in farming with minimal financial and technical support, resulting in enhanced food security of the affected households. More importantly, it helps to reduce. HIV/AIDS-related stigma and improve the individual's ...

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries

Science.gov (United States)

Gammie, Todd

2015-01-01

Objective To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. Methods A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Results Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country’s legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country’s pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Conclusions Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases. PMID:26451948

Accounting for orphaned aftershocks in the earthquake background rate

Science.gov (United States)

Van Der Elst, Nicholas

2017-01-01

Aftershocks often occur within cascades of triggered seismicity in which each generation of aftershocks triggers an additional generation, and so on. The rate of earthquakes in any particular generation follows Omori's law, going approximately as 1/t. This function decays rapidly, but is heavy-tailed, and aftershock sequences may persist for long times at a rate that is difficult to discriminate from background. It is likely that some apparently spontaneous earthquakes in the observational catalogue are orphaned aftershocks of long-past main shocks. To assess the relative proportion of orphaned aftershocks in the apparent background rate, I develop an extension of the ETAS model that explicitly includes the expected contribution of orphaned aftershocks to the apparent background rate. Applying this model to California, I find that the apparent background rate can be almost entirely attributed to orphaned aftershocks, depending on the assumed duration of an aftershock sequence. This implies an earthquake cascade with a branching ratio (the average number of directly triggered aftershocks per main shock) of nearly unity. In physical terms, this implies that very few earthquakes are completely isolated from the perturbing effects of other earthquakes within the fault system. Accounting for orphaned aftershocks in the ETAS model gives more accurate estimates of the true background rate, and more realistic expectations for long-term seismicity patterns.

Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan

Directory of Open Access Journals (Sweden)

Abdualimova Hanifa

2010-01-01

Full Text Available Abstract Background Illness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and consequently hamper tuberculosis (TB control. So far, no study has investigated patient costs of TB in the former Soviet Union. Methods All adult new pulmonary TB cases enrolled into the DOTS program in 12 study districts during the study period were enrolled. Medical and non-medical expenditure as well as loss of income were quantified in two interviews covering separate time periods. Costs of different items were summed up to calculate total costs. For missing values, multiple imputation was applied. Results A cohort of 204 patients under DOTS, 114 men and 90 women, participated in the questionnaire survey. Total illness costs of a TB episode averaged $1053 (c. $4900 purchasing power parity, PPP, of which $292, $338 and $422 were encountered before the start of treatment, during intensive phase and in continuation phase, respectively. Costs per month were highest before the start of treatment ($145 and during intensive phase ($153 and lower during continuation phase ($95. These differences were highly significant (paired t-test, p Conclusions The illness-related costs of an episode of TB exceed the per capita GDP of $1600 PPP about two-and-a-half times. Hence, these costs are catastrophic for concerned households and suggest a high risk for impoverishment. Costs are not equally spread over time, but peak in early stages of treatment, exacerbating the problem of affordability. Mitigation strategies are needed in order to control TB in Tajikistan and may include social support to the patients as well as changes in the management of TB cases. These mitigation strategies should be timed early in treatment when the cost burden is highest.

Search and localization of orphan sources

International Nuclear Information System (INIS)

Gayral, J.-P.

2001-01-01

The control of all radioactive materials should be a major and permanent concern of every state. This paper outlines some of the steps which should be taken in order to detect and localize orphan sources. Two of them are of great importance to any state wishing to resolve the orphan source problem. The first one is to analyse the situation and the second is to establish a strategy before taking action. It is the responsibility of the state to work on the first step; but for the second one it can draw on the advice of the IAEA specialists with experience grained from a variety of situations

The views of the elderly on the impact that HIV and AIDS has on their lives in the Thulamela Municipality, Vhembe District, Limpopo province

Directory of Open Access Journals (Sweden)

Vhudivhusi J. Singo

2015-06-01

Full Text Available Background: HIV and AIDS have a devastating impact on the lives of elderly people, particularly so because they are often expected to take care of their terminally ill children and assume the responsibility of looking after children orphaned by AIDS - in most cases with very little resources. Objectives: The study sought to achieve to describe the views of elderly people regarding the impact of HIV and AIDS on their lives, to determine the challenges that elderly people living with HIV or AIDS (EPLWHA face in their daily lives, and to gain a sense of the coping strategies they use to overcome the obstacles they face in relation to HIV and AIDS. Ethical issues, such as permission to conduct the study, informed consent, confidentiality and anonymity, withdrawal of participation and measure to ensure trustworthiness, were ensured. Design: This was a qualitative, explorative, descriptive study. Participants were interviewedusing an interview guide. Information provided by the participants was captured on a taperecorder and analysed using open coding, and thereafter collated into themes, categories andsub-themes. Results: The study findings revealed that HIV and AIDS have serious negative impacts on the lives of elderly people, particularly those living in poverty. The following key areas in relationto EPLWHA were established: psychological or emotional health, as well as household and socio-economic burdens. Considering the role that elderly people play in the community in so far as HIV and AIDS are concerned, primary health promotion and social welfare programmes should be directed at educating all elderly people and their service providers on how to cope with the health and social problems related to HIV and AIDS.

Determinants of orphan drugs prices in France: a regression analysis.

Science.gov (United States)

Korchagina, Daria; Millier, Aurelie; Vataire, Anne-Lise; Aballea, Samuel; Falissard, Bruno; Toumi, Mondher

2017-04-21

The introduction of the orphan drug legislation led to the increase in the number of available orphan drugs, but the access to them is often limited due to the high price. Social preferences regarding funding orphan drugs as well as the criteria taken into consideration while setting the price remain unclear. The study aimed at identifying the determinant of orphan drug prices in France using a regression analysis. All drugs with a valid orphan designation at the moment of launch for which the price was available in France were included in the analysis. The selection of covariates was based on a literature review and included drug characteristics (Anatomical Therapeutic Chemical (ATC) class, treatment line, age of target population), diseases characteristics (severity, prevalence, availability of alternative therapeutic options), health technology assessment (HTA) details (actual benefit (AB) and improvement in actual benefit (IAB) scores, delay between the HTA and commercialisation), and study characteristics (type of study, comparator, type of endpoint). The main data sources were European public assessment reports, HTA reports, summaries of opinion on orphan designation of the European Medicines Agency, and the French insurance database of drugs and tariffs. A generalized regression model was developed to test the association between the annual treatment cost and selected covariates. A total of 68 drugs were included. The mean annual treatment cost was €96,518. In the univariate analysis, the ATC class (p = 0.01), availability of alternative treatment options (p = 0.02) and the prevalence (p = 0.02) showed a significant correlation with the annual cost. The multivariate analysis demonstrated significant association between the annual cost and availability of alternative treatment options, ATC class, IAB score, type of comparator in the pivotal clinical trial, as well as commercialisation date and delay between the HTA and commercialisation. The

Community-based capital cash transfer to support orphans in Western Kenya

DEFF Research Database (Denmark)

Skovdal, Morten; Mwasiaji, W.; Morrison, J.

2008-01-01

Various types of 'cash transfer' are currently receiving much attention as a way of helping orphans and vulnerable children in Africa. Drawing on a qualitative study conducted in Western Kenya, this paper points to the strategy of community-based capital cash transfers (CCCT) as a particularly...... promising method of supporting orphans and carers. Qualitative data were obtained from 15 orphans and 26 caregivers in Bondo District, Kenya, beneficiaries of a CCCT programme run by a partnership between the community, the government social services department and a foreign donor. Our findings suggest...... that the programme not only increased food availability, but also enhanced social capital. Further research is needed to explore the potential of CCCT in supporting orphans and vulnerable children in countries with high orphanhood rates....

Access to orphan drugs in Europe: current and future issues.

Science.gov (United States)

Michel, Morgane; Toumi, Mondher

2012-02-01

Orphan drugs target small populations of patients. In order to make the field more attractive to pharmaceutical companies and encourage R&D in rare diseases, incentives were put forward by the EU, which are discussed in this article. Because they often are the only available option to treat a disease, some orphan drugs are considered to have high value and as such benefit from high prices on national markets. This has made orphan drugs an attractive market for pharmaceutical companies, with approximately 40 approved orphan drugs generating over $200 million each in yearly sales. The resulting burden this puts on national health insurances may lead to a change in regulation and will certainly lead to new national pricing and reimbursement strategies. They will need to be coherent, fair, effective and sustainable so as to be predictable for companies. Reflection on the subject needs to be initiated.

Assessing the feasibility of a web-based registry for multiple orphan lung diseases: the Australasian Registry Network for Orphan Lung Disease (ARNOLD) experience.

Science.gov (United States)

Casamento, K; Laverty, A; Wilsher, M; Twiss, J; Gabbay, E; Glaspole, I; Jaffe, A

2016-04-18

We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand. A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were sent regular emails between July 2009 and June 2014 requesting information on patients they had seen with any of 30 rare lung diseases. Prevalence rates were calculated using population statistics. Emails were sent to 649 Australian respiratory physicians and 65 in New Zealand. 231 (32.4%) physicians responded to emails a total of 1554 times (average 7.6 responses per physician). Prevalence rates of 30 rare lung diseases are reported. A multi-disease rare lung disease registry was implemented in the Australian and New Zealand health care settings that provided prevalence data on orphan lung diseases in this region but was limited by under reporting.

Evidence-based gender findings for children affected by HIV and AIDS ? a systematic overview

OpenAIRE

Sherr, Lorraine; Mueller, Joanne; Varrall, Rebecca

2009-01-01

This review (under the International Joint Learning Initiative on Children and AIDS)provides a detailed evidence analysis of gender, children and AIDS. Six systematic reviews provide the most up to date evidence base on research surrounding children and HIV on key topics of treatment resistance and adherence, schooling, nutrition, cognitive development and orphaning and bereavement. Traditional systematic review techniques were used to identify all published studies on four key topics, then s...

A roadmap for breeding orphan leafy vegetable species

OpenAIRE

Sogbohossou, E.O.D.; Achigan-Dako, Enoch G.; Maundu, Patrick; Solberg, Svein; Deguenon, Edgar M.S.; Mumm, Rita H.; Hale, Iago; Deynze, van, Allen; Schranz, M.E.

2018-01-01

Despite an increasing awareness of the potential of "orphan" or unimproved crops to contribute to food security and enhanced livelihoods for farmers, coordinated research agendas to facilitate production and use of orphan crops by local communities are generally lacking. We provide an overview of the current knowledge on leafy vegetables with a focus on Gynandropsis gynandra, a highly nutritious species used in Africa and Asia, and highlight general and species-specific guidelines for partici...

The Impact of HIV/AIDS Regarding Informal Social Security: Issues ...

African Journals Online (AJOL)

The purpose of the article is to examine the right to social assistance for households living with HIV/AIDS in South Africa. In particular, the article focuses on the impact of this pandemic on households' access to social assistance benefits in the wake of the HIV/AIDS pandemic, which has wrought untold sorrow and suffering ...

HER2 Deregulation in Lung Cancer: Right Time to Adopt an Orphan?

Science.gov (United States)

Cappuzzo, Federico; Landi, Lorenza

2018-06-01

HER2 -deregulated non-small cell lung cancer is an orphan of any specific therapy, probably because of lack of both accurate patient selection and effective drugs. Recent evidence suggests that osimertinib could be effective in HER2 -amplified or mutated lung cancer as a single agent or in combination. Clin Cancer Res; 24(11); 2470-2. ©2018 AACR See related article by Liu et al., p. 2594 . ©2018 American Association for Cancer Research.

Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

Science.gov (United States)

Lambert-Evans, Sophie; Ponsar, Frederique; Reid, Tony; Bachy, Catherine; Van Herp, Michel; Philips, Mit

2009-10-24

In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.

[GPCRs heterodimerization: a new way towards the discovery of function for the orphan receptors?].

Science.gov (United States)

Levoye, Angélique; Jockers, Ralf

2007-01-01

G protein-coupled receptors (GPCRs), also called seven transmembrane domain (7TM) proteins, represent the largest family of cell surface receptors. GPCRs control a variety of physiological processes, are involved in multiple diseases and are major drug targets. Despite a vast effort of academic and industrial research, more than one hundred receptors remain orphans. These orphan GPCRs offer a great potential for drug discovery, as almost 60% of currently prescribed drugs target GPCRs. Deorphenization strategies have concentrated mainly on the identification of the natural ligands of these proteins. Recent advances have shown that orphan GPCRs, similar to orphan nuclear receptors, can regulate the function of non-orphan receptors by heterodimerization. These findings not only help to better understand the extraordinary diversity of GPCRs, but also open new perspectives for the identification of the function of these orphan receptors that hold great therapeutic potential.

The Impact of HIV/AIDS Regarding Informal Social Security: Issues and Perspectives from a South African Context

Directory of Open Access Journals (Sweden)

C Tshoose

2010-12-01

Full Text Available The purpose of the article is to examine the right to social assistance for households living with HIV/AIDS in South Africa. In particular, the article focuses on the impact of this pandemic on households' access to social assistance benefits in the wake of the HIV/AIDS pandemic, which has wrought untold sorrow and suffering to the overwhelming majority of households in South Africa. The article analyses the consequences of HIV/AIDS in relation to households' support systems, care and dependency burdens, and the extent to which the household members either acknowledge the illness (enabling them to better engage with treatment options or alternatively, deny its existence. The article commences by reviewing the literature concerning the effects and social impact of HIV/AIDS on the livelihoods of households and their families. The social reciprocity that underpins households' livelihoods is briefly recapitulated. The article concludes that, while recent policy developments are to be welcomed, the current South African legal system of social security does not provide adequate cover for both people living with HIV/AIDS and their families. More remains to be done in order to provide a more comprehensive social security system for the excluded and marginalised people who are living with HIV/AIDS and their families.

Solution approaches of social adaptation of orphan children

OpenAIRE

Olga Vahrameeva

2013-01-01

The actual problem of social-cultural activity of boarding schools directed on process of social adaptation of orphan children and children who have remained without guardianship of parents is considered in the article. Author offers use of an individual approach during the work with orphan children. This approach includes carrying out a complex of the interconnected programs of social and pedagogical work with the use of technologies of the social-cultural activity, which main objective is a...

Orphan drugs for rare diseases: is it time to revisit their special market access status?

Science.gov (United States)

Simoens, Steven; Cassiman, David; Dooms, Marc; Picavet, Eline

2012-07-30

Orphan drugs are intended for diseases with a very low prevalence, and many countries have implemented legislation to support market access of orphan drugs. We argue that it is time to revisit the special market access status of orphan drugs. Indeed, evidence suggests that there is no societal preference for treating rare diseases. Although society appears to assign a greater value to severity of disease, this criterion is equally relevant to many common diseases. Furthermore, the criterion of equity in access to treatment, which underpins orphan drug legislation, puts more value on health improvement in rare diseases than in common diseases and implies that population health is not maximized. Finally, incentives for the development, pricing and reimbursement of orphan drugs have created market failures, including monopolistic prices and the artificial creation of rare diseases. We argue that, instead of awarding special market access status to orphan drugs, there is scope to optimize research and development (R&D) of orphan drugs and to control prices of orphan drugs by means of, for example, patent auctions, advance purchase commitments, pay-as-you-go schemes and dose-modification studies. Governments should consider carefully the right incentive strategy for R&D of orphan drugs in rare diseases.

Profitability and Market Value of Orphan Drug Companies: A Retrospective, Propensity-Matched Case-Control Study.

Science.gov (United States)

Hughes, Dyfrig A; Poletti-Hughes, Jannine

2016-01-01

Concerns about the high cost of orphan drugs has led to questions being asked about the generosity of the incentives for development, and associated company profits. We conducted a retrospective, propensity score matched study of publicly-listed orphan companies. Cases were defined as holders of orphan drug market authorisation in Europe or the USA between 2000-12. Control companies were selected based on their propensity for being orphan drug market authorisation holders. We applied system General Method of Moments to test whether companies with orphan drug market authorization are valued higher, as measured by the Tobin's Q and market to book value ratios, and are more profitable based on return on assets, than non-orphan drug companies. 86 companies with orphan drug approvals in European (4), USA (61) or both (21) markets were matched with 258 controls. Following adjustment, orphan drug market authorization holders have a 9.6% (95% confidence interval, 0.6% to 18.7%) higher return on assets than non-orphan drug companies; Tobin's Q was higher by 9.9% (1.0% to 19.7%); market to book value by 15.7% (3.1% to 30.0%) and operating profit by 516% (CI 19.8% to 1011%). For each additional orphan drug sold, return on assets increased by 11.1% (0.6% to 21.3%), Tobin's Q by 2.7% (0.2% to 5.2%), and market to book value ratio by 5.8% (0.7% to 10.9%). Publicly listed pharmaceutical companies that are orphan drug market authorization holders are associated with higher market value and greater profits than companies not producing treatments for rare diseases.

The relationship between HIV and AIDS and water scarcity in Nyamakate resettlements land, north-central Zimbabwe.

Science.gov (United States)

Mbereko, Alexio; Scott, Dianne; John Chimbari, Moses

2016-12-01

HIV and AIDS and water variability have been studied separately, yet, they impact on rural households simultaneously in an interactive manner. The study provide narratives on various realities from a study in the Nyamakate community that illustrates the dialectical relationship between HIV and AIDS and water scarcity. A qualitative research methodology was employed, and the following data collection tools were used: semi-structured interviews, focus group discussions (FGDs) and participant observations. The study showed that in the Nyamakate area, HIV- and AIDS-affected households utilise more water if there is a bedridden patient. Such households utilise an average of 145 litres per day and reported a water shortage of 103 litres per day. Although community rules and customs stipulate that water should be accessible to everyone, exclusion of HIV- and AIDS-affected households is underlined by cultural issues, scorn at poor levels of hygiene, infectious opportunistic infections and labour shortage, which limited access to water points by households directly affected by HIV and AIDS. In cases where women were overwhelmed with caregiving roles, men fetch water. We conclude that HIV and AIDS and water scarcity are dialectically related and hence should be considered in an interactive manner in order to understand the challenges faced by affected households.

Determinants of electricity demand for newly electrified low-income African households

International Nuclear Information System (INIS)

Louw, Kate; Conradie, Beatrice; Howells, Mark; Dekenah, Marcus

2008-01-01

Access to clean, affordable and appropriate energy is an important enabler of development. Energy allows households to meet their most basic subsistence needs; it is a central feature of all the millennium development goals (MDGs) and, while a lack of access to energy may not be a cause of poverty, addressing the energy needs of the impoverished lets them access services which in turn address the causes of poverty. While much is known about the factors affecting the decisions made when choosing between fuel types within a household, few quantitative studies have been carried out in South Africa to determine the extent to which these factors affect energy choice decisions. It is assumed that the factors traditionally included in economic demand such as price and income of the household affect choice; tastes and preferences as well as external factors such as distance to fuel suppliers are expected to influence preferences. This study follows two typical low-income rural sites in South Africa, Antioch and Garagapola, where the Electricity Basic Services Support Tariff (EBSST) was piloted in 2002. The EBSST is set at 50 kWh/month per household for low domestic consumers; this is worth approximately R20 (±US$3). This subsidy is a lifeline tariff, where households receive the set amount of units per month, free of charge irrespective of whether more units are purchased. These data (collected in 2001 and 2002), recently collated with detailed electricity consumption data, allow us to determine the drivers of electricity consumption within these households. The sample analysed is taken from the initial phase of the study, when no FBE had been introduced to the households. This enabled the study presented here to make use of the well-populated datasets to assess what affects the electricity use decision in these households. This paper attempts to assess which factors affected the decision-making process for electricity consumption within these households. A brief history

21 CFR 316.23 - Timing of requests for orphan-drug designation; designation of already approved drugs.

Science.gov (United States)

2010-04-01

...) A sponsor may request orphan-drug designation at any time in the drug development process prior to... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Timing of requests for orphan-drug designation..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE ORPHAN DRUGS Designation of an Orphan...

The current status of orphan drug development in Europe and the US

OpenAIRE

Hall, Anthony K; Carlson, Marilyn R

2014-01-01

Orphan drug legislation has been introduced in a number of countries in order to stimulate the development of treatments for rare diseases by introducing commercial incentives for companies wishing to undertake that development. In order to navigate the maze of regulatory regulations and procedures so that companies can make proper use of the orphan drug incentives, specialist knowledge is required. This article will review the current status of orphan drug development in the EU and the US, e...

The many "small COPDs": COPD should be an orphan disease

DEFF Research Database (Denmark)

Rennard, Stephen I; Vestbo, Jørgen

2008-01-01

COPD is one of the most common causes of morbidity and mortality. Perhaps paradoxically, COPD also should be an orphan disease. Importantly, this could advance the development of treatments for COPD. There are two criteria for orphan status in the United States. Most widely known is the criterion...... of COPD should qualify for the first criterion if the various conditions that comprise COPD are regarded separately. The subphenotyping of COPD into separate...... groups based on mechanism sets the stage for the rational development of therapeutics. In addition, many candidate treatments may alter the natural history of COPD. Testing them, however, will require large studies for a duration that will compromise the commercial life of any resulting product. Orphan...

Modeling and Deorphanization of Orphan GPCRs.

Science.gov (United States)

Diaz, Constantino; Angelloz-Nicoud, Patricia; Pihan, Emilie

2018-01-01

Despite tremendous efforts, approximately 120 GPCRs remain orphan. Their physiological functions and their potential roles in diseases are poorly understood. Orphan GPCRs are extremely important because they may provide novel therapeutic targets for unmet medical needs. As a complement to experimental approaches, molecular modeling and virtual screening are efficient techniques to discover synthetic surrogate ligands which can help to elucidate the role of oGPCRs. Constitutively activated mutants and recently published active structures of GPCRs provide stimulating opportunities for building active molecular models for oGPCRs and identifying activators using virtual screening of compound libraries. We describe the molecular modeling and virtual screening process we have applied in the discovery of surrogate ligands, and provide examples for CCKA, a simulated oGPCR, and for two oGPCRs, GPR52 and GPR34.

Budget impact analysis of drugs for ultra-orphan non-oncological diseases in Europe.

Science.gov (United States)

Schlander, Michael; Adarkwah, Charles Christian; Gandjour, Afschin

2015-02-01

Ultra-orphan diseases (UODs) have been defined by a prevalence of less than 1 per 50,000 persons. However, little is known about budget impact of ultra-orphan drugs. For analysis, the budget impact analysis (BIA) had a time horizon of 10 years (2012-2021) and a pan-European payer's perspective, based on prevalence data for UODs for which patented drugs are available and/or for which drugs are in clinical development. A total of 18 drugs under patent protection or orphan drug designation for non-oncological UODs were identified. Furthermore, 29 ultra-orphan drugs for non-oncological diseases under development that have the potential of reaching the market by 2021 were found. Total budget impact over 10 years was estimated to be €15,660 and €4965 million for approved and pipeline ultra-orphan drugs, respectively (total: €20,625 million). The analysis does not support concerns regarding an uncontrolled growth in expenditures for drugs for UODs.

Household electricity demand profiles

DEFF Research Database (Denmark)

Marszal, Anna Joanna; Heiselberg, Per Kvols; Larsen, Olena Kalyanova

2016-01-01

Highlights •A 1-min resolution household electricity load model is presented. •Model adapts a bottom-up approach with single appliance as the main building block. •Load profiles are used to analyse the flexibility potential of household appliances. •Load profiles can be applied in other domains, .......g. building energy simulations. •The demand level of houses with different number of occupants is well captured....

The impact of a school food aid program on household food insecurity

Science.gov (United States)

Petralias, Athanassios; Papadimitriou, Eleni; Riza, Elena; Karagas, Margaret R.; Zagouras, Alexia B.A.

2016-01-01

Background: We had a unique opportunity to establish the extent of food insecurity and the potential impact of a large-scale school-based nutritional program, in low-socioeconomic status districts of Greece, during the current economic crisis. Methods: Around 162 schools with 25 349 students participated during the 2012–2013 school year. Each student received a daily healthy meal designed by nutrition specialists. Food insecurity levels, measured using the Food Security Survey Module were assessed at baseline and after a 1–8-month intervention period. Pre–post intervention responses were matched at an individual level. Results: Around 64.2% of children’s households experienced food insecurity at baseline. This percentage decreased to 59.1% post-intervention, P insecurity score diminished by 6.5%, P insecurity score increased by 6.3% (OR = 1.06, 95% CI: 1.02–1.11). Those experiencing food insecurity with hunger at baseline were more likely to improve food insecurity score than those who did not (OR = 3.51, 95%CI: 2.92–4.21). Conclusion: Children and families residing in low socioeconomic areas of Greece, experience high levels of food insecurity. Our findings suggest that participation in a school-based food aid program may reduce food insecurity for children and their families in a developed country in times of economic hardship. PMID:26873860

Cultural practices and sexual risk behaviour among adolescent orphans and non-orphans: a qualitative study on perceptions from a community in western Kenya

OpenAIRE

Juma, Milka; Askew, Ian; Alaii, Jane; Bartholomew, L Kay; van den Borne, Bart

2014-01-01

Background This study explored community perceptions of cultural beliefs and practices that may increase sexual risk behaviour of adolescents, to understand more about meaning they hold within the culture and how they expose adolescent orphans and non-orphans to higher risks in a high HIV and teenage pregnancy prevalence context. Methods Using a qualitative descriptive cross-sectional design 14 focus group discussions were conducted with 78 adolescents and 68 parents/guardians purposively sel...

Orphan drugs and the NHS: Should we value rarity

OpenAIRE

Claxton, K.; McCabe, C.; Tsuchiya, A.

2005-01-01

Cost effectiveness plays an important part in current decisions about the funding of health technologies. Drugs for rare disease (orphan drugs) are often expensive to produce and, by definition, will benefit only small numbers of patients. Several countries have put measures in place to safeguard research and development of orphan drugs, but few get close to meeting the cost effectiveness criteria for funding by healthcare providers. We examine the justifications for special status for rare d...

The current status of orphan drug development in Europe and the US.

Science.gov (United States)

Hall, Anthony K; Carlson, Marilyn R

2014-02-01

Orphan drug legislation has been introduced in a number of countries in order to stimulate the development of treatments for rare diseases by introducing commercial incentives for companies wishing to undertake that development. In order to navigate the maze of regulatory regulations and procedures so that companies can make proper use of the orphan drug incentives, specialist knowledge is required. This article will review the current status of orphan drug development in the EU and the US, explain the incentives and procedures, and touch on the role of patient organisations in the process.

Stirling based micro co-generation system for single households

Energy Technology Data Exchange (ETDEWEB)

Ribberink, J.S.; Zutt, J.G.M.; Rabou, L.P.L.M.; Beckers, G.J.J. [ECN Clean Fossil Fuels, Petten (Netherlands); Baijens, C.A.W.; Luttikholt, J.J.M. [ATAG Verwarming, Lichtenvoorde (Netherlands)

2000-04-01

This paper describes the progress made in the ENATEC development program for a free piston Stirling engine based micro co-generation system that serves the supply of up to 1 kW{sub e} and up to 24 kW heat for domestic heating and/or for hot tap water production for single households at overall system efficiencies of 96%. Experiments show that the free piston Stirling engines from Stirling Technology Company run very reliably and controllably, and that the efficiency targets for the 1 kW{sub e} micro co-generation system are feasible. A ceramic foam burner with good heat transfer characteristics and low NOx emissions was developed. A demonstration micro co-generation unit was built and successfully presented. A 1 kW{sub e} free piston Stirling engine for the European market was developed. High efficiencies at full load and at part load, low emissions, low noise, and minimum maintenance make the Stirling engine based micro co-generation system an attractive candidate for the next generation of domestic boilers in Europe. 5 refs.

A SUPPORTING AID FOR BEEF CATTLE INVESTMENT OF FARM HOUSEHOLD IN CENTRAL JAVA

Directory of Open Access Journals (Sweden)

T. Ekowati

2014-10-01

Full Text Available The research was conducted to analyze some factors influencing production, income, farmhousehold consumption and investment of farm household beef cattle in Central Java. Five districts werepurposively chosen for research location based on the number of beef cattle population, namelyRembang, Blora, Grobogan, Boyolali and Wonogiri. Forty respondents of each district were chosenrandomly using quota sampling. Data were analyzed through Simultaneous Regression and estimated byTwo Stage Least Square (TSLS. The results showed that independent variables were simultaneouslysignificant to dependent variables (production, income, farm household consumption and investmentwith the Probability F test 0.0000 and adjusted R2 were 91%; 89%; 96%; 62%, respectively. Thesimulation’s analysis of agribusiness implementation consisted of 1 decreasing 15% of service perconception, 2 increasing of beef cattle breed and number of beef cattle 15% respectively, 3 raising ofprice of rice and number of household member 15% respectively and 4 increasing of income and priceof beef cattle 10% respectively influenced to farm household consumption and investment 0.446% and5.14%, respectively, meanwhile production and income did not change. The research can be concludedthat the independent variables simultaneously significant influenced to production, income, farmhousehold consumption and beef cattle investment. The simulation of changing usage of input factor andprice significantly influenced to farm household consumption and beef cattle investment.

Prioritizing orphan proteins for further study using phylogenomics and gene expression profiles in Streptomyces coelicolor

Directory of Open Access Journals (Sweden)

Takano Eriko

2011-09-01

Full Text Available Abstract Background Streptomyces coelicolor, a model organism of antibiotic producing bacteria, has one of the largest genomes of the bacterial kingdom, including 7825 predicted protein coding genes. A large number of these genes, nearly 34%, are functionally orphan (hypothetical proteins with unknown function. However, in gene expression time course data, many of these functionally orphan genes show interesting expression patterns. Results In this paper, we analyzed all functionally orphan genes of Streptomyces coelicolor and identified a list of "high priority" orphans by combining gene expression analysis and additional phylogenetic information (i.e. the level of evolutionary conservation of each protein. Conclusions The prioritized orphan genes are promising candidates to be examined experimentally in the lab for further characterization of their function.

What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

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Kikuchi, Kimiyo; Poudel, Krishna C; Muganda, John; Sato, Tomoko; Mutabazi, Vincent; Muhayimpundu, Ribakare; Majyambere, Adolphe; Nyonsenga, Simon P; Sase, Eriko; Jimba, Masamine

2014-01-01

Every year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because it is not well understood. The purpose of this study is to explore the background related to ART non-adherence, specifically in relation to the orphan status of children in Kigali, Rwanda. We conducted 19 focus group discussions with a total of 121 caregivers of HIV-positive children in Kigali. The primary data for analysis were verbatim transcripts and socio-demographic data. A content analysis was performed for qualitative data analysis and interpretation. The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans' caregivers, and feelings of guilt about the child's condition among non-orphaned caregivers. Knowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV-positive children. In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

Regional cooperation to reduce the safety and security risks of Orphan radioactive sources

International Nuclear Information System (INIS)

Howard, Geoffrey; Hacker, Celia; Murray, Allan; Romallosa, Kristine; Caseria, Estrella; Africa del Castillo, Lorena

2008-01-01

ANSTO's Regional Security of Radioactive Sources (RSRS) Project, in cooperation with the Philippine Nuclear Research Institute (PNRI), has initiated a program to reduce the safety and security risks of orphan radioactive sources in the Philippines. Collaborative work commenced in February 2006 during the Regional Orphan Source Search and Methods Workshop, co-hosted by ANSTO and the US National Nuclear Security Administration. Further professional development activities have occurred following requests by PNRI to ANSTO to support improvements in PNRI's capability and training programs to use a range of radiation survey equipment and on the planning and methods for conducting orphan source searches. The activities, methods and outcomes of the PNRI-ANSTO cooperative program are described, including: i.) Delivering a training workshop which incorporates use of source search and nuclide identification equipment and search methodology; and train-the-trainer techniques for effective development and delivery of custom designed training in the Philippines; ii.) Support and peer review of course work on Orphan Source Search Equipment and Methodology developed by PNRI Fellows; iii.) Supporting the delivery of the inaugural National Training Workshop on Orphan Source Search hosted by PNRI in the Philippines; iv.) Partnering in searching for orphan sources in Luzon, Philippines, in May 2007. The methods employed during these international cooperation activities are establishing a new model of regional engagement that emphasises sustainability of outcomes for safety and security of radioactive sources. (author)

HIV/AIDS, artisanal fishing and food security in the Okavango Delta, Botswana

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Ngwenya, B. N.; Mosepele, K.

Generally, rural households pursue all year round natural and non-natural resource-based livelihood systems to diversify these options in order to cope with risks emanating from a range of shocks and stressors. Artisanal fishing in the Delta is not only a major livelihood option but also a source of food security. This paper is based on analysis of primary data collected from a survey of 248 subsistence fishers’ households through simple random sampling in 22 villages in the Delta. The overall objectives of the survey were to assess the general prevalence of HIV/AIDS in the Ngamiland district of Botswana, to investigate potential effects of AIDS-related stressors, particularly chronic illness on artisanal fishing activities, and to assess implications towards food security. Results from this study indicate that HIV prevalence rates for pregnant women attending antenatal clinics in the Delta are approximately 30% and are related to factors such as marriage, education, and employment. Despite this relatively high prevalence percentage, most of the affected households do not have adequate access to HIV/AIDS support facilities. Support services are provided on the basis of population size and/or status of the settlement (i.e. urban, urban village, rural or remote). Therefore, since about 50% of the Delta’s population lives in settlements of less than 500 people, they receive health services indirectly through major population centres whose capacity to deliver timely HIV/AIDS services is limited. This disproportionate access to HIV/AIDS services disadvantages the majority of fishing communities in the Delta, and may affect their ability to fish. Moreover, about 53% of sampled households had cared for a continuously ill person/s (CIP’s) in the last 5 years, out of which approximately 29% felt that this seriously impacted fishing activities. These serious impacts included sale of family assets, depletion of savings, and switching or abandoning fishing activities

Financial protection effects of modification of China's New Cooperative Medical Scheme on rural households with chronic diseases.

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Wang, Jing; Chen, Lina; Ye, Ting; Zhang, Zhiguo; Ma, Jingdong

2014-07-15

Several years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment. We conducted an empirical study using multi-stage stratified random sampling. We surveyed 1,661 rural households in three provinces and analyzed the responses from 1,525 households that participated in NCMS, using descriptive and logistic regression analysis. The NCMS has reduced the prevalence of poverty and catastrophic health expenditure (CHE), as measured by out-of-pocket (OOP) payments exceeding 40% of total household expenditure, by decreasing medical expenditure. It provides obvious protection to households which include someone with chronic diseases. However, these households continue to face a higher financial risk than those without anyone suffering from chronic diseases. Variables about health service utilization and OOP payment differed significantly between households with or without people suffering from chronic disease. And CHE risk is commonly associated with household income, the number of family members with chronic diseases, OOP payment of outpatient and inpatient service in all three provinces. To reduce CHE risk for these households, it is critical to decrease OOP payments for health services by enhancing the effective reimbursement level of NCMS and strictly regulating the providers' behaviors. We recommend that a combinatory changes should be made to the rural health insurance scheme in China to improve its effect. These include improving the NCMS benefit package by broadening the catalogue of drugs and treatments covered, decreasing or abolishing deductible and increasing the reimbursement ratio of outpatient

Orphan Drug Debate: A Cheat Sheet.

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Patel, Krishna R

2017-06-01

In some respects, the 1983 Orphan Drug Act is a success story. But high prices and allegations that some drug companies have twisted the law to their advantage have made it controversial. Here are some of the main points in the debate.

Oral lesions and dental status among institutionalized orphans in Yemen: A matched case-control study

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Sadeq Ali Al-Maweri

2014-01-01

Full Text Available Objectives: The aim of this study was to assess the prevalence of oral mucosal lesions (OMLs and dental caries and to evaluate oral health practices among institutionalized orphan-children in Sana′a city, Yemen. Subjects and Methods: A sample of 202 institutionalized male-orphan-children in the main orphanage in Sana′a city, were matched to 202 non-orphan schoolchildren. Clinical examination included assessment of OMLs based on standard international diagnostic criteria and evaluation of dental status using the Decayed/decayed, Missed/missed and Filled/filled (DMFT/dmft index according to World Health Organization recommendations. Demographic data and oral hygiene practices were obtained by interviewing each subject using special questionnaire form. Results: Majority of children were in the 12-15 year age group. Nine types of lesions were reported among orphans; the most common lesions were fissured tongue (24.3%, herpes labialis (7.9% and traumatic ulcers (2.5%. The occurrence of herpes labialis was found to be significantly higher in orphans than in controls (P < 0.01. The prevalence of dental caries was insignificantly lower among the orphans (84.7% compared with the non-orphans (89.61%; P = 0.136. The mean dmft score was significantly lower in orphans than in controls (2.28 vs. 3.82; P = 0.001. Conclusions: The institutionalized children in this orphanage had a high prevalence of OMLs but low prevalence of dental caries, though they revealed poor oral hygiene practices. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of children living in orphanages.

The Impact of Successful Cataract Surgery on Quality of Life, Household Income and Social Status in South India

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Fenwick, Eva; Balasubramaniam, Bharath; Ramani, Ramanathan V.; Holz, Frank G.; Gilbert, Clare E.

2012-01-01

Background To explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status. Methods Participants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19). Results Of the 294 participants, mean age ± standard deviation (SD) 60±8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; ppoverty in the long run. PMID:22952945

Orphan sources

International Nuclear Information System (INIS)

Pust, R.; Urbancik, L.

2008-01-01

The presentation describes how the stable detection systems (hereinafter referred to as S DS ) have contributed to reveal the uncontrolled sources of ionizing radiation on the territory of the State Office for Nuclear Safety (SONS) Brno Regional Centre (RC Brno). It also describes the emergencies which were solved by or in which the workers from the Brno. Regional Centre participated in. The contribution is divided into the following chapters: A. SDS systems installed on the territory of SONS RC Brno; B. Selected unusual emergencies; C. Comments to individual emergencies; D. Aspects of SDS operation in term of their users; E. Aspects of SDS operation and related activities in term of radiation protection; F. Current state of orphan sources. (authors)

Between Charity and Education: Orphans and Orphanages in Early Modern Times

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Jacobi, Juliane

2009-01-01

In early modern times orphans have been children who could not expect sufficient support from their family because of lack of at least one parent, in most cases the father. This article will clarify of whom we are talking if we talk about orphans and what have been the conditions of living in a society which was organised by a high variety of…

Orphan sources control in the Republic of Korea

International Nuclear Information System (INIS)

Kim, C.-W.

2001-01-01

In this paper, the orphan source control programme in Korea will be discussed. Orphan sources are, in general, classified into three groups: 1) Illegally trafficking radioactive sources; 2) Domestic loss of radioactive sources due to the bankruptcy of licensees or authorized suppliers; and 3) Contaminated metal scrap, which has been imported. There are, currently, two approaches going on to control and manage orphan sources in Korea. First, the Korean regulatory authority (Ministry of Science and Technology: MOST) will fully run an information system on radiation safety to effectively trace and monitor all radioactive sources in the country by the year 2001. Second, the regulatory authority strongly advises steel mill companies to closely scrutinize and inspect scrap metal through a scrap monitoring system when they attempt to reutilize it in order to prevent it from being contaminated by uncontrolled sources. The Korea Institute of Nuclear Safety (KINS), a regulatory expert organization, is carrying out a three-year multiphase project to control and monitor orphan sources in Korea. The system, called the Information System on Integrated Radiation Safety (ISIRS) on the inter- and intra-net system has been developed to effectively control and accurately monitor radioactive sources on a real time basis since 1998. If the system is successfully set up as scheduled by the middle of May next year, the regulatory authority will be able to control any reutilization of uncontrolled sources efficiently. At the same time, the system can also provide, not only licensees, suppliers, or perspective end users but also the Korean general public of interests with information on radiation safety, safe radiation management tools and public services. The system has been created because of the necessity to effectively control radioactive sources safely. Also, it serves to prepare necessary protective measures in a timely manner for abnormal events of uncontrolled radiation from

HIV/AIDS and time allocation in rural Malawi

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Simona Bignami-Van Assche

2011-05-01

Full Text Available AIDS morbidity and mortality are expected to have a large impact on households' labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women's time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores to cash-generating tasks (such as casual labor.

Next generation DNA sequencing technology delivers valuable genetic markers for the genomic orphan legume species, Bituminaria bituminosa

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Pazos-Navarro María

2011-12-01

Full Text Available Abstract Background Bituminaria bituminosa is a perennial legume species from the Canary Islands and Mediterranean region that has potential as a drought-tolerant pasture species and as a source of pharmaceutical compounds. Three botanical varieties have previously been identified in this species: albomarginata, bituminosa and crassiuscula. B. bituminosa can be considered a genomic 'orphan' species with very few genomic resources available. New DNA sequencing technologies provide an opportunity to develop high quality molecular markers for such orphan species. Results 432,306 mRNA molecules were sampled from a leaf transcriptome of a single B. bituminosa plant using Roche 454 pyrosequencing, resulting in an average read length of 345 bp (149.1 Mbp in total. Sequences were assembled into 3,838 isotigs/contigs representing putatively unique gene transcripts. Gene ontology descriptors were identified for 3,419 sequences. Raw sequence reads containing simple sequence repeat (SSR motifs were identified, and 240 primer pairs flanking these motifs were designed. Of 87 primer pairs developed this way, 75 (86.2% successfully amplified primarily single fragments by PCR. Fragment analysis using 20 primer pairs in 79 accessions of B. bituminosa detected 130 alleles at 21 SSR loci. Genetic diversity analyses confirmed that variation at these SSR loci accurately reflected known taxonomic relationships in original collections of B. bituminosa and provided additional evidence that a division of the botanical variety bituminosa into two according to geographical origin (Mediterranean region and Canary Islands may be appropriate. Evidence of cross-pollination was also found between botanical varieties within a B. bituminosa breeding programme. Conclusions B. bituminosa can no longer be considered a genomic orphan species, having now a large (albeit incomplete repertoire of expressed gene sequences that can serve as a resource for future genetic studies. This

The disposal of orphan wastes using the greater confinement disposal concept

International Nuclear Information System (INIS)

Bonano, E.J.; Chu, M.S.Y.; Price, L.L.; Conrad, S.H.; Dickman, P.T.

1991-01-01

In the United States, radioactive wastes are conventionally classified as high-level wastes, transuranic wastes, or low-level wastes. Each of these types of wastes, by law, has a ''home'' for their final disposal; i.e., high-level wastes are destined for disposal at the proposed repository at Yucca Mountain, transuranic waste for the proposed Waste Isolation Pilot Plant, and low-level waste for shallow-land disposal sites. However, there are some radioactive wastes within the United States Department of Energy (DOE) complex that do not meet the criteria established for disposal of either high-level waste, transuranic waste, or low-level waste. The former are called ''special-case'' or ''orphan'' wastes. This paper describes an ongoing project sponsored by the DOE's Nevada Operations Office for the disposal of orphan wastes at the Radioactive Waste Management Site at Area 5 of the Nevada Test Site using the greater confinement disposal (GCD) concept. The objectives of the GCD project are to evaluate the safety of the site for disposal of orphan wastes by assessing compliance with pertinent regulations through performance assessment, and to examine the feasibility of this disposal concept as a cost-effective, safe alternative for management of orphan wastes within the DOE complex. Decisions on the use of GCD or other alternate disposal concepts for orphan wastes be expected to be addressed in a Programmatic Environmental Impact Statement being prepared by DOE. The ultimate decision to use GCD will require a Record of Decision through the National Environmental Policy Act (NEPA) process. 20 refs., 3 figs., 2 tabs

Parental Bereavement in Young Children Living in South Africa and Malawi: Understanding Mental Health Resilience.

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Macedo, A; Sherr, L; Tomlinson, M; Skeen, S; Roberts, K J

2018-04-17

Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time. This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi, and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and non-orphaned children. Consecutive attenders of community based organisations (children;4-13 years, and their caregivers) were interviewed at baseline and 15-18 month follow up (n=833). Interviews comprised of inventories on demographic information, family data, child mental health, bereavement experience and community characteristics. Mental health screens were used to operationalise resilience as the absence of symptoms of depression, suicidality, trauma, emotional and behavioural problems. Almost 60% of children experienced parental loss. One quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) vs. non-orphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, gender, country of residence or between orphaned and non-orphaned children. This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.

Multi-criteria decision analysis for assessment and appraisal of orphan drugs

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Georgi Iskrov

2016-09-01

Full Text Available Background: Limited resources and expanding expectations push all countries and types of health systems to adopt new approaches in priority setting and resources allocation. Despite best efforts, it is difficult to reconcile all competing interests and trade-offs are inevitable. This is why multi-criteria decision analysis (MCDA has played a major role in recent uptake of value-based reimbursement. MCDA framework enables exploration of stakeholders’ preferences, as well as explicit organization of broad range of criteria on which real-world decisions are made.Assessment and appraisal of orphan drugs tend to be one of the most complicated health technology assessment (HTA tasks. Access to market approved orphan therapies remains an issue. Early constructive dialogue among rare disease stakeholders and elaboration of orphan drug-tailored decision support tools could set the scene for ongoing accumulation of evidence, as well as for proper reimbursement decision-making.Objective: The objective of this study was to create a MCDA value measurement model to assess and appraise orphan drugs. This was achieved by exploring the preferences on decision criteria’s weights and performance scores through a stakeholder-representative survey and a focus group discussion that were both organized in Bulgaria.Results/Conclusions: Decision criteria that describe the health technology’s characteristics were unanimously agreed as the most important group of reimbursement considerations. This outcome, combined with the high individual weight of disease severity and disease burden criteria underlined some of the fundamental principles of healthcare – equity and fairness. Our study proved that strength of evidence may be a key criterion in orphan drug assessment and appraisal. Evidence is not only used to shape reimbursement decision-making, but also to lend legitimacy to policies pursued. The need for real-world data on orphan drugs was largely stressed

Psychological health of orphan bonobos and chimpanzees in African sanctuaries.

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Victoria Wobber

Full Text Available Facilities across Africa care for apes orphaned by the trade for "bushmeat." These facilities, called sanctuaries, provide housing for apes such as bonobos (Pan paniscus and chimpanzees (Pan troglodytes who have been illegally taken from the wild and sold as pets. Although these circumstances are undoubtedly stressful for the apes, most individuals arrive at the sanctuaries as infants and are subsequently provided with rich physical and social environments that can facilitate the expression of species-typical behaviors.We tested whether bonobo and chimpanzee orphans living in sanctuaries show any behavioral, physiological, or cognitive abnormalities relative to other individuals in captivity as a result of the early-life stress they experience. Orphans showed lower levels of aberrant behaviors, similar levels of average cortisol, and highly similar performances on a broad battery of cognitive tests in comparisons with individuals of the same species who were either living at a zoo or were reared by their mothers at the sanctuaries.Taken together, these results support the rehabilitation strategy used by sanctuaries in the Pan-African Sanctuary Alliance (PASA and suggest that the orphans we examined did not show long-term signs of stress as a result of their capture. Our findings also show that sanctuary apes are as psychologically healthy as apes in other captive settings and thus represent a valuable resource for non-invasive research.

[The Euro-orphans phenomenon and the courses in therapeutic work and psychiatric treatment--a case study].

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Nowak, Marta; Gaweda, Agnieszka; Janas-Kozik, Małgorzata

2012-01-01

Today, the phenomenon of Euro-orphan is more and more frequently reported in the literature. This term refers to children with one or both parents emigrated from the country for work purposes. In connection with the social transformations of orphan-hood types described in the literature (nature, spiritual, social), the definition has been broadened by the definition ofeuro-orphan. The Ministry of Education describes the euro-orphan as the destruction of the family structure, the disorder of the socialisation process of children and reduction of the emotional exchanges among family members, as a result of migration of their parents. It provides further that not every child whose parents are not present in the country is covered as an euro-orphan. However, this group has become an increasingly larger populations. Lack of physical proximity and accessibility of important persons may have some psychological and pedagogical implications. These in turn can be shaped over time, into pathological symptoms, which are diagnostic entities in developmental psychiatry. It is not know precisely how many children in Poland are Euro-orphans. The aim of this paper is an attempt to understand the social phenomenon of Euro-orphanhood in the light of the observed psychopathologies of children and adolescents. The case study of the psychotherapy of a patient suffering from the Euro-orphanhood syndrome. Euro-orphanhood is a social phenomenon that generates Euro-orphans with a wide range of psychopathological symptoms classified in different diagnostic categories. The type and intensification of the psychopathological symptoms depend on the quality of relationships with meaningful persons prior to the Euro-orphanhood period. The course of the psychotherapeutic work with Euro-orphans should cover an individual aspect taking into consideration the maturity of defensive mechanisms as well as the work-through of negative feelings cumulated due to becoming a Euro-orphan.

Environmental impoverishment and aging alter object recognition, spatial learning, and dentate gyrus astrocytes.

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Diniz, Daniel G; Foro, César A R; Rego, Carla M D; Gloria, David A; de Oliveira, Fabio R R; Paes, Juliana M P; de Sousa, Aline A; Tokuhashi, Tatyana P; Trindade, Lucas S; Turiel, Maíra C P; Vasconcelos, Erick G R; Torres, João B; Cunnigham, Colm; Perry, Victor H; Vasconcelos, Pedro F da Costa; Diniz, Cristovam W P

2010-08-01

Environmental and age-related effects on learning and memory were analysed and compared with changes observed in astrocyte laminar distribution in the dentate gyrus. Aged (20 months) and young (6 months) adult female albino Swiss mice were housed from weaning either in impoverished conditions or in enriched conditions, and tested for episodic-like and water maze spatial memories. After these behavioral tests, brain hippocampal sections were immunolabeled for glial fibrillary acid protein to identify astrocytes. The effects of environmental enrichment on episodic-like memory were not dependent on age, and may protect water maze spatial learning and memory from declines induced by aging or impoverished environment. In the dentate gyrus, the number of astrocytes increased with both aging and enriched environment in the molecular layer, increased only with aging in the polymorphic layer, and was unchanged in the granular layer. We suggest that long-term experience-induced glial plasticity by enriched environment may represent at least part of the circuitry groundwork for improvements in behavioral performance in the aged mice brain.

Therapies for inborn errors of metabolism: what has the orphan drug act delivered?

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Talele, Sonali S; Xu, Kui; Pariser, Anne R; Braun, M Miles; Farag-El-Massah, Sheiren; Phillips, M Ian; Thompson, Barry H; Coté, Timothy R

2010-07-01

The 1983 US Orphan Drug Act established a process through which promising therapies are designated as orphan products and, later, with satisfactory safety and efficacy data, receive marketing approval and fiscal incentives. We examined accomplishments in drug development for inborn errors of metabolism (IEMs). Food and Drug Administration data were used to identify orphan product designations and approvals for IEMs, and the trends for the past 26 years were summarized. Individual clinical development times (CDTs) from filing investigational new drug application to marketing approval were determined. We examined 1956 orphan product designations from 1983 through 2008 and found 93 (4.8%) for IEMs. Of those, 24 (25.8%) received marketing approval. This proportion of approval was significantly (P = .036) higher than that for non-IEM orphan products (17%). Among the IEM products, disorders of complex molecules received the most designations and approvals (61 and 11, respectively). Among the subgroups, lysosomal storage diseases received the most designations and approvals (43 and 9, respectively), whereas mitochondrial diseases (other than fatty acid oxidation disorders) received 7 designations with no approvals. We then examined the CDTs for the approved IEM products and found a median of 6.4 years (range: 2.6-25.1 years). Biological products had significantly shorter CDTs than drugs (mean: 4.6 vs 11.0 years; P = .003). For 26 years, the Orphan Drug Act has generated new therapies for IEMs. Why some IEMs have motivated successful drug development and others have not remains enigmatic; yet the needs of IEM patients without treatment are a certainty.

Fertility among orphans in rural Malawi: challenging common assumptions about risk and mechanisms.

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Kidman, Rachel; Anglewicz, Philip

2014-12-01

Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love. Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15-25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death. Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47). The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.

Maternal-related deaths and impoverishment among adolescent girls in India and Niger: findings from a modelling study.

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Verguet, Stéphane; Nandi, Arindam; Filippi, Véronique; Bundy, Donald A P

2016-09-26

High levels of maternal mortality and large associated inequalities exist in low-income and middle-income countries. Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty. We examined the distribution across socioeconomic groups of maternal deaths and impoverishment among adolescent girls (15-19 years old) in Niger, which has the highest total fertility rate globally, and India, which has the largest number of maternal deaths. In Niger and India, among adolescent girls, we estimated the distribution per income quintile of: the number of maternal deaths; and the impoverishment, measured by calculating the number of cases of catastrophic health expenditure incurred, caused by complicated pregnancies. We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year. We used epidemiological and cost inputs sourced from surveys and the literature. The number of maternal deaths would be larger among the poorer adolescents than among the richer adolescents in Niger and India. Impoverishment would largely incur among the richer adolescents in Niger and among the poorer adolescents in India. Increasing educational attainment of adolescent girls might avert both a large number of maternal deaths and a significant number of cases of catastrophic health expenditure in the 2 countries. Adolescent pregnancies can lead to large equity gaps and substantial impoverishment in low-income and middle-income countries. Increasing female education can reduce such inequalities and provide financial risk protection and poverty alleviation to adolescent girls. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Challenges of ligand identification for the second wave of orphan riboswitch candidates.

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Greenlee, Etienne B; Stav, Shira; Atilho, Ruben M; Brewer, Kenneth I; Harris, Kimberly A; Malkowski, Sarah N; Mirihana Arachchilage, Gayan; Perkins, Kevin R; Sherlock, Madeline E; Breaker, Ronald R

2018-03-04

Orphan riboswitch candidates are noncoding RNA motifs whose representatives are believed to function as genetic regulatory elements, but whose target ligands have yet to be identified. The study of certain orphans, particularly classes that have resisted experimental validation for many years, has led to the discovery of important biological pathways and processes once their ligands were identified. Previously, we highlighted details for four of the most common and intriguing orphan riboswitch candidates. This facilitated the validation of riboswitches for the signaling molecules c-di-AMP, ZTP, and ppGpp, the metal ion Mn 2+ , and the metabolites guanidine and PRPP. Such studies also yield useful linkages between the ligands sensed by the riboswitches and numerous biochemical pathways. In the current report, we describe the known characteristics of 30 distinct classes of orphan riboswitch candidates - some of which have remained unsolved for over a decade. We also discuss the prospects for uncovering novel biological insights via focused studies on these RNAs. Lastly, we make recommendations for experimental objectives along the path to finding ligands for these mysterious RNAs.

Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

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Iskrov G

2014-01-01

Full Text Available Georgi Iskrov, Rumen Stefanov Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria Abstract: This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisciplinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug

Acute stress in adulthood impoverishes social choices and triggers aggressiveness in preclinical models

Directory of Open Access Journals (Sweden)

Anne eNosjean

2015-01-01

Full Text Available Adult C57BL/6J mice are known to exhibit high level of social flexibility while mice lacking the β2 subunit of nicotinic receptors (β2-/- mice present social rigidity. We asked ourselves what would be the consequences of a restraint acute stress (45 min on social interactions in adult mice of both genotypes, hence the contribution of neuronal nicotinic receptors in this process. We therefore dissected social interaction complexity of stressed and not stressed dyads of mice in a social interaction task. We also measured plasma corticosterone levels in our experimental conditions. We showed that a single stress exposure occurring in adulthood reduced and disorganized social interaction complexity in both C57BL/6J and β2-/- mice. These stress-induced maladaptive social interactions involved alteration of distinct social categories and strategies in both genotypes, suggesting a dissociable impact of stress depending on the functioning of the cholinergic nicotinic system. In both genotypes, social behaviors under stress were coupled to aggressive reactions with no plasma corticosterone changes. Thus, aggressiveness appeared a general response independent of nicotinic function. We demonstrate here that a single stress exposure occurring in adulthood is sufficient to impoverish social interactions: stress impaired social flexibility in C57BL/6J mice whereas it reinforced β2-/- mice behavioral rigidity.

Acute stress in adulthood impoverishes social choices and triggers aggressiveness in preclinical models.

Science.gov (United States)

Nosjean, Anne; Cressant, Arnaud; de Chaumont, Fabrice; Olivo-Marin, Jean-Christophe; Chauveau, Frédéric; Granon, Sylvie

2014-01-01

Adult C57BL/6J mice are known to exhibit high level of social flexibility while mice lacking the β2 subunit of nicotinic receptors (β2(-/-) mice) present social rigidity. We asked ourselves what would be the consequences of a restraint acute stress (45 min) on social interactions in adult mice of both genotypes, hence the contribution of neuronal nicotinic receptors in this process. We therefore dissected social interaction complexity of stressed and not stressed dyads of mice in a social interaction task. We also measured plasma corticosterone levels in our experimental conditions. We showed that a single stress exposure occurring in adulthood reduced and disorganized social interaction complexity in both C57BL/6J and β2(-/-) mice. These stress-induced maladaptive social interactions involved alteration of distinct social categories and strategies in both genotypes, suggesting a dissociable impact of stress depending on the functioning of the cholinergic nicotinic system. In both genotypes, social behaviors under stress were coupled to aggressive reactions with no plasma corticosterone changes. Thus, aggressiveness appeared a general response independent of nicotinic function. We demonstrate here that a single stress exposure occurring in adulthood is sufficient to impoverish social interactions: stress impaired social flexibility in C57BL/6J mice whereas it reinforced β2(-/-) mice behavioral rigidity.

Acute stress in adulthood impoverishes social choices and triggers aggressiveness in preclinical models

Science.gov (United States)

Nosjean, Anne; Cressant, Arnaud; de Chaumont, Fabrice; Olivo-Marin, Jean-Christophe; Chauveau, Frédéric; Granon, Sylvie

2015-01-01

Adult C57BL/6J mice are known to exhibit high level of social flexibility while mice lacking the β2 subunit of nicotinic receptors (β2−/− mice) present social rigidity. We asked ourselves what would be the consequences of a restraint acute stress (45 min) on social interactions in adult mice of both genotypes, hence the contribution of neuronal nicotinic receptors in this process. We therefore dissected social interaction complexity of stressed and not stressed dyads of mice in a social interaction task. We also measured plasma corticosterone levels in our experimental conditions. We showed that a single stress exposure occurring in adulthood reduced and disorganized social interaction complexity in both C57BL/6J and β2−/− mice. These stress-induced maladaptive social interactions involved alteration of distinct social categories and strategies in both genotypes, suggesting a dissociable impact of stress depending on the functioning of the cholinergic nicotinic system. In both genotypes, social behaviors under stress were coupled to aggressive reactions with no plasma corticosterone changes. Thus, aggressiveness appeared a general response independent of nicotinic function. We demonstrate here that a single stress exposure occurring in adulthood is sufficient to impoverish social interactions: stress impaired social flexibility in C57BL/6J mice whereas it reinforced β2−/− mice behavioral rigidity. PMID:25610381

A Regulatory Network Analysis of Orphan Genes in Arabidopsis Thaliana

Science.gov (United States)

Singh, Pramesh; Chen, Tianlong; Arendsee, Zebulun; Wurtele, Eve S.; Bassler, Kevin E.

Orphan genes, which are genes unique to each particular species, have recently drawn significant attention for their potential usefulness for organismal robustness. Their origin and regulatory interaction patterns remain largely undiscovered. Recently, methods that use the context likelihood of relatedness to infer a network followed by modularity maximizing community detection algorithms on the inferred network to find the functional structure of regulatory networks were shown to be effective. We apply improved versions of these methods to gene expression data from Arabidopsis thaliana, identify groups (clusters) of interacting genes with related patterns of expression and analyze the structure within those groups. Focusing on clusters that contain orphan genes, we compare the identified clusters to gene ontology (GO) terms, regulons, and pathway designations and analyze their hierarchical structure. We predict new regulatory interactions and unravel the structure of the regulatory interaction patterns of orphan genes. Work supported by the NSF through Grants DMR-1507371 and IOS-1546858.

Cellular and molecular biology of orphan G protein-coupled receptors.

Science.gov (United States)

Oh, Da Young; Kim, Kyungjin; Kwon, Hyuk Bang; Seong, Jae Young

2006-01-01

The superfamily of G protein-coupled receptors (GPCRs) is the largest and most diverse group of membrane-spanning proteins. It plays a variety of roles in pathophysiological processes by transmitting extracellular signals to cells via heterotrimeric G proteins. Completion of the human genome project revealed the presence of approximately 168 genes encoding established nonsensory GPCRs, as well as 207 genes predicted to encode novel GPCRs for which the natural ligands remained to be identified, the so-called orphan GPCRs. Eighty-six of these orphans have now been paired to novel or previously known molecules, and 121 remain to be deorphaned. A better understanding of the GPCR structures and classification; knowledge of the receptor activation mechanism, either dependent on or independent of an agonist; increased understanding of the control of GPCR-mediated signal transduction; and development of appropriate ligand screening systems may improve the probability of discovering novel ligands for the remaining orphan GPCRs.

Using a Calendar and Explanatory Instructions to Aid Within-Household Selection in Mail Surveys

Science.gov (United States)

Stange, Mathew; Smyth, Jolene D.; Olson, Kristen

2016-01-01

Although researchers can easily select probability samples of addresses using the U.S. Postal Service's Delivery Sequence File, randomly selecting respondents within households for surveys remains challenging. Researchers often place within-household selection instructions, such as the next or last birthday methods, in survey cover letters to…

Rapid identification of sequences for orphan enzymes to power accurate protein annotation.

Directory of Open Access Journals (Sweden)

Kevin R Ramkissoon

Full Text Available The power of genome sequencing depends on the ability to understand what those genes and their proteins products actually do. The automated methods used to assign functions to putative proteins in newly sequenced organisms are limited by the size of our library of proteins with both known function and sequence. Unfortunately this library grows slowly, lagging well behind the rapid increase in novel protein sequences produced by modern genome sequencing methods. One potential source for rapidly expanding this functional library is the "back catalog" of enzymology--"orphan enzymes," those enzymes that have been characterized and yet lack any associated sequence. There are hundreds of orphan enzymes in the Enzyme Commission (EC database alone. In this study, we demonstrate how this orphan enzyme "back catalog" is a fertile source for rapidly advancing the state of protein annotation. Starting from three orphan enzyme samples, we applied mass-spectrometry based analysis and computational methods (including sequence similarity networks, sequence and structural alignments, and operon context analysis to rapidly identify the specific sequence for each orphan while avoiding the most time- and labor-intensive aspects of typical sequence identifications. We then used these three new sequences to more accurately predict the catalytic function of 385 previously uncharacterized or misannotated proteins. We expect that this kind of rapid sequence identification could be efficiently applied on a larger scale to make enzymology's "back catalog" another powerful tool to drive accurate genome annotation.

Rapid Identification of Sequences for Orphan Enzymes to Power Accurate Protein Annotation

Science.gov (United States)

Ojha, Sunil; Watson, Douglas S.; Bomar, Martha G.; Galande, Amit K.; Shearer, Alexander G.

2013-01-01

The power of genome sequencing depends on the ability to understand what those genes and their proteins products actually do. The automated methods used to assign functions to putative proteins in newly sequenced organisms are limited by the size of our library of proteins with both known function and sequence. Unfortunately this library grows slowly, lagging well behind the rapid increase in novel protein sequences produced by modern genome sequencing methods. One potential source for rapidly expanding this functional library is the “back catalog” of enzymology – “orphan enzymes,” those enzymes that have been characterized and yet lack any associated sequence. There are hundreds of orphan enzymes in the Enzyme Commission (EC) database alone. In this study, we demonstrate how this orphan enzyme “back catalog” is a fertile source for rapidly advancing the state of protein annotation. Starting from three orphan enzyme samples, we applied mass-spectrometry based analysis and computational methods (including sequence similarity networks, sequence and structural alignments, and operon context analysis) to rapidly identify the specific sequence for each orphan while avoiding the most time- and labor-intensive aspects of typical sequence identifications. We then used these three new sequences to more accurately predict the catalytic function of 385 previously uncharacterized or misannotated proteins. We expect that this kind of rapid sequence identification could be efficiently applied on a larger scale to make enzymology’s “back catalog” another powerful tool to drive accurate genome annotation. PMID:24386392

Computer-aided discovery of aromatic L-α-amino acids as agonists of the orphan G protein-coupled receptor GPR139

DEFF Research Database (Denmark)

Ísberg, Vignir; Andersen, Kirsten Bayer; Bisig, Christoph

2014-01-01

GPR139 is an orphan G protein-coupled receptor expressed mainly in the central nervous system. We developed a pharmacophore model based on known GPR139 surrogate agonists which led us to propose aromatic-containing dipeptides as potential ligands. Upon testing, the dipeptides demonstrated agonism...... in the Gq pathway. Next, testing all 20 proteinogenic L-α-amino acids; L-tryptophan and L-phenylalanine were found to have EC50 values of 220 µM and 320 µM, respectively, making them the first putative endogenous agonists for GPR139....

The handling with orphan sources of ionizing radiation in Belarus

International Nuclear Information System (INIS)

Dubrovskij, A.I.; Beresneva, V.A.; Pribylev, S.V.

2013-01-01

In Belarus, the emergency response actions, when detecting orphan sources, provide specific organs of government within their competence. Overall coordination and work on the collection, processing, exchange, accounting and transfer in the established order information about the sources of ionizing radiation interacting organs and relevant international organizations assigned to the Emergency Situations Ministry. Created in Belarus response system in case of detection of orphan sources can provide the level of emergency preparedness and response, and generally satisfy international best practice in this area. (authors)

Stirling engine based micro co-generation system for single households

Energy Technology Data Exchange (ETDEWEB)

Ribberink, H.; Zutt, S.; Rabou, L.; Beckers, G. [Netherlands Energy Research Foundation (ECN), Petten (Netherlands); Baijens, K.; Luttikholt, J. [Atag Verwarming BV (Netherlands)

2000-07-01

This paper describes the progress made in the ENATEC development program for a free piston Stirling engine based micro co-generation system that serves the supply of up to 1 kW{sub e} and up to 24 kW heat for domestic heating and/or for hot tap water production for single households at overall system efficiencies of 96%: Experiments show that the free piston Stirling engines from Stirling Technology Company run very reliably and controllably, and that the efficiency targets for the 1 kW{sub e} micro co-generation system are feasible. A ceramic foam burner with good heat transfer characteristics and low NOx emissions was developed. A demonstration micro co-generation unit was built and successfully presented. A 1 kW{sub e} free piston Stirling engine for the European market was developed. High efficiencies at full load and at part load, low emissions, low noise, and minimum maintenance make the Stirling engine based micro co-generation system an attractive candidate for the next generation of domestic boilers in Europe. (orig.)

An ultra-HTS process for the identification of small molecule modulators of orphan G-protein-coupled receptors.

Science.gov (United States)

Cacace, Angela; Banks, Martyn; Spicer, Timothy; Civoli, Francesca; Watson, John

2003-09-01

G-protein-coupled receptors (GPCRs) are the most successful target proteins for drug discovery research to date. More than 150 orphan GPCRs of potential therapeutic interest have been identified for which no activating ligands or biological functions are known. One of the greatest challenges in the pharmaceutical industry is to link these orphan GPCRs with human diseases. Highly automated parallel approaches that integrate ultra-high throughput and focused screening can be used to identify small molecule modulators of orphan GPCRs. These small molecules can then be employed as pharmacological tools to explore the function of orphan receptors in models of human disease. In this review, we describe methods that utilize powerful ultra-high-throughput screening technologies to identify surrogate ligands of orphan GPCRs.

National strategies for improving control over orphan sources of ionising radiation

International Nuclear Information System (INIS)

Nizamska, M.

2007-01-01

Since 1989 Bulgaria started reformation of economy sector. Part of this process is the intensive privatisation, as well as in the sited using radioactive materials for different applications - industry, medicine, agriculture, etc. The quick change of property ownership results in difficulties to identify the assessor of radioactive source or material and finally led to appearance of orphan sources. A orphan source is defined as a source that poses sufficient radiological hazard to warrant regulatory control, but which is not under regulatory control because it has never been so, or because it has been abandoned, lost, misplaced, stolen or otherwise transferred without proper authorisation. A face on these problems, Bulgaria is performing a series of measure to improve the control over orphan sources and to strengthening the control over the nuclear and radioactive materials. The report presents briefly this measures. (author)

Psychological Characteristics of Adolescents Orphans with Different Experience of Living in a Family

Science.gov (United States)

Shulga, Tatyana I.; Savchenko, Daria D.; Filinkova, Evgeniya B.

2016-01-01

The complexity of settling adolescents-orphans in foster families and significant number of break-downs in these families are the problems which determine the relevance of current research. Many adolescent orphans get in social institutions repeatedly, because their psychological features lead to difficulties that their foster parents are unable…

Households' vulnerability and responses to shocks: evidence from rural Kenya

NARCIS (Netherlands)

Ndirangu, L.

2007-01-01

Key words: Vulnerability, HIV/AIDS, weather shocks, risk management, coping strategies, rural households, gender. Empirical investigation on household’s responses to sources of vulnerability is important for designing and implementation of social policies. The design of an effective

Single, Divorced, or Separated? Factors That Impact the Lives of Women Who Are Heads of Household in Lima, Peru

Directory of Open Access Journals (Sweden)

Beatriz Alvarado

2015-10-01

Full Text Available The rupture of a conjugal relationship has both a positive and negative impact on the lives of immediate family members. Although for many women terminating marriage may signal freedom from an oppressive, even violent conjugal relationship, it is undeniable that this separation also results in strong social pressure and discrimination in certain contexts, a situation which limits the woman’s freedom of action in and outside of the home. The purpose of this descriptive, phenomenological study is to explore the experiences of 15 Peruvian, urban-based mothers, all of whom made the decision to exchange marriage for single parenthood within the confines of a strong patriarchal system. The study follows the actions of the women as they seek to overcome obstacles related to parenting and the management of their respective households. Three emerging themes are identified in this study: (a the development of the woman’s relationship as wife and mother, (b impact of the separation/divorce on the maternal role, and (c experiences in the single parent household. Implications for social research studies and practice are discussed.

Constitutive Activity among Orphan Class-A G Protein Coupled Receptors.

Directory of Open Access Journals (Sweden)

Adam L Martin

Full Text Available The purpose of this study was to evaluate the extent of constitutive activity among orphan class-A G protein coupled receptors within the cAMP signaling pathway. Constitutive signaling was revealed by changes in gene expression under control of the cAMP response element. Gene expression was measured in Chinese hamster ovary cells transiently co-transfected with plasmids containing a luciferase reporter and orphan receptor. Criteria adopted for defining constitutive activation were: 1 200% elevation over baseline reporter gene expression; 2 40% inhibition of baseline expression; and 3 40% inhibition of expression stimulated by 3 μM forskolin. Five patterns of activity were noted: 1 inhibition under both baseline and forskolin stimulated expression (GPR15, GPR17, GPR18, GPR20, GPR25, GPR27, GPR31, GPR32, GPR45, GPR57, GPR68, GPR83, GPR84, GPR132, GPR150, GPR176; 2 no effect on baseline expression, but inhibition of forskolin stimulated expression (GPR4, GPR26, GPR61, GPR62, GPR78, GPR101, GPR119; 3 elevation of baseline signaling coupled with inhibition of forskolin stimulated expression (GPR6, GPR12; 4 elevation of baseline signaling without inhibition of forskolin stimulated expression (GPR3, GPR21, GPR52, GPR65; and 5 no effect on expression (GPR1, GPR19, GPR22, GPR34, GPR35, GPR39, GPR63, GPR82, GPR85, GPR87. Constitutive activity was observed in 75% of the orphan class-A receptors examined (30 of 40. This constitutive signaling cannot be explained by simple overexpression of the receptor. Inhibition of cAMP mediated expression was far more common (65% than stimulation of expression (15%. Orphan receptors that were closely related based on amino acid homology tended to have similar effects on gene expression. These results suggest that identification of inverse agonists may be a fruitful approach for categorizing these orphan receptors and targeting them for pharmacological intervention.

Constitutive Activity among Orphan Class-A G Protein Coupled Receptors.

Science.gov (United States)

Martin, Adam L; Steurer, Michael A; Aronstam, Robert S

2015-01-01

The purpose of this study was to evaluate the extent of constitutive activity among orphan class-A G protein coupled receptors within the cAMP signaling pathway. Constitutive signaling was revealed by changes in gene expression under control of the cAMP response element. Gene expression was measured in Chinese hamster ovary cells transiently co-transfected with plasmids containing a luciferase reporter and orphan receptor. Criteria adopted for defining constitutive activation were: 1) 200% elevation over baseline reporter gene expression; 2) 40% inhibition of baseline expression; and 3) 40% inhibition of expression stimulated by 3 μM forskolin. Five patterns of activity were noted: 1) inhibition under both baseline and forskolin stimulated expression (GPR15, GPR17, GPR18, GPR20, GPR25, GPR27, GPR31, GPR32, GPR45, GPR57, GPR68, GPR83, GPR84, GPR132, GPR150, GPR176); 2) no effect on baseline expression, but inhibition of forskolin stimulated expression (GPR4, GPR26, GPR61, GPR62, GPR78, GPR101, GPR119); 3) elevation of baseline signaling coupled with inhibition of forskolin stimulated expression (GPR6, GPR12); 4) elevation of baseline signaling without inhibition of forskolin stimulated expression (GPR3, GPR21, GPR52, GPR65); and 5) no effect on expression (GPR1, GPR19, GPR22, GPR34, GPR35, GPR39, GPR63, GPR82, GPR85, GPR87). Constitutive activity was observed in 75% of the orphan class-A receptors examined (30 of 40). This constitutive signaling cannot be explained by simple overexpression of the receptor. Inhibition of cAMP mediated expression was far more common (65%) than stimulation of expression (15%). Orphan receptors that were closely related based on amino acid homology tended to have similar effects on gene expression. These results suggest that identification of inverse agonists may be a fruitful approach for categorizing these orphan receptors and targeting them for pharmacological intervention.

The role of Vinca Institute in national Orphan sources recovery program

International Nuclear Information System (INIS)

Orlic, Milan; Pavlovic, Snezana; Gajic-Kvascev, Maja

2008-01-01

Full text: According with establishing of radiation safety regulatory system of Republic of Serbia, Goverment of Republic of Serbia in cooperation with international community (IAEA, DOE), has developed a national Orphan sources recovery program. The role, possibilities the results of Vinca Institute in that program has been presented in this paper. The main goal of the program is to put all orphan sources found in Serbia in storage in Vinca Institute, and restore regulatory control. In this paper existing state of Orphan sources programe, goals of the system development, programmes for seaching of sources, plans, stuff education and training are given. Special concern was given to planning process for seaching of sources. It includes decission on location to be treated, quantity and types of expected source estimation and resources wich will be used. Plan of training includes radiation protection and quality assurance aspects. (author)

Orphan Drug Pricing: An Original Exponential Model Relating Price to the Number of Patients

Directory of Open Access Journals (Sweden)

Andrea Messori

2016-10-01

Full Text Available In managing drug prices at the national level, orphan drugs represent a special case because the price of these agents is higher than that determined according to value-based principles. A common practice is to set the orphan drug price in an inverse relationship with the number of patients, so that the price increases as the number of patients decreases. Determination of prices in this context generally has a purely empirical nature, but a theoretical basis would be needed. The present paper describes an original exponential model that manages the relationship between price and number of patients for orphan drugs. Three real examples are analysed in detail (eculizumab, bosentan, and a data set of 17 orphan drugs published in 2010. These analyses have been aimed at identifying some objective criteria to rationally inform this relationship between prices and patients and at converting these criteria into explicit quantitative rules.

Do payers value rarity? : An analysis of the relationship between disease rarity and orphan drug prices in Europe

NARCIS (Netherlands)

Medic, Goran; Korchagina, Daria; Young, Katherine Eve; Toumi, Mondher; Postma, Maarten Jacobus; Wille, Micheline; Hemels, Michiel

2017-01-01

Background and Objective: Orphan drugs have been a highlight of discussions due to their higher prices than non-orphan drugs. There is currently no European consensus on the method of value assessment for orphan drugs. This study assessed the relationship between the prevalence of rare diseases and

orphans in mediterranean antiquity and early christianity

African Journals Online (AJOL)

animalium 588a8).3 Yet we must immediately qualify these studies and statements by .... of Anna in Luke 2:3637, who was married for just seven years, yet was still living as a ... has unlimited power, whereas the orphan has none. In what ...

Awareness And Knowledge Of HIV and AIDS In The Fishing ...

African Journals Online (AJOL)

The issue of HIV and AIDS among rural households has become important topic worldwide both in developing and developed countries Rural households run a high risk of being infected with the disease and are capable of transmitting it to others thereby reducing labour force for agricultural and other rural livelihood ...

Histone H3.3 promotes IgV gene diversification by?enhancing formation of AID?accessible single?stranded DNA

OpenAIRE

Romanello, Marina; Schiavone, Davide; Frey, Alexander; Sale, Julian E

2016-01-01

Abstract Immunoglobulin diversification is driven by activation?induced deaminase (AID), which converts cytidine to uracil within the Ig variable (IgV) regions. Central to the recruitment of AID to the IgV genes are factors that regulate the generation of single?stranded DNA (ssDNA), the enzymatic substrate of AID. Here, we report that chicken DT40 cells lacking variant histone H3.3 exhibit reduced IgV sequence diversification. We show that this results from impairment of the ability of AID t...

Household food security and HIV status in rural and urban ...

African Journals Online (AJOL)

Household food security and HIV status in rural and urban communities in the Free State ... SAHARA-J: Journal of Social Aspects of HIV/AIDS ... In all areas, a high percentage of HIV-infected respondents relied on a limited number of foods to ...

High GC content causes orphan proteins to be intrinsically disordered.

Directory of Open Access Journals (Sweden)

Walter Basile

2017-03-01

Full Text Available De novo creation of protein coding genes involves the formation of short ORFs from noncoding regions; some of these ORFs might then become fixed in the population. These orphan proteins need to, at the bare minimum, not cause serious harm to the organism, meaning that they should for instance not aggregate. Therefore, although the creation of short ORFs could be truly random, the fixation should be subjected to some selective pressure. The selective forces acting on orphan proteins have been elusive, and contradictory results have been reported. In Drosophila young proteins are more disordered than ancient ones, while the opposite trend is present in yeast. To the best of our knowledge no valid explanation for this difference has been proposed. To solve this riddle we studied structural properties and age of proteins in 187 eukaryotic organisms. We find that, with the exception of length, there are only small differences in the properties between proteins of different ages. However, when we take the GC content into account we noted that it could explain the opposite trends observed for orphans in yeast (low GC and Drosophila (high GC. GC content is correlated with codons coding for disorder promoting amino acids. This leads us to propose that intrinsic disorder is not a strong determining factor for fixation of orphan proteins. Instead these proteins largely resemble random proteins given a particular GC level. During evolution the properties of a protein change faster than the GC level causing the relationship between disorder and GC to gradually weaken.

Orphan Products: Hope for People with Rare Diseases

Science.gov (United States)

... drug and biologics manufacturers, including tax credits for costs of clinical research, government grant funding, assistance for clinical research, and a seven-year period of exclusive marketing given to the first sponsor of an orphan- ...

Does food aid disrupt local food market?

OpenAIRE

Ferrière, Nathalie; Suwa-Eisenmann, Akiko

2014-01-01

This paper analyses empirically the impact of food aid on production, sales and purchases. We estimate the discrete choice and the level choice using the Ethiopian rural household survey. The panel dimension allows us to deal with food aid selection. Running a panel Tobit with sample selection and endogeneity we find that food aid reduces the probability of being a producer. It increases the one of being a seller and decreases the one of being a buyer only after 2004 that corresponds to chang...

Household Food Security Policy Analysis A System Dynamics Perspective

Directory of Open Access Journals (Sweden)

Isdore Paterson Guma

2015-08-01

Full Text Available Household food security FS is complex and requires multiple stakeholder intervention. Systemic approach aids stakeholders to understand the mechanisms and feedback between complexities in food security providing effective decision making as global resource consumption continues to grow. The study investigated food security challenges and a system dynamics model was developed for evaluating policies and intervention strategies for better livelihood at household level. Dynamic synthesis methodology questionnaires and interview guide were used to unearth food security challenges faced by households. A causal loop diagram was drawn. The model demonstrates a balance between food stock seeds preserved seeds for sale and consumption from crop harvest throughout the food cycles. This research makes contribution to the literature by evaluating dynamic synthesis methodology and FS policy discussions from a feedback point of view.

Student Aid Simplification: Looking Back and Looking Ahead

OpenAIRE

Dynarski, Susan; Wiederspan, Mark

2012-01-01

Each year, 14 million households seeking federal aid for college complete a detailed questionnaire about their finances, the Free Application for Federal Student Aid (FAFSA). With 116 questions, the FAFSA is almost as long as IRS Form 1040 and substantially longer than Forms 1040EZ and 1040A. Aid for college is intended to increase college attendance by reducing its price and loosening liquidity constraints. Economic theory, empirical evidence, and common sense suggest that complexity in appl...

The prevalence of HIV and AIDS and average demographic data in ...

African Journals Online (AJOL)

HIV infection and AIDS are non-notifiable conditions with a serious effect on forestry contracting businesses due to the effect on human resource productivity. The condition affects households as it burdens the household income, affects breadwinners and the family. With information available concerning the prevalence rate ...

What is known about the cost-effectiveness of orphan drugs? Evidence from cost-utility analyses.

Science.gov (United States)

Picavet, E; Cassiman, D; Simoens, S

2015-06-01

In times of financial and economic hardship, governments are looking to contain pharmaceutical expenditure by focusing on cost-effective drugs. Because of their high prices and difficulties in demonstrating effectiveness in small patient populations, orphan drugs are often perceived as not able to meet traditional reimbursement threshold value for money. The aim of this study was to provide an overview of the available evidence on the cost-effectiveness of orphan drugs. All orphan drugs listed as authorized on the website of the European Medicines Agency on 21 November 2013 were included in the analysis. Cost-utility analyses (CUAs) were identified by searching the Tufts Medical Center Cost-Effectiveness Analysis Registry and Embase. For each CUA, a number of variables were collected. The search identified 23 articles on the Tufts registry and 167 articles on Embase. The final analysis included 45 CUAs and 61 incremental cost-utility ratios (ICURs) for 19 orphan drugs. Of all ICURS, 16·3% were related to dominant drugs (i.e. more effective and less expensive than the comparator), 70·5% were related to drugs that are more effective, but at a higher cost, and 13·1% were related to dominated drugs (i.e. less effective and more expensive than the comparator). The median overall ICUR was €40 242 per quality-adjusted life year (QALY) with a minimum ICUR of €6311/QALY and a maximum ICUR of €974,917/QALY. This study demonstrates that orphan drugs can meet traditional reimbursement thresholds. Considering a threshold of £30,000/QALY, in this study, ten (52·6%) of a total of 19 orphan drugs for which data were available meet the threshold. As much as fifteen orphan drugs (78·9%) are eligible for reimbursement if a threshold of €80,000/QALY is considered. © 2015 John Wiley & Sons Ltd.

Control of orphan sources. Import to and transport through Slovenia

International Nuclear Information System (INIS)

Cesarek, J.; Vokal Nemec, B.

2007-01-01

Orphan sources are radioactive sources which are not under regulatory control, either because they have never been under regulatory control, or because they have been abandoned, lost, misplaced, stolen or transferred without proper authorisation. The issue of orphan sources is not a new one but the situation has been highlighted more and more in the last ten years. One of the most important international milestones in this regard was the conference in Dijon, France in 1998. The orphan sources have become an international problem due to steady increase in international trade which made impossible to control every transfer of goods between countries. Shipments of metal scrap, either national or international, could comprise orphan sources which had come into metal stream. The consequences of such events vary greatly: from contaminated metal just above exemption levels to a melting of volatile radionuclides of significant activity which may cause enormous remediation costs. In addition, the phenomenon of deliberate abuse of nuclear material and radioactive material or previous accidents with found orphan sources worldwide and fatalities have made this issue even more provoking. In Slovenia, no such drastic events have occurred so far. Since 1991 there have been a few meltings of cobalt-60 sources with only economic impact. On several occasions, Italy - the country with strict import control - has detected elevated radiation and denied shipments of scrap metal. They had originated either from Slovenia or from other countries, mostly from former Yugoslav republics. The Slovenian experience shows that majority of cases is related to import of scrap metal in Slovenia or to transit of such material through Slovenia. These orphan sources have originated from past industrial activities or have been under no or weak regulatory control in their countries of origin. In order to prevent inadvertent movement and illicit trafficking of nuclear material and radioactive sources some

Shifting the burden: the private sector's response to the AIDS epidemic in Africa.

Science.gov (United States)

Rosen, Sydney; Simon, Jonathon L.

2003-01-01

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved. PMID:12751421

Shifting the burden: the private sector's response to the AIDS epidemic in Africa.

Science.gov (United States)

Rosen, Sydney; Simon, Jonathon L

2003-01-01

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved.

Orphan Drug Regulation: A missed opportunity for children and adolescents with cancer.

Science.gov (United States)

Vassal, Gilles; Kearns, Pam; Blanc, Patricia; Scobie, Nicole; Heenen, Delphine; Pearson, Andy

2017-10-01

Oncology represents a major sector in the field of orphan drug development in Europe. The objective was to evaluate whether children and adolescents with cancer benefited from the Orphan Drug Regulation. Data on orphan drug designations (ODDs) and registered orphan drugs from 8th August 2000 to 10th September 2016 were collected from the Community Register of medicinal products for human use. Assessment history, product information and existence of paediatric investigation plans were searched and retrieved from the European Medicine Agency website. Over 16 years, 272 of 657 oncology ODDs (41%) concerned a malignant condition occurring both in adults and children. The five most common were acute myeloid leukaemia, high-grade glioma, acute lymphoblastic leukaemia, graft-versus-host disease and soft-tissue sarcomas. 74% of 31 marketing authorisations (MAs) for an indication both in adults and children (26 medicines) had no information for paediatric use in their Summary of Product Characteristics (SmPC) at the time of the first MA. Furthermore, 68% still have no paediatric information in their most recently updated SmPC, at a median of 7 years after. Only 15 ODDs (2%) pertained to a malignancy occurring specifically in children and only two drugs received an MA: Unituxin for high-risk neuroblastoma and Votubia for sub-ependymal giant-cell astrocytoma. The Orphan Drug Regulation failed to promote the development of innovative therapies for malignancies occurring in children. Major delays and waivers occurred through the application of the Paediatric Medicines Regulation. The European regulatory environment needs to be improved to accelerate innovation for children and adolescents dying of cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures.

Science.gov (United States)

Danzon, Patricia M

2018-03-01

To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The role of globalization in drug development and access to orphan drugs: orphan drug legislation in the US/EU and in Latin America.

Science.gov (United States)

Arnold, Renée J G; Bighash, Lida; Bryón Nieto, Alejandro; Tannus Branco de Araújo, Gabriela; Gay-Molina, Juan Gabriel; Augustovski, Federico

2015-01-01

Compared to a decade ago, nearly three times as many drugs for rare diseases are slated for development. This article addresses the market access issues associated with orphan drug status in Europe and the United States in contrast to the legislation in five Latin American (LA) countries that have made strides in this regard--Mexico, Brazil, Colombia, Chile and Argentina. Based on the success of orphan drug legislation in the EU and US, LA countries should strive to adopt similar strategies with regard to rare diseases and drug development. With the implementation of new targeted regulations, reimbursement strategies, and drug approvals, accessibility to treatment will be improved for people afflicted with rare diseases in these developing countries.

Orphans in the Dead Sea Scrolls

African Journals Online (AJOL)

2016-08-12

Aug 12, 2016 ... ISSN: (Online) 2072-8050, (Print) 0259-9422 ... Orphans also feature in some non-biblical compositions of the .... (ntk ἰt n nmḥ hἰ n ḫᴈrt sn n wḏᶜt šndyt nt ἰwty mwt.f) (P.Berlin .... Collins (2010:7) defines 'sect' in the following ...... 2014, Social and economic life in second temple Judea, Westminster John.

Perceptions of health promoters about health promotion programmes for families with adolescents orphaned as a result of AIDS in the rural Hammanskraal region in South Africa

Directory of Open Access Journals (Sweden)

Maseapo P. Mthobeni

2013-02-01

Full Text Available South African communities are still greatly affected by the high rate of infection with HIV or who are living with AIDS, mirrored in the 2008 overall national HIV prevalence of 29.3%(UNAIDS 2010:10. In addressing the challenge, the health system is dependent on community care level workers such as caregivers to render health promotion and education in the homes and communities. The caregivers based in the communities are the ones with first-hand information on what is needed for the success of health promotion programmes. This study, aimed at exploring the challenges faced by the health promoters, described their perceptions regarding a health promotion programme for families with adolescents orphaned as a result of AIDS. Data were collected on the purposively selected participants at the rural Hammanskraal region in South Africa and the research question: ‘What is your perception regarding health promotion programmes for families with adolescents orphaned as a result of AIDS’ was asked and discussed by participants in a focus group interview. Data were analysed using the adapted Tesch method to organize and isolate the main categories, sub-categories and themes. The following main categories were isolated: attitudes of adolescents, effectiveness of home visits, need for health education and limited resources. Based on the findings, it was therefore recommended that health care planners assist in the improvement of health promotion and education by using the community and national media, providing information material and providing access to the internet in order to allow more people, including young people, to access the information.Suid-Afrikaanse gemeenskappe word steeds grootliks beïnvloed deur die hoë vlak van MIV en vigs, soos weerspieël in die algehele nasionale MIV-syfer in 2008 van 29.3% (UNAIDS 2010:10. In die aanspreek van hierdie uitdaging is die gesondheidstelsel afhanklik van gemeenskapsorgwerkers om gesondheidsbevordering

Perceptions of health promoters about health promotion programmes for families with adolescents orphaned as a result of AIDS in the rural Hammanskraal region in South Africa

Directory of Open Access Journals (Sweden)

Maseapo P. Mthobeni

2013-02-01

Full Text Available South African communities are still greatly affected by the high rate of infection with HIV or who are living with AIDS, mirrored in the 2008 overall national HIV prevalence of 29.3%(UNAIDS 2010:10. In addressing the challenge, the health system is dependent on community care level workers such as caregivers to render health promotion and education in the homes and communities. The caregivers based in the communities are the ones with first-hand information on what is needed for the success of health promotion programmes. This study, aimed at exploring the challenges faced by the health promoters, described their perceptions regarding a health promotion programme for families with adolescents orphaned as a result of AIDS. Data were collected on the purposively selected participants at the rural Hammanskraal region in South Africa and the research question: ‘What is your perception regarding health promotion programmes for families with adolescents orphaned as a result of AIDS’ was asked and discussed by participants in a focus group interview. Data were analysed using the adapted Tesch method to organize and isolate the main categories, sub-categories and themes. The following main categories were isolated: attitudes of adolescents, effectiveness of home visits, need for health education and limited resources. Based on the findings, it was therefore recommended that health care planners assist in the improvement of health promotion and education by using the community and national media, providing information material and providing access to the internet in order to allow more people, including young people, to access the information. Suid-Afrikaanse gemeenskappe word steeds grootliks beïnvloed deur die hoë vlak van MIV en vigs, soos weerspieël in die algehele nasionale MIV-syfer in 2008 van 29.3% (UNAIDS 2010:10. In die aanspreek van hierdie uitdaging is die gesondheidstelsel afhanklik van gemeenskapsorgwerkers om gesondheidsbevordering

Tuberculosis screening among homeless persons with AIDS living in single-room-occupancy hotels.

Science.gov (United States)

Layton, M C; Cantwell, M F; Dorsinville, G J; Valway, S E; Onorato, I M; Frieden, T R

1995-11-01

Congregate facilities for homeless persons with the acquired immunodeficiency syndrome (AIDS) are often endemic for tuberculosis. We evaluated tuberculosis screening methods at single-room-occupancy hotels housing persons with AIDS. Residents were screened by cross matching the New York City Tuberculosis Registry, interviewing for tuberculosis history, skin testing, and chest radiography. Cases were classified as either previously or newly diagnosed. Among the 106 participants, 16 (15%) previously diagnosed tuberculosis cases were identified. Participants' tuberculosis histories were identified by the questionnaire (100%) or by registry match (69%). Eight participants (50%) were noncompliant with therapy. These findings prompted the establishment of a directly observed therapy program on site.

A proposal for prevention of acute radiation hazard and social panic regarding orphan sources in Japan

Energy Technology Data Exchange (ETDEWEB)

Takahash, T. [Research Reactor Institute, Kyoto Univ., Osaka (Japan); Kai, M. [Oita Univ., of Nursing and Health Sciences, Oita (Japan); Yamazaki, K. [Chiyoda Technol Corporation, Tokyo (Japan); Gomi, K. [Japan Radioisotope Association, Tokyo (Japan); Nakazato, K. [School of Medicine, Keio univ., Tokyo (Japan); Iida, T. [Nagoya Univ., Nagoya (Japan)

2002-07-01

To respond to an increase of social problems concerning orphan sources in Japan, a working group was formed in the Japan Health Physics Society. In this working group, we investigated how to prevent acute radiation hazard or social panic regarding orphan sources in scrap metal and detection system for orphan sources brought into scrap yards before recycle. For detection system in a scrap yard we conducted an experiment on detectability of monitoring instrument using a radiation source mixed in scrap metal on a truck. The result showed that it was not easy to detect even a high-level source if it was shielded by scrap metal. We also estimated detection limits for radioactive materials in scrap metal by calculation that was validated with experimental data. We summarized present status about orphan sources in Japan and proposed a categorization of orphan sources according to dose rates to deal with unknown sources in a scrap yard. Our report includes some proposals to the government, industry and academic world for preventing acute radiation hazard and social panic.

A proposal for prevention of acute radiation hazard and social panic regarding orphan sources in Japan

International Nuclear Information System (INIS)

Takahash, T.; Kai, M.; Yamazaki, K.; Gomi, K.; Nakazato, K.; Iida, T.

2002-01-01

To respond to an increase of social problems concerning orphan sources in Japan, a working group was formed in the Japan Health Physics Society. In this working group, we investigated how to prevent acute radiation hazard or social panic regarding orphan sources in scrap metal and detection system for orphan sources brought into scrap yards before recycle. For detection system in a scrap yard we conducted an experiment on detectability of monitoring instrument using a radiation source mixed in scrap metal on a truck. The result showed that it was not easy to detect even a high-level source if it was shielded by scrap metal. We also estimated detection limits for radioactive materials in scrap metal by calculation that was validated with experimental data. We summarized present status about orphan sources in Japan and proposed a categorization of orphan sources according to dose rates to deal with unknown sources in a scrap yard. Our report includes some proposals to the government, industry and academic world for preventing acute radiation hazard and social panic

Factors Influencing Household Food Security in West Africa: The Case of Southern Niger

Directory of Open Access Journals (Sweden)

Seydou Zakari

2014-03-01

Full Text Available Food insecurity is a major challenge for Niger and for many African countries. The purpose of this study is to investigate the factors affecting household food security in Niger. Based on survey data covering 500 households, drought, high food prices, poverty, soil infertility, disease and insect attacks are reported by the respondents to be the main causes of food insecurity. The empirical results from logistic regression revealed that the gender of the head of household, diseases and pests, labor supply, flooding, poverty, access to market, the distance away from the main road and food aid are significant factors influencing the odds ratio of a household having enough daily rations. Another important finding is that female headed households are more vulnerable to food insecurity compared to male headed households. The findings of this study provide evidence that food insecurity continues to affect the Nigerien population.

A review of international coverage and pricing strategies for personalized medicine and orphan drugs.

Science.gov (United States)

Degtiar, Irina

2017-12-01

Personalized medicine and orphan drugs share many characteristics-both target small patient populations, have uncertainties regarding efficacy and safety at payer submission, and frequently have high prices. Given personalized medicine's rising importance, this review summarizes international coverage and pricing strategies for personalized medicine and orphan drugs as well as their impact on therapy development incentives, payer budgets, and therapy access and utilization. PubMed, Health Policy Reference Center, EconLit, Google Scholar, and references were searched through February 2017 for articles presenting primary data. Sixty-nine articles summarizing 42 countries' strategies were included. Therapy evaluation criteria varied between countries, as did patient cost-share. Payers primarily valued clinical effectiveness; cost was only considered by some. These differences result in inequities in orphan drug access, particularly in smaller and lower-income countries. The uncertain reimbursement process hinders diagnostic testing. Payer surveys identified lack of comparative effectiveness evidence as a chief complaint, while manufacturers sought more clarity on payer evidence requirements. Despite lack of strong evidence, orphan drugs largely receive positive coverage decisions, while personalized medicine diagnostics do not. As more personalized medicine and orphan drugs enter the market, registries can provide better quality evidence on their efficacy and safety. Payers need systematic assessment strategies that are communicated with more transparency. Further studies are necessary to compare the implications of different payer approaches. Copyright © 2017 Elsevier B.V. All rights reserved.

Systematic review on the evaluation criteria of orphan medicines in Central and Eastern European countries.

Science.gov (United States)

Zelei, Tamás; Molnár, Mária J; Szegedi, Márta; Kaló, Zoltán

2016-06-04

In case of orphan drugs applicability of the standard health technology assessment (HTA) process is limited due to scarcity of good clinical and health economic evidence. Financing these premium priced drugs is more controversial in the Central and Eastern European (CEE) region where the public funding resources are more restricted, and health economic justification should be an even more important aspect of policy decisions than in higher income European countries. To explore and summarize the recent scientific evidence on value drivers related to the health technology assessment of ODs with a special focus on the perspective of third party payers in CEE countries. The review aims to list all potentially relevant value drivers in the reimbursement process of orphan drugs. A systematic literature review was performed; PubMed and Scopus databases were systematically searched for relevant publications until April 2015. Extracted data were summarized along key HTA elements. From the 2664 identified publications, 87 contained relevant information on the evaluation criteria of orphan drugs, but only 5 had direct information from the CEE region. The presentation of good clinical evidence seems to play a key role especially since this should be the basis of cost-effectiveness analyses, which have more importance in resource-constrained economies. Due to external price referencing of pharmaceuticals, the relative budget impact of orphan drugs is expected to be higher in CEE than in Western European (WE) countries unless accessibility of patients remains more limited in poorer European regions. Equity principles based on disease prevalence and non-availability of alternative treatment options may increase the price premium, however, societies must have some control on prices and a rationale based on multiple criteria in reimbursement decisions. The evaluation of orphan medicines should include multiple criteria to appropriately measure the clinical added value of orphan

The psychological well being of learners affected by HIV/AIDS / Tsihoane Maria Tenyane

OpenAIRE

Tenyane, Tsihoane Maria

2006-01-01

The aims of this research were to investigate the condition of the psychological well being of learners affected or orphaned by HIV/AIDS; investigate the way in which these learners perform at schools, investigate the nature and extent of social support these learners get from their families, community and society; investigate the condition of the physical well being of these learners; and make recommendations for their psychosocial support in order to enhance and strengthen their psychologic...

Therapist-Aided Exposure for Women with Lifelong Vaginismus: A Replicated Single-Case Design

Science.gov (United States)

ter Kuile, Moniek M.; Bulte, Isis; Weijenborg, Philomeen T. M.; Beekman, Aart; Melles, Reinhilde; Onghena, Patrick

2009-01-01

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period…

78 FR 5828 - Agency Information Collection Activities: Petition To Classify Orphan as an Immediate Relative...

Science.gov (United States)

2013-01-28

...-0028] Agency Information Collection Activities: Petition To Classify Orphan as an Immediate Relative, Form I-600; Application for Advance Processing of Orphan Petition, Form I-600A; Listing of Adult Member... are encouraged and will be accepted until February 27, 2013. This process is conducted in accordance...

[Will AIDS overtake them?].

Science.gov (United States)

Boukhari, S

UNICEF estimates that the streets are now the home of some 5 million African children aged 7-15 who are victims of rapid population growth and urbanization as well as the disintegration of traditional family structure. These children, deprived of a home and of all parental control, are potentially very vulnerable to the threat of AIDS. Prostitution, which is almost institutionalized in the most impoverished urban areas, represents for young girls the most immediate means of survival and occasionally even of helping their families. Male prostitution is highly tabu and marginal in sub-Saharan Africa, and is only slightly developed around the tourist hotels. Homeless children are somewhat protected against contamination through the blood by their lack of access to health care. Intravenous drugs are rare in Africa, and drug use is at most an indirect risk factor for AIDS to the extent that in increases the need for money and weakens the immune system. The frequency of sexually transmitted diseases, deplorable hygienic conditions, and poor general health of homeless children increase their risk of contracting the virus. Many homeless children do not even know of the existence of condoms and in any event condoms are usually inaccessible or too costly for them. Homeless children, like the general population, have false ideas about AIDS that discourage self-protective behaviors. In addition they are cut off from the activities of existing prevention programs. In a context of permanent daily insecurity, AIDS appears as just 1 more menace among others. According to an anthropologist working with the UNESCO program to help homeless children, the only way of making such children aware of the threat of AIDS in the large African cities will be to increase the number of prevention programs targeted at them. At the same time, the children need to be educated and taught an income-generating skill; in short, they need to be given a reason to believe in the future.

Abilities in tactile discrimination of textures in adult rats exposed to enriched or impoverished environments.

Science.gov (United States)

Bourgeon, Stéphanie; Xerri, Christian; Coq, Jacques-Olivier

2004-08-12

In previous studies, we have shown that housing in enriched environment for about 3 months after weaning improved the topographic organization and decreased the size of the receptive fields (RFs) located on the glabrous skin surfaces in the forepaw maps of the primary somatosensory cortex (SI) in rats [Exp. Brain Res. 121 (1998) 191]. In contrast, housing in impoverished environment induced a degradation of the SI forepaw representation, characterized by topographic disruptions, a reduction of the cutaneous forepaw area and an enlargement of the glabrous RFs [Exp. Brain Res. 129 (1999) 518]. Based on these two studies, we postulated that these representational alterations could underlie changes in haptic perception. Therefore, the present study was aimed at determining the influence of housing conditions on the rat's abilities in tactile texture discrimination. After a 2-month exposure to enriched or impoverished environments, rats were trained to perform a discrimination task during locomotion on floorboards of different roughness. At the end of every daily behavioral session, rats were replaced in their respective housing environment. Rats had to discriminate homogeneous (low roughness) from heterogeneous floorboards (combination of two different roughness levels). To determine the maximum performance in texture discrimination, the roughness contrast of the heterogeneous texture was gradually reduced, so that homogeneous and heterogeneous floorboards became harder to differentiate. We found that the enriched rats learned the first steps of the behavioral task faster than the impoverished rats, whereas both groups exhibited similar performances in texture discrimination. An individual "predilection" for either homogeneous or heterogeneous floorboards, presumably reflecting a behavioral strategy, seemed to account for the absence of differences in haptic discrimination between groups. The sensory experience depending on the rewarded texture discrimination task

Orphan crops can turn into winners | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

2010-10-06

Oct 6, 2010 ... It is not surprising that many of the orphan crops, in particular the protein-packed pulse ... diet in India, for example, accompanying almost every Indian meal. ... Canada's niche is high-quality pulses that we sell to the emerging ...

From orphan virus to pathogen: the path to the clinical lab.

Science.gov (United States)

Li, Linlin; Delwart, Eric

2011-10-01

Viral metagenomics has recently yielded numerous previously uncharacterized viral genomes from human and animal samples. We review some of the metagenomics tools and strategies to determine which orphan viruses are likely pathogens. Disease association studies compare viral prevalence in patients with unexplained symptoms versus healthy individuals but require these case and control groups to be closely matched epidemiologically. The development of an antibody response in convalescent serum can temporarily link symptoms with a recent infection. Neutralizing antibody detection require often difficult cell culture virus amplification. Antibody binding assays require proper antigen synthesis and positive control sera to set assay thresholds. High levels of viral genetic diversity within orphan viral groups, frequent co-infections, low or rare pathogenicity, and chronic virus shedding, can all complicate disease association studies. The limited availability of matched cases and controls sample sets from different age groups and geographic origins is a major block for estimating the pathogenic potential of recently characterized orphan viruses. Current limitations on the practical use of deep sequencing for viral diagnostics are listed.

Teachers’ Pastoral Role in Response to the Needs of Orphaned Learners

Directory of Open Access Journals (Sweden)

Teresa Auma Ogina

2010-12-01

Full Text Available This article discusses a study that explored the way teachers perceive and describe their roles in responding to the needs of orphaned learners. The participants in the study comprised three secondary and two primary school teachers. The data on the teachers’ experiences were collected through semi-structured interviews, and the findings revealed that, although some of the teachers attempted to fulfill some of the orphaned learners’ needs, most were unable to cope with the combined roles of teaching and learning and care giving. The study identified a lack of material, social, and emotional support for grieving learners. The findings indicate that there is a need for teacher development in terms of preparing teachers to provide pastoral care for orphaned learners. For the teachers’ efforts to be more fruitful, there is also an urgent need for supportive school leadership. In addition, the study highlights the need for counsellors and social workers to be appointed to work in collaboration with the teachers in providing for the needs of the learners.

Thirty Years of Orphan Drug Legislation and the Development of Drugs to Treat Rare Seizure Conditions: A Cross Sectional Analysis.

Science.gov (United States)

Döring, Jan Henje; Lampert, Anette; Hoffmann, Georg F; Ries, Markus

2016-01-01

Epilepsy is a serious chronic health condition with a high morbidity impairing the life of patients and afflicted families. Many epileptic conditions, especially those affecting children, are rare disorders generating an urgent medical need for more efficacious therapy options. Therefore, we assessed the output of the US and European orphan drug legislations. Quantitative analysis of the FDA and EMA databases for orphan drug designations according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria. Within the US Orphan Drug Act 40 designations were granted delivering nine approvals, i.e. clobazam, diazepam viscous solution for rectal administration, felbamate, fosphenytoin, lamotrigine, repository corticotropin, rufinamide, topiramate, and vigabatrin. Since 2000 the EMA granted six orphan drug designations whereof two compounds were approved, i.e. rufinamide and stiripentol. In the US, two orphan drug designations were withdrawn. Orphan drugs were approved for conditions including Lennox-Gastaut syndrome, infantile spasms, Dravet syndrome, and status epilepticus. Comparing time to approval for rufinamide, which was approved in the US and the EU to treat rare seizure conditions, the process seems faster in the EU (2.2 years) than in the US (4.3 years). Orphan drug development in the US and in the EU delivered only few molecular entities to treat rare seizure disorders. The development programs focused on already approved antiepileptic drugs or alternative pharmaceutical formulations. Most orphan drugs approved in the US are not approved in the EU to treat rare seizures although some were introduced after 2000 when the EU adopted the Orphan Drug Regulation.

Orphan drugs assessment in the centralised procedure.

Science.gov (United States)

Nisticò, Giuseppe

2011-01-01

On the basis of the author's experience as member of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) and in order to facilitate the access of new orphan drugs to the patients, some suggestions were given. Among these the following should be taken into account by the regulatory bodies: 1) conditional approval or approval under exceptional circumstances should be granted more frequently; 2) the opinion of international societies for rare diseases should be taken into greater account by the EMA Committees; 3) the guidelines requirements should be interpreted more flexibly; 4) in comparison to the fulfilment of primary and secondary endpoints, the improvement of the quality of life should justify the approval of a new orphan drug; 5) the rigidity of guideline requirements should not prevail over the unmet medical need for severe and lethal rare disorders; 6) the statistical values of clinical data to the limit of significance should not prevail over the opinion of patients' associations and international scientific societies; 7) the current legislation should be amended.

National campaign for the search and recovery of Orphan radioactive sources

International Nuclear Information System (INIS)

Carboneras, Pedro; Ortiz, Maria T.; Correa, Cristina; Rueda, Carmen

2008-01-01

This paper aims to describe the main initial approaches of the campaign for the 'Recovery of Orphan Radioactive Sources' undertaken in Spain, in addition to the steps taken, the experience gained and the partial results obtained. The campaign began on 19th February 2007 and this paper reports the findings until 31st December 2007. The paper aims to share the experience gained with others who are considering or are already involved in similar campaigns and to enable opinions to be exchanged with those responsible for such campaigns in other countries. The campaign was initiated by the Spanish Ministry of Industry, Tourism and Trade with the expert assistance of the Nuclear Security Council. The initiative came about as a result of national legislation currently in force regarding the control of highly active and orphan radioactive source, which implements a European Directive. The campaign was commissioned to ENRESA (the Spanish National Company for Radioactive Waste Management) and the work, which began in 2007, will continue into 2008. The campaign aims to seek and recover the largest possible number of orphan radioactive sources (an Orphan radioactive source is understood to be one which is detected outside the standard control system and which, when detected, has an activity level higher than the exemption levels established in national and European regulations), and involves the collaboration of various different agents and organisations where such sources are or may be found. Finally, the paper provides details regarding the number and radiological characteristics of the sources which have already been recovered in Spain during the 2007 campaign. (author)

Empowering caregivers of orphans and vulnerable children in ...

African Journals Online (AJOL)

A comparison of orphan data between 2010 and 2014 shows a slight ... The training included the use of mobile technology to report weekly ... health, psychosocial support, protection, education, and ... Data were collected on members' demographic, socio-economic status, ... mobile technology platform for data collection.

A review and update on orphan drugs for the treatment of noninfectious uveitis

Science.gov (United States)

You, Caiyun; Sahawneh, Haitham F; Ma, Lina; Kubaisi, Buraa; Schmidt, Alexander; Foster, C Stephen

2017-01-01

Introduction Uveitis, a leading cause of preventable blindness around the world, is a critically underserved disease in regard to the medications approved for use. Multiple immunomodulatory therapy (IMT) drugs are appropriate for uveitis therapy but are still off-label. These IMT agents, including antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents, have been designated as “orphan drugs” and are widely used for systemic autoimmune diseases or organ transplantation. Area covered The purpose of this paper is to comprehensively review and summarize the approved orphan drugs and biologics that are being used to treat systemic diseases and to discuss drugs that have not yet received approval as an “orphan drug for treating uveitis” by the US Food and Drug Administration (FDA). Our perspective IMT, as a steroid-sparing agent for uveitis patients, has shown promising clinical results. Refractory and recurrent uveitis requires combination IMT agents. IMT is continued for a period of 2 years while the patient is in remission before considering tapering medication. Our current goals include developing further assessments regarding the efficacy, optimal dose, and safety in efforts to achieve FDA approval for “on-label” use of current IMT agents and biologics more quickly and to facilitate insurance coverage and expand access to the products for this orphan disease. PMID:28203051

Histone H3.3 promotes IgV gene diversification by enhancing formation of AID-accessible single-stranded DNA.

Science.gov (United States)

Romanello, Marina; Schiavone, Davide; Frey, Alexander; Sale, Julian E

2016-07-01

Immunoglobulin diversification is driven by activation-induced deaminase (AID), which converts cytidine to uracil within the Ig variable (IgV) regions. Central to the recruitment of AID to the IgV genes are factors that regulate the generation of single-stranded DNA (ssDNA), the enzymatic substrate of AID Here, we report that chicken DT40 cells lacking variant histone H3.3 exhibit reduced IgV sequence diversification. We show that this results from impairment of the ability of AID to access the IgV genes due to reduced formation of ssDNA during IgV transcription. Loss of H3.3 also diminishes IgV R-loop formation. However, reducing IgV R-loops by RNase HI overexpression in wild-type cells does not affect IgV diversification, showing that these structures are not necessary intermediates for AID access. Importantly, the reduction in the formation of AID-accessible ssDNA in cells lacking H3.3 is independent of any effect on the level of transcription or the kinetics of RNAPII elongation, suggesting the presence of H3.3 in the nucleosomes of the IgV genes increases the chances of the IgV DNA becoming single-stranded, thereby creating an effective AID substrate. © 2016 MRC Laboratory of Molecular Biology. Published under the terms of the CC BY 4.0 license.

Rwanda’s Orphans – Care and Integration During Uncertain Times

Directory of Open Access Journals (Sweden)

Manuela Elisabeth Kuehr

2015-04-01

Full Text Available Children and youth are considered cornerstones of development in post-conflict state-building practices. In the case of Rwanda, the government has engaged in an ambitious state-initiated deinstitutionalization project that anticipates the closure of all officially registered orphanages between 2012 and 2014. As a consequence, all orphans within institutional care will return to their extended families or be placed with foster parents to be given the opportunity to grow up within a Rwandan family environment. By investigating the lived realities of orphans before their departure from the orphanage, it becomes apparent that there is no “one size fits all” approach to systems of child care as historical and psychosocial dynamics play a crucial role.

The impact of the Orphan Drug Act on drug discovery.

Science.gov (United States)

Haffner, Marlene E; Maher, Paul D

2006-11-01

For nearly a quarter of a century the FDA Office of Orphan Products Development has administered the US Orphan Drug Act, which assists in bringing a wide variety of drug and biological (drug) products to treat rare diseases to market. Enthusiasm for rare disease product development has been sustained, seen throughout a wide spectrum of product types and disease conditions, and has resulted in clinically meaningful medical advances. Development of programmes for rare disease treatment worldwide, coupled with the development of drugs for diseases affecting developing countries, attests to the strength of this legislation. The marketing of almost 300 products in the US for rare diseases also testifies to the depth and intensity of scientific endeavour in this area.

Mortality in North Korean migrant households: a retrospective study.

Science.gov (United States)

Robinson, W C; Lee, M K; Hill, K; Burnham, G M

1999-07-24

A deteriorating economy, coupled with a series of natural disasters in 1995-97, led to a severe food crisis in North Korea. Although the country has received substantial international aid since 1996, demographic assessments of crisis impact have been limited. We assessed mortality trends in North Korea since 1995. At 15 randomly selected sites in China, 440 North Korean adult migrants were interviewed during July-September, 1998. Respondents were asked about births, deaths, and migration patterns in their households between mid-1994 and mid-1998, and about household food sources. The respondents also provided basic demographic information about the households of their relatives. We compared mortality rates from migrant households with data from the 1993 census and with data about households of non-migrant relatives. Households that included a recent migrant to China showed increasing mortality: crude death rates rose from 28.9 per 1000 in 1995, to 45.6 per 1000 in 1996, and to 56.0 per 1000 in 1997 (p=0.0001), with a 3-year average rate of 42.8 per 1000. The crude 3-year birth rate was 11.0 per 1000. Average household size declined from 4.0 at the beginning of 1995 to 3.4 at the end of 1997 (p=0.0002). Among 259 households of non-migrant relatives, the crude death rate was 43.2 per 1000 and the crude birth rate was 8.8 per 1000. In these households, the 3-year trend of increasing mortality was significant (p=0.001), as was the decline in average household size from 4.3 at the beginning of 1995 to 3.7 at the end of 1997 (p=0.0001). Among North Korean households that include a recent migrant to China, mortality has increased and household size has declined since 1995. This trend raises concern about the state of the general population, at least in the province of North Hamkyong, from where most of the migrants originated.

Why Distinctive Information Reduces False Memories: Evidence for Both Impoverished Relational-Encoding and Distinctiveness Heuristic Accounts

Science.gov (United States)

Hege, Amanda C. G.; Dodson, Chad S.

2004-01-01

Two accounts explain why studying pictures reduces false memories within the Deese-Roediger-McDermott paradigm (J. Deese, 1959; H. L. Roediger & K. B. McDermott, 1995). The impoverished relational-encoding account suggests that studying pictures interferes with the encoding of relational information, which is the primary basis for false memories…

Characterization of radioactive orphan sources by gamma spectrometry

International Nuclear Information System (INIS)

Cruz W, H.

2013-01-01

The sealed radioactive sources are widely applicable in industry. They must have a permanent control and must be registered with the Technical Office of the National Authority (OTAN). However, at times it has identified the presence of abandoned sealed sources unknown to the owner. These sources are called 'orphan sources'. Of course these sources represent a high potential risk because accidents can trigger dire consequences depending on your activity and chemical form in which it presents the radioisotope. This paper describes the process and the actions taken to characterize two orphan radioactive sources from the smelter a Aceros Arequipa. For characterization we used a gamma spectrometry system using a detector NaI(Tl) 3″ x 3″ with a multichannel analyzer Nucleus PCA-II. The radioisotope identified was cesium - 137 ( 137 Cs) in both cases. Fortunately, the sources maintained their integrity would otherwise have generated significant pollution considering the chemical form of the radioisotope and easy dispersion. (author)

Afican Health Sciences Vol 9 No 2.pmd

African Journals Online (AJOL)

Administrator

Intra-household differences in health seeking behaviour for orphans ... 1 Department of Psychiatry, Makerere University College of Health Sciences, ... closing the gap between orphans and non-orphans. This ... the degree to which the NGO support had translated into ... in Makulubita sub-county and 195 children (an equal.

The effect of providing free autopoweroff plugs to households on electricity consumption - a field experiment

DEFF Research Database (Denmark)

Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

on metered electricity consumption for different types of households. We find effects for single men and couples without children, while we find no effect for single women and households with children. We suggest that this could be because of differences in saving potential (e.g. some households do not have......Experimental evidence of the effect of providing cheap energy saving technology to households is sparse. We present results from a field experiment in which autopoweroff plugs are provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...... increase efficiency of programmes....

Validity of measures of pain and symptoms in HIV/AIDS infected households in resources poor settings: results from the Dominican Republic and Cambodia

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Morineau Guy

2006-03-01

Full Text Available Abstract Background HIV/AIDS treatment programs are currently being mounted in many developing nations that include palliative care services. While measures of palliative care have been developed and validated for resource rich settings, very little work exists to support an understanding of measurement for Africa, Latin America or Asia. Methods This study investigates the construct validity of measures of reported pain, pain control, symptoms and symptom control in areas with high HIV-infected prevalence in Dominican Republic and Cambodia Measures were adapted from the POS (Palliative Outcome Scale. Households were selected through purposive sampling from networks of people living with HIV/AIDS. Consistencies in patterns in the data were tested used Chi Square and Mantel Haenszel tests. Results The sample persons who reported chronic illness were much more likely to report pain and symptoms compared to those not chronically ill. When controlling for the degrees of pain, pain control did not differ between the chronically ill and non-chronically ill using a Mantel Haenszel test in both countries. Similar results were found for reported symptoms and symptom control for the Dominican Republic. These findings broadly support the construct validity of an adapted version of the POS in these two less developed countries. Conclusion The results of the study suggest that the selected measures can usefully be incorporated into population-based surveys and evaluation tools needed to monitor palliative care and used in settings with high HIV/AIDS prevalence.

Evolution and dynamics of orphan penumbrae in the solar photosphere: Analysis from multi-instrument observations

International Nuclear Information System (INIS)

Zuccarello, Francesca; Guglielmino, Salvo L.; Romano, Paolo

2014-01-01

We investigate the dynamics and magnetic properties of orphan penumbrae observed in the solar photosphere to understand the formation process of such structures. We observed two orphan penumbrae in active region NOAA 11089 during a coordinated observing campaign carried out in 2010 July, involving the Hinode/Solar Optical Telescope (SOT) and Dutch Open Telescope (DOT), benefiting also from continuous observations acquired by the SDO satellite. We follow their evolution during about three days. The two structures form in different ways: one seems to break off the penumbra of a nearby sunspot, the other is formed through the emergence of new flux. Then they fragment while evolving. The SDO Helioseismic and Magnetic Imager measurements indicate the presence of strong line-of-sight motions in the regions occupied by these orphan penumbrae, lasting for several hours and decreasing with time. This is confirmed by SOT spectro-polarimetric measurements of the Fe I 630.2 nm pair. The latter also show that Stokes parameters exhibit significant asymmetries in the orphan penumbral regions, typical of an uncombed filamentary structure. The orphan penumbrae lie above polarity inversion lines, where peculiar plasma motions take place with velocities larger than ±3 km s –1 . The vector magnetic field in these regions is highly inclined, with the average magnetic field strength decreasing with time. The DOT observations in the Hα line and SDO Atmospheric Imaging Assembly measurements in the He II 30.4 nm line indicate that there is no counterpart for the orphan penumbrae at midchromospheric heights or above. Our findings suggest that in at least one of the features investigated the emerging flux may be trapped in the low atmospheric layers by the overlying pre-existing fields, forming these filamentary structures.

Evolution and dynamics of orphan penumbrae in the solar photosphere: Analysis from multi-instrument observations

Energy Technology Data Exchange (ETDEWEB)

Zuccarello, Francesca [Dipartimento di Fisica e Astronomia, Università di Catania, Via S. Sofia 78, I-95123 Catania (Italy); Guglielmino, Salvo L.; Romano, Paolo, E-mail: fzu@oact.inaf.it [INAF-Osservatorio Astrofisico di Catania, Via S. Sofia 78, I-95123 Catania (Italy)

2014-05-20

We investigate the dynamics and magnetic properties of orphan penumbrae observed in the solar photosphere to understand the formation process of such structures. We observed two orphan penumbrae in active region NOAA 11089 during a coordinated observing campaign carried out in 2010 July, involving the Hinode/Solar Optical Telescope (SOT) and Dutch Open Telescope (DOT), benefiting also from continuous observations acquired by the SDO satellite. We follow their evolution during about three days. The two structures form in different ways: one seems to break off the penumbra of a nearby sunspot, the other is formed through the emergence of new flux. Then they fragment while evolving. The SDO Helioseismic and Magnetic Imager measurements indicate the presence of strong line-of-sight motions in the regions occupied by these orphan penumbrae, lasting for several hours and decreasing with time. This is confirmed by SOT spectro-polarimetric measurements of the Fe I 630.2 nm pair. The latter also show that Stokes parameters exhibit significant asymmetries in the orphan penumbral regions, typical of an uncombed filamentary structure. The orphan penumbrae lie above polarity inversion lines, where peculiar plasma motions take place with velocities larger than ±3 km s{sup –1}. The vector magnetic field in these regions is highly inclined, with the average magnetic field strength decreasing with time. The DOT observations in the Hα line and SDO Atmospheric Imaging Assembly measurements in the He II 30.4 nm line indicate that there is no counterpart for the orphan penumbrae at midchromospheric heights or above. Our findings suggest that in at least one of the features investigated the emerging flux may be trapped in the low atmospheric layers by the overlying pre-existing fields, forming these filamentary structures.

Evolution and Dynamics of Orphan Penumbrae in the Solar Photosphere: Analysis from Multi-instrument Observations

Science.gov (United States)

Zuccarello, Francesca; Guglielmino, Salvo L.; Romano, Paolo

2014-05-01

We investigate the dynamics and magnetic properties of orphan penumbrae observed in the solar photosphere to understand the formation process of such structures. We observed two orphan penumbrae in active region NOAA 11089 during a coordinated observing campaign carried out in 2010 July, involving the Hinode/Solar Optical Telescope (SOT) and Dutch Open Telescope (DOT), benefiting also from continuous observations acquired by the SDO satellite. We follow their evolution during about three days. The two structures form in different ways: one seems to break off the penumbra of a nearby sunspot, the other is formed through the emergence of new flux. Then they fragment while evolving. The SDO Helioseismic and Magnetic Imager measurements indicate the presence of strong line-of-sight motions in the regions occupied by these orphan penumbrae, lasting for several hours and decreasing with time. This is confirmed by SOT spectro-polarimetric measurements of the Fe I 630.2 nm pair. The latter also show that Stokes parameters exhibit significant asymmetries in the orphan penumbral regions, typical of an uncombed filamentary structure. The orphan penumbrae lie above polarity inversion lines, where peculiar plasma motions take place with velocities larger than ±3 km s-1. The vector magnetic field in these regions is highly inclined, with the average magnetic field strength decreasing with time. The DOT observations in the Hα line and SDO Atmospheric Imaging Assembly measurements in the He II 30.4 nm line indicate that there is no counterpart for the orphan penumbrae at midchromospheric heights or above. Our findings suggest that in at least one of the features investigated the emerging flux may be trapped in the low atmospheric layers by the overlying pre-existing fields, forming these filamentary structures.

A roadmap for breeding orphan leafy vegetable species: a case study of Gynandropsis gynandra (Cleomaceae).

Science.gov (United States)

Sogbohossou, E O Deedi; Achigan-Dako, Enoch G; Maundu, Patrick; Solberg, Svein; Deguenon, Edgar M S; Mumm, Rita H; Hale, Iago; Van Deynze, Allen; Schranz, M Eric

2018-01-01

Despite an increasing awareness of the potential of "orphan" or unimproved crops to contribute to food security and enhanced livelihoods for farmers, coordinated research agendas to facilitate production and use of orphan crops by local communities are generally lacking. We provide an overview of the current knowledge on leafy vegetables with a focus on Gynandropsis gynandra , a highly nutritious species used in Africa and Asia, and highlight general and species-specific guidelines for participatory, genomics-assisted breeding of orphan crops. Key steps in genome-enabled orphan leafy vegetables improvement are identified and discussed in the context of Gynandropsis gynandra breeding, including: (1) germplasm collection and management; (2) product target definition and refinement; (3) characterization of the genetic control of key traits; (4) design of the 'process' for cultivar development; (5) integration of genomic data to optimize that 'process'; (6) multi-environmental participatory testing and end-user evaluation; and (7) crop value chain development. The review discusses each step in detail, with emphasis on improving leaf yield, phytonutrient content, organoleptic quality, resistance to biotic and abiotic stresses and post-harvest management.

Challenges in the clinical development of orphan drugs

NARCIS (Netherlands)

Kreeftmeijer-Vegter, A.R.

2015-01-01

Rare diseases are characterised by a low prevalence. There are so many different rare diseases, that millions of people are affected.The vast majority of these diseases suffer from a lack of approved treatment options and orphan drugs (ODs) therefore represent a huge unmet medical need. ODs face

Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries

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Messer Lynne C

2010-08-01

Full Text Available Abstract Background In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little research has considered the relationship between caregiver attributes and caregiver-reported HIV-related stigma. In light of the paucity of this literature, this paper will describe HIV-related stigma among caregivers of OAC in five less wealthy nations. Methods Baseline data were collected between May 2006 through February 2008. The sample included 1,480 community-based and 192 institution-based caregivers. Characteristics of the community-based and institution-based caregivers are described using means and standard deviations for continuous variables or counts and percentages for categorical variables. We fit logistic regression models, both for the full sample and separately for community-based and institution-based caregivers, to explore predictors of acceptance of HIV. Results Approximately 80% of both community-based and institution-based caregivers were female; and 84% of institution-based caregivers, compared to 66% of community-based caregivers, said that they would be willing to care for a relative with HIV. Similar proportions were reported when caregivers were asked if they were willing to let their child play with an HIV-infected child. In a multivariable model predicting willingness to care for an HIV-infected relative, adjusted for site fixed effects, being an institution-based caregiver was associated with greater willingness (less stigma than community-based caregivers. Decreased willingness was reported by older respondents, while willingness increased with greater formal education. In the adjusted models predicting willingness to allow one's child to play with an HIV-infected child, female gender and older age was associated with less willingness. However, willingness

A review and update on orphan drugs for the treatment of noninfectious uveitis

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You C

2017-01-01

Full Text Available Caiyun You,1–3 Haitham F Sahawneh,1,2 Lina Ma,1,2 Buraa Kubaisi,1,2 Alexander Schmidt,1,2 C Stephen Foster1,2,4 1Massachusetts Eye Research and Surgery Institution (MERSI, Waltham, 2Ocular Immunology and Uveitis Foundation, Weston, MA, USA; 3Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 4Harvard Medical School, Boston, MA, USA Introduction: Uveitis, a leading cause of preventable blindness around the world, is a critically underserved disease in regard to the medications approved for use. Multiple immunomodulatory therapy (IMT drugs are appropriate for uveitis therapy but are still off-label. These IMT agents, including antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents, have been designated as “orphan drugs” and are widely used for systemic autoimmune diseases or organ transplantation.Area covered: The purpose of this paper is to comprehensively review and summarize the approved orphan drugs and biologics that are being used to treat systemic diseases and to discuss drugs that have not yet received approval as an “orphan drug for treating uveitis” by the US Food and Drug Administration (FDA.Our perspective: IMT, as a steroid-sparing agent for uveitis patients, has shown promising clinical results. Refractory and recurrent uveitis requires combination IMT agents. IMT is continued for a period of 2 years while the patient is in remission before considering tapering medication. Our current goals include developing further assessments regarding the efficacy, optimal dose, and safety in efforts to achieve FDA approval for “on-label” use of current IMT agents and biologics more quickly and to facilitate insurance coverage and expand access to the products for this orphan disease. Keywords: immunomodulatory, orphan drug, steroid sparing, uveitis

Chemical pneumonitis and subsequent reactive airways dysfunction syndrome after a single exposure to a household product: a case report

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Khalid Imran

2009-11-01

Full Text Available Abstract Introduction Household products are usually safe to use. Adverse events arising from their use are mostly reported in patients with pre-existing atopy or pulmonary problems and usually only after a prolonged exposure to such products. We report the case of a patient with no prior problems who developed significant side effects from a single exposure to a domestic product. Case presentation A 43-year-old Caucasian American man, previously in good health, used a domestic aerosol product called 'Stand N' Seal "Spray-On" Grout Sealer' in an enclosed room in his house. The product contained n-butyl acetate ( Conclusion A household product may still prove unsafe to use even after it has gone through vigorous testing and approval processes. Even healthy individuals are susceptible to adverse outcomes after a brief exposure. Extra precautions should be taken when using any chemical product at home.

76 FR 29183 - Exclusion of Orphan Drugs for Certain Covered Entities Under 340B Program

Science.gov (United States)

2011-05-20

... and, if they are, at what price. These covered entities do not know if they can buy these orphan drugs... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 10 RIN 0906-AA94 Exclusion of Orphan Drugs for... Prices of Drugs Purchased by Covered Entities.'' Section 340B implemented a drug pricing program by which...

Household Income Composition and Household Goods

OpenAIRE

Voynov, Ivan

2005-01-01

The paper focuses on the change in household income composition and the factors that determine it. The results bring additional knowledge about household poverty dynamics. Based on the collective approach to the family and the cooperative game theory it is constructed theoretical model of household income composition change. The change in income composition is a result from bargaining between household members in attempt to defend the most suitable for them income source. Decisive influence i...

2018-05-05T20:30:37Z https://www.ajol.info/index.php/index/oai oai ...

African Journals Online (AJOL)

article/50082 2018-05-05T20:30:37Z safp:ART The experiences of family caregivers concerning their care of HIV/AIDS orphans Hlabyago, KE Ogunbanjo, GA HIV/AIDS; orphans; caregivers; South Africa Introduction: The HIV/AIDS pandemic is ...

Psychosocial attributes of orphaned youths in Ibadan Metropolis ...

African Journals Online (AJOL)

Methods: A total of 1850 youth from 20 schools in 3 urban and 2 rural school districts in South-western Nigeria had the self-administered instruments: Global School Health Questionnaire to assess reproductive and other health indices and the Culture Free Self Esteem Inventory. Results: The overall prevalence of orphans ...

[The family. The poorest households with female heads].

Science.gov (United States)

Acosta Diaz, F

1992-01-01

Data from the household questionnaire of the 1987 Mexican Fertility and Health Survey were the basis for an analysis of the characteristics of households headed by women. 14.1% of households were headed by women in 1987, of which 14% were in rural and 86% in urban areas. 41.9% of the households headed by women contained only a woman and her children. Child care responsibilities are the main determinant of discrimination in the labor market for these women and oblige them to accept jobs that are not adequately paid. The social disadvantage of households headed by women is also related to their age and marital and educational status. Among male and female household heads respectively, 16.3% and 36.5% were over age 60, 16.4% and 27.5% were illiterate, and 92.7% and 8.4% were married or in union. 15.5% of the female heads were single, 24.7% were divorced or separated, and 51.4% were widows. Among employed female household heads, 49.2% were salaried, 36.5% were self-employed, and 10.1% were domestic workers. 63.8% of female and 46.3% of male household heads earned one minimum salary or less per month. The average size of households headed by women was 3.9 members, compared to 5.4 for households headed by men.

HIV/AIDS, the erosion of social capital and the collapse of rural ...

African Journals Online (AJOL)

HIV/AIDS is a major driver of livelihood insecurity. The AIDS epidemic, through the death or disability of economically productive adults, destabilises and erodes the social networks which sustain the livelihoods of vulnerable households. This paper draws upon research with home-based care workers and family members of ...

“The Impact of Community-based Capital Cash Transfers on the Schooling of Orphaned and Vulnerable Children in Kenya”

DEFF Research Database (Denmark)

Skovdal, Morten; Webale, A.; Mwasiaji, W.

2013-01-01

In this article we report on a community-based capital cash transfer initiative (CCCT) in Kenya that sought to mobilise and enable HIV-affected communities to respond to the needs of orphaned and vulnerable children. With bilateral funding, the Social Services Department in Kenya provided 80 comm...... of orphaned children, particularly amongst girls. We conclude that CCCT is a viable strategy for improving orphan schooling in sub-Saharan Africa....

Rare diseases and orphan drugs

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