Research Article
The Main Patterns in the Trend Change of Stomach Cancer Incidence amongst Selected African Countries
- Fahimeh Shokouhi, Aida Amiripour, Hadi Raeisi Shahraki, Godfred Agongo
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- Published online by Cambridge University Press:
- 01 January 2024, e1
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Aim. The current study aimed to investigate the trend changes of stomach cancer incidence amongst African countries and identify the main patterns. Methods. The annual reports of stomach cancer incidence rate (per 100,000 people) for males and females in 53 African countries from 1990 to 2016 were maintained from the World Health Organization archive. The growth mixture model was used for fitting the models in Mplus 7.4. The estimated linear trend in each pattern was characterized by intercept (the rate at 1990) and slope (the observed biennial trend changes), and finally, each country was grouped into a cluster with the most similar pattern. Results. Three main patterns for males and two main patterns for females were determined. For males, the first cluster, containing Cape Verde, Central African Republic, and Mauritius, showed a sharp fall, while countries in the second pattern including Algeria, Côte d’Ivoire, Egypt, Gambia, Libya, Malawi, Morocco, Namibia, Nigeria, and Tunisia were categorized in a pattern with a slight decrease, and other 43 countries were in the third pattern with a moderate falling trend. For females, 19 countries including Angola, Botswana, Burundi, Cape Verde, Central African Republic, Congo Republic, Equatorial Guinea, Ethiopia, Gabon, Kenya, Mali, Mauritius, Rwanda, Sao Tome and Principe, Sudan, Swaziland, Uganda, Zambia, and Zimbabwe were categorized in the moderate-to-high falling pattern, but the other 34 countries had a gentle downward pattern. Conclusion. Although most of the observed trends of stomach cancer were falling, only a few countries had experienced a favorable decreasing trend (three countries in male incidence and nineteen countries in female incidence). Therefore, taking effective actions to accelerate the observed falling trends seems necessary.
An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India
- Jatoveda Haldar, Rajesh Kamath, Kramer Stallone D’lima, Jossil Nazareth, Dimitri Poddighe
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- Published online by Cambridge University Press:
- 01 January 2024, e2
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Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India’s employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. This is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees’ State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy, vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. The patient records were examined from the hospital’s Medical Records Department (MRD). The patients’ bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor’s fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT, manpower cost-nursing, and allocated indirect costs associated with the medical treatment. These were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.
Evaluating Community Engagement Strategies to Manage Stigma in Two African Genomics Studies Involving People Living with Schizophrenia or Rheumatic Heart Disease
- Megan M. Campbell, Olivia P. Matshabane, Sibonile Mqulwana, Michael Mndini, Mohamed Nagdee, Dan J. Stein, Jantina De Vries, Gerald Mboowa
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- Published online by Cambridge University Press:
- 01 January 2024, e3
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In global health research and genomics research specifically, community engagement has gained prominence in enhancing ethical conduct, particularly in managing the risk of stigmatization, but there is minimal scientific evidence on how to do this effectively. This article reports on community engagement evaluation strategies in two African genomics studies: the Stigma in African Genomics Research study and the Genomics of Schizophrenia in South African Xhosa People (SAX) study. Within the Stigma in African Genomics Research study, a self-report rating scale and open-ended questions were used to track participant responses to an experiential theatre workshop. The workshop focused on participant experiences of living with schizophrenia or rheumatic heart disease (RHD). While the schizophrenia group reported more alienation and less stigma resistance than the RHD group, both groups demonstrated increased stigma resistance over time, after participating in the workshops. Hearing from others living with and managing the same illness normalised participants’ own experiences and encouraged them. Within the SAX study, a short rating scale and qualitative feedback methods were used to evaluate a Mental Health Literacy Day targeting mental health stigma. Information talks about (i) the symptoms of schizophrenia and treatment options and (ii) the illness experiences of a patient in recovery were rated as the most helpful on the day. Audience members reported that these talks challenged negative perceptions about severe mental illness. Three important learnings emerged from these evaluations: firstly, integration of evaluation strategies at the research study planning phase is likely to promote more effective community engagement. Secondly, a combination of quantitative and qualitative methods that draw on simple descriptive statistics and thematic analysis can provide nuanced perspectives about the value of community engagement. Thirdly, such evidence is necessary in establishing and promoting the science of community engagement in genomics research and health research more broadly.