Person: Baernighausen, Till
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Baernighausen
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Till
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Baernighausen, Till
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Publication The prevalence of cardiovascular disease risk factors among adults living in extreme poverty(Springer Science and Business Media LLC, 2024-03-13) Geldsetzer, Pascal; Tisdale, Rebecca L; Stehr, Lisa; Michalik, Felix; Lemp, Julia; Aryal, Krishna K.; Damasceno, Albertino; Houehanou, Corine; Jørgensen, Jutta M. A.; Lunet, Nuno; Mayige, Mary; Moghaddam, Sahar S.; Mwangi, Kibachio J.; Bommer, Christian; Marcus, Maja-Emilia; Theilmann, Michaela; Ebert, Cara; Atun, Rifat; Davies, Justine I.; Flood, David; Manne-Goehler, Jennifer; Seiglie, Jacqueline; Baernighausen, Till; Vollmer, SebastianEvidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank’s international line for extreme poverty globally is sparse, as prior studies have used setting-specific rather than absolute measures of poverty. Here, we e pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in extreme poverty globally, and sorted individuals by country-specific measures of household income or wealth to identify those in extreme poverty. CVD risk factors (hypertension, diabetes, smoking, obesity, and dyslipidemia) were present among a substantial proportion of adults in extreme poverty, and most were not treated for CVD-related conditions (e.g., among those with hypertension earning <$1.90/day, 15.2% (95% CI: 13.3% – 17.1%) reported taking BP-lowering medication). The main limitation of our analysis is its potential measurement error-related misestimation of CVD risk factor . Nonetheless, our results could inform equity discussions for resource allocation and design of effective interventions.Publication Time trends of baseline demographics and clinical characteristics of HIV infected children enrolled in care and treatment service in Dar es Salaam, Tanzania(Springer Science + Business Media, 2015) Sando, David; Spiegelman, Donna; Machumi, Lameck; Mwanyika-Sando, Mary; Aris, Eric; Muya, Aisa; Jackson, Elizabeth; Baernighausen, Till; Hertzmark, Ellen; Chalamilla, Guerino; Fawzi, WafaieBackground Few studies have described time-based trends of clinical and demographic characteristics of children enrolling in HIV and AIDS care and treatment services. We present findings of a study that explored time-based trends of baseline characteristics among children enrolling into 26 public HIV care facilities in Dar es Salaam, Tanzania. Methods Children enrolled between October 2004 and September 2011 was included in these analyses. The year of enrollment was used as the primary predictor of interest, and log linear and linear regressions model were used to analyze dichotomous and continuous variables respectively. P-values under 0.05 were considered significant. Results Among the 6,579 children enrolled, the proportion with advanced disease at enrollment increased from 35% to 58%, mean age increasing from 5.0 to 6.2 years (p < 0.0001), proportion of children less than 2 years decreased from 35% to 29%. While the median hemoglobin concentration rose from 9.1 g/dl to 10.3 g/dl (P <0.0001), proportion with a history of past TB dropped from 25% to 12.8% (P < 0.0001). Over time, health centers and dispensaries enrolled more children as compared to hospitals (P < 0.0001). Temeke district, which has the lowest socioeconomic status among the three districts in Dar es Salaam, had a significant increase in enrollment from 22% to 25% (P = 0.02). Conclusion We found that as time progressed, children were enrolled in care and treatment services at an older age sicker status as evidenced by increase in mean age and more advanced disease stage at first contact with providers. We recommend more efforts be focused on scaling up early HIV infant diagnosis and enrollment to HIV care and treatment.Publication Hypertension and Obesity in Adults Living in a High HIV Prevalence Rural Area in South Africa(Public Library of Science, 2012) Malaza, Abraham; Mossong, Joel; Newell, Marie-Louise; Baernighausen, TillHypertension and excess body weight are major risk factors of cardiovascular morbidity and mortality in developing countries. In countries with a high HIV prevalence, it is unknown how increased antiretroviral treatment and care (ART) coverage has affected the prevalence of overweight, obesity, and hypertension. We conducted a health survey in 2010 based on the WHO STEPwise approach in 14,198 adult resident participants of a demographic surveillance area in rural South Africa to investigate factors associated with hypertension and excess weight including HIV infection and ART status. Women had a significantly higher median body mass index (BMI) than men (26.4 vs. 21.2 kg/\(m^2\), p<0.001). The prevalence of obesity (BMI≥30 kg/\(m^2\)) in women (31.3%, 95% confidence interval (CI) 30.2–32.4) was 6.5 times higher than in men (4.9%, 95% CI 4.1–5.7), whereas prevalence of hypertension (systolic or diastolic blood pressure≥140 or 90 mm Hg, respectively) was 1.4 times higher in women than in men (28.5% vs 20.8%, p<0.001). In multivariable regression analysis, both hypertension and obesity were significantly associated with sex, age, HIV and ART status. The BMI of women and men on ART was on average 3.8 (95% CI 3.2–3.8) and 1.7 (95% CI 0.9–2.5) kg/\(m^2\) lower than of HIV-negative women and men, respectively. The BMI of HIV-infected women and men not on ART was on average 1.2 (95% CI 0.8–1.6) and 0.4 (95% CI -0.1–0.9) kg/m2 lower than of HIV-negative women and men, respectively. Obesity was a bigger risk factor for hypertension in men (adjusted odds ratio (aOR) 2.99, 95% CI 2.00–4.48) than in women (aOR 1.64, 95% CI 1.39–1.92) and overweight (25≤BMI<30) was a significant risk factor for men only (aOR 1.53 95% CI 1.14–2.06). Our study suggests that, cardiovascular risk factors of hypertension and obesity differ substantially between women and men in rural South Africa.Publication Health Worker Preferences for Community-Based Health Insurance Payment Mechanisms: A Discrete Choice Experiment(BioMed Central, 2012) Robyn, Paul Jacob; Souares, Aurélia; Savadogo, Germain; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer; Baernighausen, TillBackground: In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods: A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results: Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions: Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid.