Amit Patel

Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?

Background The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public–private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CYs effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India. Methods Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method. Results Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance. Conclusions This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation.

A GIS approach to plan and deliver healthcare services to urban poor

Purpose – To provide a public private partnership (PPP) model for urban health centres (UHC) in developing countries that can be useful for urban local governments and private service providers willing to enter into meaningful partnerships so as to improve primary healthcare services.Design/methodology/approach – This research is based on geographical information system methodology to identify suitable locations to address availability, access, affordability and equity concerns and to provide a practical framework for PPP for establishing UHC. The methodology involved survey and mapping of slum communities and private healthcare facilities.Findings – The research provides intricate details about planning healthcare services for urban poor, operational and managerial aspects of service provision and processes involved in PPP for urban health.Research limitations/implications – The model is developed and tested for Ahmedabad city (sixth largest city in India) and may need a certain amount of customisation f...

Geographic Variation in Cold Ischemia Time: Kidney Versus Liver Transplantation in the United States, 2003 to 2011

Background Regional variations in kidney and liver transplant outcomes have been reported, but their causes remain largely unknown. This study investigated variations in kidney and liver cold ischemia times (CITs) across organ procurement organizations (OPO) as potential causes of variations in transplant outcomes. Methods This retrospective study analyzed the Standard Transplant Analysis and Research data of deceased donor kidney (n = 61,335) and liver (n = 39,285) transplants performed between 2003 and 2011. The CIT variations between the 2 types of organs were examined and compared. Factors associated with CIT were explored using multivariable regressions. Spearman rank tests were used to associate CIT with graft failure at the OPO level. Results Significant CIT variations were found across OPOs for both organs (P < 0.05). The variation was particularly large for kidney CIT. Those OPOs with longer average kidney CIT were likely to have a lower graft survival rate (P = 0.01). For liver, this association was insignificant (P = 0.23). The regression analysis revealed sharp contrasts between the factors associated with kidney and liver CITs. High-risk kidney transplant recipients and marginal kidneys were associated with longer average CIT. The reverse was true for liver transplants. Conclusions Large variations in kidney CIT compared to liver CIT may indicate that there is a room to reduce kidney CIT. Reducing kidney CIT through managerial improvements could be a cost-effective way to improve the current transplant system.

Redesigning Organ Allocation Boundaries for Liver Transplantation in the United States

Geographic disparities in access to and outcomes in transplantation have been a persistent problem widely discussed by transplant researchers and the transplant community. One of the alleged causes of disparities in the United States is administratively determined organ allocation boundaries that limit organ sharing across regions. This paper applies mathematical programming to construct alternative liver allocation boundaries that achieve more geographic equity in access to transplants than the current system. The performance of the optimal boundaries were evaluated and compared to that of current allocation system using discrete event simulation.

Compression neuropathy of the common peroneal nerve by the fabella.

The fabella is a normal anatomical variant and has been found in up to 30% of the general population. We present the case of a 67-year-old man with pain down the lateral aspect of the left lower limb of 18 months duration. A clinical examination revealed a palpable fabella and nerve conduction studies confirmed a common peroneal nerve neuropathy at its level. Dynamic ultrasound scan and MRI of the knee showed the fabella to be impinging on the common peroneal nerve. Operative excision of the fabella was performed with significant improvement at 3 months and full recovery at 1 year. A literature review has shown that the last reported case of a compression neuropathy of the common peroneal nerve was in 1976. Anatomical considerations need to be taken into account and operative treatment has been recommended due to the favourable outcome in this case.

A Preliminary Assessment of Chlamydia and Gonnorhea Infections in the U.S.A. Communities Neighboring Military Installations

Sexually transmitted infections (STIs) among U.S. military personnel and neighboring communities prior, during, and after deployment are a threat to military readiness and community health. This pilot study used data from the Virginia Department of Health. Geographic and spatial pattern analysis of two STIs, Chlamydia trachomatis and Neisseria gonorrhoeae, were conducted. Of special interest was the STI spread patterns correlated with locations of military staging bases, in the aftermath of September 11, 2001. Higher prevalence rates of STIs were found in the counties contiguous to military installations.

A novel surgical technique for manipulation of intertrochanteric hip fractures in above-knee amputees

Intertrochanteric femoral fractures are commonly treated by closed reduction and internal fixation, with successful outcomes dependent upon manipulation of the fracture, satisfactory reduction and optimal implant positioning. Typically, on table traction and internal rotation are applied to achieve closed reduction, with the foot immobilised in a boot. This fracture pattern is rare and potentially fatal in above-knee amputees presenting surgeons with significant technical challenges. Previously described and published techniques in above-knee amputees include placing the ipsilateral stump on the radiolucent thigh support without traction or adhesive strapping.

Space - time spread of sexually transmitted diseases (STDs) in 2 states: A preliminary analysis

This study preliminarily assesses spatial patterns of the spread of two common sexually transmitted diseases (STDs), Chlamydia and Gonorrhea, in Virginia and California. In particular, we ask how spread patterns correlate with locations of recently deployed military personnel. In Virginia, higher prevalence rates of STDs were found almost consistently in the counties with or adjacent to military installations. However, the equivalent correlation was not found in California.