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  1. Article ; Online: Quantifying the potential market for new contraceptive technologies

    Meghan Reidy / William Winfrey / Michelle Weinberger

    Gates Open Research, Vol

    global projections of 2040 contraceptive needs and preferences [version 1; peer review: 2 approved]

    2021  Volume 5

    Abstract: Background: Despite a wide range of contraceptive methods, unmet need persists. New contraceptive technologies (CTs) have the potential to improve uptake and continuation. CT development has a long-time horizon; products will be introduced into markets ... ...

    Abstract Background: Despite a wide range of contraceptive methods, unmet need persists. New contraceptive technologies (CTs) have the potential to improve uptake and continuation. CT development has a long-time horizon; products will be introduced into markets that look very different than today. Identifying viable investments requires an understanding of these future markets. For this work the 2040 potential contraceptive market is described utilizing seven market segments based on marital status, fertility preferences, and patterns of sexual activity outside of marriage. Methods: Market size estimates are developed by country for all countries in the world for a current market (2020) and a future market (2040). United Nation’s (UN) population projections of the number of women of reproductive age (WRA) form the basis of this work. WRA are then segmented into market segments based on marital status, fertility intentions, and patterns of sexual activity outside of marriage. Each segment is further subdivided by contraceptive use versus non-use. Segmentation draws from UN projections, household surveys, census data, and modeling techniques developed for this work. Results: The largest market increases will be seen in Africa; most notably among the segment of married women wanting no more children. By contrast, Asia will see declines across all three married segments, coupled with increases among sexually active unmarried segments. Levels of contraceptive use are projected to vary widely by segment, with differential patters across regions. Conclusions: This analysis projects the impact of demographic changes, evolving fertility preferences, shifts in sexual activity outside of marriage and increased utilization of contraceptives in shaping the contraceptive market of 2040. Results show that there is not one global market, but distinct markets that vary in size and shape across the world. This diversity suggests that a range of different new CTs could have potential for uptake.
    Keywords Contraception ; family planning ; user preferences ; market segmentation ; eng ; Medicine ; R
    Subject code 650
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher F1000 Research Ltd
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: The effects of family planning and other factors on fertility, abortion, miscarriage, and stillbirths in the Spectrum model

    John Stover / William Winfrey

    BMC Public Health, Vol 17, Iss S4, Pp 43-

    2017  Volume 50

    Abstract: Abstract Background The Lives Saved Tool (LiST) estimates the effects of maternal and child health interventions on mortality rates and the number of deaths. The family planning module in Spectrum interacts with LiST by providing estimates of the effects ...

    Abstract Abstract Background The Lives Saved Tool (LiST) estimates the effects of maternal and child health interventions on mortality rates and the number of deaths. The family planning module in Spectrum interacts with LiST by providing estimates of the effects of scaling up family planning use on the number of live births, miscarriages, abortions, and stillbirths. Methods We use the proximate determinants of fertility framework to estimate the effects of changes in contraceptive use, proportion married, postpartum insusceptibility, abortion and sterility on the total fertility rate. We extend this framework to estimate the number of intended and unintended pregnancies and the resulting live births, abortions, stillbirths, and miscarriages. Results We apply the model to four countries (Mali, Kenya, Indonesia, and Ukraine) to demonstrate possible trends with a range of family planning and fertility levels. In high-fertility countries, such as Mali, increases in contraceptive use will partially compensate for the increasing number of women of reproductive age to reduce the annual increases in pregnancies and births. Most unintended pregnancies occur to women defined as having unmet need for contraception. In low-fertility countries, increases in contraceptive use may reduce abortion rates and low levels of unmet need mean that most unintended pregnancies are due to method failure. Conclusions The family planning module in Spectrum provides a useful framework to incorporate changes in contraceptive practices and pregnancy outcomes in the LiST calculations of mortality rates and deaths.
    Keywords Spectrum ; Avenir health ; Lives saved tool ; Family planning ; Public aspects of medicine ; RA1-1270
    Subject code 331 ; 310
    Language English
    Publishing date 2017-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Cost and impact of scaling up female genital mutilation prevention and care programs

    Itamar Katz / Rachel Sanders / Maria Nadia Carvalho / Howard S Friedman / Berhanu Legesse / William Winfrey / Nafissatou Diop

    PLoS ONE, Vol 16, Iss 1, p e

    Estimated resource requirements and impact on incidence and prevalence.

    2021  Volume 0244946

    Abstract: Purpose SDG 5.3 targets include eliminating harmful practices such as Female Genital Mutilation (FGM). Limited information is available about levels of investment needed and realistic estimates of potential incidence change. In this work, we estimate the ...

    Abstract Purpose SDG 5.3 targets include eliminating harmful practices such as Female Genital Mutilation (FGM). Limited information is available about levels of investment needed and realistic estimates of potential incidence change. In this work, we estimate the cost and impact of FGM programs in 31 high burden countries. Methods This analysis combines program data, secondary data analysis, and population-level costing methods to estimate cost and impact of high and moderate scaleup of FGM programs between 2020 and 2030. Cost per person or community reached was multiplied by populations to estimate costs, and regression analysis was used to estimate new incidence rates, which were applied to populations to estimate cases averted. Results Reaching the high-coverage targets for 31 countries by 2030 would require an investment of US$ 3.3 billion. This scenario would avert more than 24 million cases of FGM, at an average cost of US$ 134 per case averted. A moderate-coverage scenario would cost US$ 1.6 billion and avert more than 12 million cases of FGM. However, average cost per case averted hides substantial variation based on country dynamics. The most cost-effective investment would be in countries with limited historic change in FGM incidence, with the average cost per case averted between US$ 3 and US$ 90. The next most effective would be those with high approval for FGM, but a preexisting trend downward, where cost per case averted is estimated at around US$ 240. Interpretation This analysis shows that although data on FGM is limited, we can draw useful findings from population-level surveys and program data to guide resource mobilization and program planning.
    Keywords Medicine ; R ; Science ; Q
    Subject code 333
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Lives Saved Tool (LiST) costing

    Lori A. Bollinger / Rachel Sanders / William Winfrey / Adebiyi Adesina

    BMC Public Health, Vol 17, Iss S4, Pp 21-

    a module to examine costs and prioritize interventions

    2017  Volume 28

    Abstract: Abstract Background Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST) has been used widely to calculate the impact of maternal, neonatal and child ... ...

    Abstract Abstract Background Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST) has been used widely to calculate the impact of maternal, neonatal and child health (MNCH) interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries. A limited LiST costing module was introduced several years ago, but with gaps in cost types. Updates to inputs have now been added to make the module fully functional for a range of uses. Methods This paper builds on previous work that developed an initial version of the LiST costing module to provide costs for MNCH interventions using an ingredients-based costing approach. Here, we update in 2016 the previous econometric estimates from 2013 with newly-available data and also include above-facility level costs such as program management. The updated econometric estimates inform percentages of intervention-level costs for some direct costs and indirect costs. These estimates add to existing values for direct cost requirements for items such as drugs and supplies and required provider time which were already available in LiST Costing. Results Results generated by the LiST costing module include costs for each intervention, as well as disaggregated costs by intervention including drug and supply costs, labor costs, other recurrent costs, capital costs, and above-service delivery costs. These results can be combined with mortality estimates to support prioritization of interventions by countries. Conclusions The LiST costing module provides an option for countries to identify resource requirements for scaling up a maternal, neonatal, and child health program, and to examine the financial impact of different resource allocation strategies. It can be a useful tool for ...
    Keywords Lives saved tool ; Costing ; OneHealth Tool ; LiST costing ; LiST ; Public aspects of medicine ; RA1-1270
    Subject code 670
    Language English
    Publishing date 2017-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: New findings for maternal mortality age patterns

    Ann K Blanc / William Winfrey / John Ross

    PLoS ONE, Vol 8, Iss 4, p e

    aggregated results for 38 countries.

    2013  Volume 59864

    Abstract: Background With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even ... ...

    Abstract Background With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality. Methods We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level. Findings The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A "J" shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence. Conclusions The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns.
    Keywords Medicine ; R ; Science ; Q
    Subject code 310
    Language English
    Publishing date 2013-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Patterns and trends of postpartum family planning in Ethiopia, Malawi, and Nigeria

    Sennen Hounton / William Winfrey / Aluisio J. D. Barros / Ian Askew

    Global Health Action, Vol 8, Iss 0, Pp 1-

    evidence of missed opportunities for integration

    2015  Volume 10

    Abstract: Background: The first 12 months following childbirth are a period when a subsequent pregnancy holds the greatest risk for mother and baby, but also when there are numerous contacts with the healthcare system for postnatal care for mother and baby ( ... ...

    Abstract Background: The first 12 months following childbirth are a period when a subsequent pregnancy holds the greatest risk for mother and baby, but also when there are numerous contacts with the healthcare system for postnatal care for mother and baby (immunisation, nutrition, etc.). The benefits and importance of postpartum family planning are well documented. They include a reduction in risk of miscarriage, as well as mitigation of (or protection against) low birth weight, neonatal and maternal death, preterm birth, and anaemia. Objectives: The objectives of this paper are to assess patterns and trends in the use of postpartum family planning at the country level, to determine whether postpartum family planning is associated with birth interval and parity, and to identify the health services most closely associated with postpartum family planning after adjusting for socio-economic characteristics. Design: Data were used from Demographic and Health Surveys that contain a reproductive calendar, carried out within the last 10 years, from Ethiopia, Malawi, and Nigeria. All women for whom the calendar was completed and who gave birth between 57 and 60 months prior to data collection were included in the analysis. For each of the births, we merged the reproductive calendar with the birth record into a survey for each country reflecting the previous 60 months. The definition of the postpartum period in this paper is based on a period of 3 months postpartum. We used this definition to assess early adoption of postpartum family planning. We assessed variations in postpartum family planning according to demographic and socio-economic variables, as well as its association with various contact opportunities with the health system [antenatal care (ANC), childbirth in facilities, immunisation, etc.]. We did simple descriptive analysis with tabular, graphic, and ‘equiplot’ displays and a logistic regression controlling for important background characteristics. Results: Overall, variation in postpartum use of modern contraception was not affected over the years by age or marital status. One contrast to this is in Ethiopia, where the data show a significant increase in uptake of postpartum contraception among adolescents from 2005 to 2011. There are systematic and pervasive equity issues in the use of modern postpartum family planning by education level, place of residence, and wealth quintile, especially in Ethiopia where the gaps are very large. Disaggregation of data also point to significant sub-national variations. After adjusting for socio-economic variables, the most consistent health sector services associated with modern postpartum contraception are institutional childbirth and child immunisation. ANC is less likely to be associated with the use of modern postpartum family planning. Conclusion: Postpartum use of modern family planning has remained very low over the years, including for childbearing adolescents. Our results indicate that improving postpartum family planning requires policies and strategies to address the inequalities caused by socio-economic factors and the integration of family planning with maternal and newborn health services, particularly with childbirth in facilities and child immunisation. Scaling up systematic screening, training of providers, and generation of demand are some possible ways forward.
    Keywords postpartum contraception ; integration ; maternal and newborn health services ; sub-Saharan Africa ; Public aspects of medicine ; RA1-1270
    Subject code 300 ; 360
    Language English
    Publishing date 2015-11-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Impact of malaria interventions on child mortality in endemic African settings

    Eline Korenromp / Matthew Hamilton / Rachel Sanders / Guy Mahiané / Olivier J. T. Briët / Thomas Smith / William Winfrey / Neff Walker / John Stover

    BMC Public Health, Vol 17, Iss S4, Pp 29-

    comparison and alignment between LiST and Spectrum-Malaria model

    2017  Volume 42

    Abstract: Abstract Background In malaria-endemic countries, malaria prevention and treatment are critical for child health. In the context of intervention scale-up and rapid changes in endemicity, projections of intervention impact and optimized program scale-up ... ...

    Abstract Abstract Background In malaria-endemic countries, malaria prevention and treatment are critical for child health. In the context of intervention scale-up and rapid changes in endemicity, projections of intervention impact and optimized program scale-up strategies need to take into account the consequent dynamics of transmission and immunity. Methods The new Spectrum-Malaria program planning tool was used to project health impacts of Insecticide-Treated mosquito Nets (ITNs) and effective management of uncomplicated malaria cases (CMU), among other interventions, on malaria infection prevalence, case incidence and mortality in children 0–4 years, 5–14 years of age and adults. Spectrum-Malaria uses statistical models fitted to simulations of the dynamic effects of increasing intervention coverage on these burdens as a function of baseline malaria endemicity, seasonality in transmission and malaria intervention coverage levels (estimated for years 2000 to 2015 by the World Health Organization and Malaria Atlas Project). Spectrum-Malaria projections of proportional reductions in under-five malaria mortality were compared with those of the Lives Saved Tool (LiST) for the Democratic Republic of the Congo and Zambia, for given (standardized) scenarios of ITN and/or CMU scale-up over 2016–2030. Results Proportional mortality reductions over the first two years following scale-up of ITNs from near-zero baselines to moderately higher coverages align well between LiST and Spectrum-Malaria —as expected since both models were fitted to cluster-randomized ITN trials in moderate-to-high-endemic settings with 2-year durations. For further scale-up from moderately high ITN coverage to near-universal coverage (as currently relevant for strategic planning for many countries), Spectrum-Malaria predicts smaller additional ITN impacts than LiST, reflecting progressive saturation. For CMU, especially in the longer term (over 2022–2030) and for lower-endemic settings (like Zambia), Spectrum-Malaria projects larger proportional impacts, reflecting onward dynamic effects not fully captured by LiST. Conclusions Spectrum-Malaria complements LiST by extending the scope of malaria interventions, program packages and health outcomes that can be evaluated for policy making and strategic planning within and beyond the perspective of child survival.
    Keywords Malaria ; Child health ; Model ; Prevention ; Treatment ; Health impact ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2017-11-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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