While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.
ImportanceAn early minimally symptomatic phase is often followed by deterioration in patients with COVID-19 infection. This study shows that the addition of age and a minimal set of common blood tests taken in patients on admission to hospital significantly improves the National Early Warning Score (NEWS2) for risk-stratification of severe COVID disease.
BackgroundHigh quality of care in family planning (FP) services has been found to be associated with increased and continued use of contraceptive methods. The interpersonal skills and technical competence of the provider is one of the main components of quality of care. To study the process component of quality of care, the distribution of the FP counseling topics was examined by client, provider and facility characteristics. To assess the outcomes of quality of care, client satisfaction and their knowledge of their method’s protection from STIs were used. This study examined the factors associated with these outcomes with a focus on provider counseling and training.MethodsData from the 2012–2013 Senegal Service Provision Assessment survey was used for the analysis. The survey included a representative sample of the health facilities in Senegal and collects data by observing the clients’ FP visits and conducting exit interviews. The main outcomes of interest were provider’s counseling in FP, client’s satisfaction with FP services and client’s knowledge of their method’s protection from STIs. Several covariates were used in the analysis which represent client, provider and facility characteristics.ResultsThe level of counseling was inadequate-- very low proportions of providers that performed different types of counseling. Counseling was more likely to be provided to new than returning clients. Approximately 84% of the clients were very satisfied with services but only 58% had correct knowledge of their method’s protection from STIs. Clients were significantly less likely to be very satisfied when their providers counseled on side effects and when to return, and counseling provided on method’s protection from STIs did not significantly improve knowledge in this area. Clients seen by a provider with FP training had almost twice the odds of having correct knowledge about their method’s protection from STIs compared with clients seen by a provider with no recent training.ConclusionsThe percentage of providers offering FP counseling to their clients was relatively low and was ineffective on the client-focused outcomes. Interventions may be required for more effective counseling methods that are client-centered as well as providing more FP training to providers.
The monthly mean suspended sediment concentration in the upper layer of the East China Seas was derived from the retrieval of the monthly binned SeaWiFS Level 3 data during 1998 to 2006. The seasonal variation and spatial distribution of the suspended sediment concentration in the study area were investigated. It was found that the suspended sediment distribution presents apparent spatial characteristics and seasonal variations, which are mainly affected by the resuspension and transportation of the suspended sediment in the study area. The concentration of suspended sediment is high inshore and low offshore, and river mouths are generally high concentration areas. The suspended sediment covers a much wider area in winter than in summer, and for the same site the concentration is generally higher in winter. In the Yellow and East China Seas the suspended sediment spreads farther to the open sea in winter than in summer, and May and October are the transitional periods of the extension. Winds, waves, currents, thermocline, halocline, pycnocline as well as bottom sediment feature and distribution in the study area are important influencing factors for the distribution pattern. If the 10 mg L -1 contour line is taken as an indicator, it appears that the transportation of suspended sediment can hardly reach 124˚00´E in summer or 126˚00´E in winter, which is due to the obstruction of the Taiwan Warm Current and the Kuroshio Current in the southern Yellow Sea and the East China Sea.
The facile two-step preparation procedure of a novel magnetic nano-solid acid catalyst is described, which includes grafting an ionic liquid onto Fe 3 O 4 nanoparticles, followed by the sulfonation of phenyl groups in the ionic liquid. The catalytic performance of this novel material has been systematically studied in the acetal formation of benzaldehyde and ethylene glycol. The experimental results testify this catalyst possesses high catalytic activity with a yield of 97% under mild reaction conditions. Furthermore, the catalyst is readily separated using a permanent magnet and it is reusable without any significant decrease in catalytic activity.
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