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A JAMA THEME ISSUE
Edited by Annette Flanagin, RN, MA, and Margaret A. Winker, MD
Lack of awareness of entitled health and social services may contribute to poor delivery of these services in some communities. In a cluster randomized trial in rural India, Pandey and colleagues examined whether structured public meetings to inform villagers about entitled health and education services and governance requirements would be associated with improved delivery of health and social services. The authors found that compared with control villages where no public meetings were held, residents of villages randomized to the intervention reported enhanced delivery of health and social services, including more prenatal examinations and supplements, tetanus and infant vaccinations, and a decrease in excess school fees paid.
In an analysis of data from 42 countries in Latin America and the Caribbean, South Asia, and sub-Saharan Africa, Gakidou and colleagues evaluated whether programs and policies to eradicate extreme poverty and hunger and ensure environmental sustainability improve child survival and whether improvement is related to household income. The authors' analyses suggest that interventions that improve nutrition and provide clean water, sanitation, and clean household fuels would be associated with substantial reductions in mortality of children younger than 5 years, particularly among the poor.
A pediatric AIDS treatment program delivered by nurses and clinical officers in Lusaka, Zambia, enrolled 4975 children between May 1, 2004, and June 29, 2007. Seventy-two percent of the children had World Health Organization stage III or IV disease, and 2938 of the children were prescribed 3-drug antiretroviral therapy (ART). Bolton-Moore and colleagues report survival, weight gain, CD4 cell count, and hemoglobin response for children receiving ART and discuss the factors associated with survival and improvement in clinical status.
Cash transfers conditional on certain behaviors—for example, attending primary health clinics for preventive care—have been advanced as a means to improve access to and use of health services in developing countries. However, evidence that the programs achieve these goals is lacking. In a review of the literature on conditional cash transfers and health access, use, and outcomes, Lagarde and colleagues found some evidence that cash transfers improve access and use of preventive services, but success is dependent on the adequacy of the existing health and community infrastructures.
Control of the 13 neglected tropical diseases—infectious conditions that occur in areas of extreme poverty—includes evaluation of oral medications that may simultaneously treat multiple diseases. Reddy and colleagues conducted a systematic review of randomized clinical trials that assessed the efficacy of existing oral medications to simultaneously control 2 or more of the 7 most prevalent neglected diseases and report reductions in disease prevalence associated with single or combined oral drug therapies.
Featured articles explore this issue’s theme of poverty and human development.
Microfinance programs and health
China's health care system
Health effects of declining US income
Innovation, licensing, and global health
Disseminating global health change
Eiss and Glass Article and Flanagin and Winker Article discuss global health disparities, successful interventions, and the commitment needed to reduce poverty and improve global health.
Submit your views on the diagnostic or treatment options for a patient at a medical crossroads. Your response may be selected for online publication. Go to www.jama.com to read the first case. Submission deadline is October 31.
For your patients: Information about poverty and health.
This Week in JAMA . JAMA. 2007;298(16):1835. doi:10.1001/jama.298.16.1835