S. Ouedraogo

Evaluation of Health in Pregnancy grants in Scotland: a protocol for a natural experiment

Introduction A substantial proportion of low birth weight is attributable to the mothers cultural and socioeconomic circumstances. Early childhood programmes have been widely developed to improve child outcomes. In the UK, the Health in Pregnancy (HiP) grant, a universal conditional cash transfer of £190, was introduced for women reaching the 25th week of pregnancy with a due date on/or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on/or after 1 January 2011. The current study focuses on the evaluation of the effectiveness and cost-effectiveness of the HiP grant. Methods and analysis The population under study will be all singleton births in Scotland over the periods of January 2004 to March 2009 (preintervention), April 2009 to April 2011 (intervention) and May 2011 to December 2013 (postintervention). Data will be extracted from the Scottish maternity and neonatal database. The analysis period 2004–2013 should yield over 585 000 births. The primary outcome will be birth weight among singleton births. Other secondary outcomes will include gestation at booking, booking before 25 weeks; measures of size and stage; gestational age at delivery; weight-for-dates, term at birth; birth outcomes and maternal smoking. The main statistical method we will use is interrupted time series. Outcomes will be measured on individual births nested within mothers, with mothers themselves clustered within data zones. Multilevel regression models will be used to determine whether the outcomes changed during the period in which the HiP grants was in effect. Subgroup analyses will be conducted for those groups most likely to benefit from the payments. Ethics and dissemination Approval for data collection, storage and release for research purpose has been given (6 May 2014, PAC38A/13) by the Privacy Advisory Committee. The results of this study will be disseminated through peer-reviewed publications in journals, national and international conferences.

Characterisation of the rural indigent population in Burkina Faso: a screening tool for setting priority healthcare services in sub-Saharan Africa

Background In Africa, health research on indigent people has focused on how to target them for services, but little research has been conducted to identify the social groups that compose indigence. Our aim was to identify what makes someone indigent beyond being recognised by the community as needing a card for free healthcare. Methods We used data from a survey conducted to evaluate a state-led intervention for performance-based financing of health services in two districts of Burkina Faso. In 2015, we analysed data of 1783 non-indigents and 829 people defined as indigents by their community in 21 villages following community-based targeting processes. Using a classification tree, we built a model to select socioeconomic and health characteristics that were likely to distinguish between non-indigents and indigents. We described the screening performance of the tree using data from specific nodes. Results Widow(er)s under 45 years of age, unmarried people aged 45 years and over, and married women aged 60 years and over were more likely to be identified as indigents by their community. Simple rules based on age, marital status and gender detected indigents with sensitivity of 75.6% and specificity of 55% among those 45 years and over; among those under 45, sensitivity was 85.5% and specificity 92.2%. For both tests combined, sensitivity was 78% and specificity 81%. Conclusion In moving towards universal health coverage, Burkina Faso should extend free access to priority healthcare services to widow(er)s under 45, unmarried people aged 45 years and over, and married women aged 60 years and over, and services should be adapted to their health needs. Ethics considerations The collection, storage and release of data for research purposes were authorised by a government ethics committee in Burkina Faso (Decision No. 2013-7-066). Respondent consent was obtained verbally.

OP86 Evaluating Health in Pregnancy grants in Scotland: a natural experiment

Background The developmental model of the origins of chronic diseases has shown the importance of undernutrition and poor development in utero on disease in later life, including coronary heart disease and stroke. Tracing disease back to fetal development means that this period can also be seen as the origin of health inequalities and, as such, a priority time for intervention to improve health outcomes. This paper reports on the evaluation of Health in Pregnancy (HiP) grants, a UK-wide unconditional universal cash transfer of £190 made to pregnant women who had sought medical advice before the 25th week of pregnancy. The grant was designed to provide additional financial support towards a healthy lifestyle including diet, with the cash element providing a greater incentive to seek advice at the appropriate time. Methods This natural experiment was evaluated using routinely collected data for all singleton births in Scotland before (2004–2009), during (2009–2011) and after (2011–2013) the introduction of the HiP grants. In addition to the primary outcome of birthweight (BW) we evaluated the effect on other measures of stage and size and maternal behaviour including contacting the midwife before 25 weeks. We looked for evidence of differential effects among subgroups including those defined by area deprivation, social class, marital status and maternal diabetes. The analysis was restricted to Scotland because of the high quality routine data available. We used interrupted time series models adjusted for time trends and seasonality in addition to maternal and birth characteristics to estimate the effect of the intervention (INT) and post-intervention (POST) periods relative to the years pre-intervention, and used multiple imputation to reduce any bias due to missing data. Results Among the 525,400 singleton births from 2004–2013 there was no significant relationship with BW (INT = −2.3 g, 95% CI: −1.9 to 6.6) or other measures of size and stage. The intervention was associated with an increase in the odds of booking before 25 weeks that disappeared post-intervention (INT OR = 1.10, 95% CI: 1.02 to 1.18; POST OR = 0.91, 95% CI: 0.83–1.00). Results for the subgroups largely mirrored those seen for the population. Conclusion The small financial incentive did not have an impact on birthweight or other measures of size or stage but did appear to have changed health seeking behaviour. It is not clear that a threshold of 25 weeks is optimal to improve birth outcomes given that this is late in the pregnancy. Future evaluations would be enhanced if some randomisation were included in the study design.

Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso

We evaluated the effectiveness of a community-based intervention for dengue vector control in Ouagadougou, the capital city of Burkina Faso. Households in the intervention (n = 287) and control (n = 289) neighborhoods were randomly sampled and the outcomes collected before the intervention (October 2015) and after the intervention (October 2016). The intervention reduced residents’ exposure to dengue vector bites (vector saliva biomarker difference −0.08 [95% CI −0.11 to −0.04]). The pupae index declined in the intervention neighborhood (from 162.14 to 99.03) and increased in the control neighborhood (from 218.72 to 255.67). Residents in the intervention neighborhood were less likely to associate dengue with malaria (risk ratio 0.70 [95% CI 0.58–0.84]) and had increased knowledge about dengue symptoms (risk ratio 1.44 [95% CI 1.22–1.69]). Our study showed that well-planned, evidence/community-based interventions that control exposure to dengue vectors are feasible and effective in urban settings in Africa that have limited resources.

Evaluation of a Cash Transfer for Behaviour Change in Pregnancy: A Natural Experiment of Routine Data in Scotland 2004-13

Purpose: The epidemiology of hospitalization for pediatric brain tumors (PBT) in the United States has not been reported recently. We examined trends and outcomes associated with admission for PBT at the national level across 10 years. Methods: All patients 18 years of age with PBT were identified in the Nationwide Inpatient Sample from 2001-2010 and hospitalization trends and patient outcomes were examined. Results: A total of 137,500 PBT admissions were identified; most occurred among younger patients: 33.9% were 0-4years, 27.0% 5-9years, 22.9% 1014years, and 16.2% 15-18years of age. Overall, 55.3% of patients were male. Private insurance was the predominant payer (58.8%) followed by Medicaid (34.3%); 6.9% of patients had other/unknown coverage. Admissions were centered in teaching hospitals (90.8%) and urban areas (96.3%). Most tumors were malignant (85.5%) with similar proportions classified as benign (7.4%) and undetermined (7.1%). Patients with malignancies were younger than those with benign disease (7.5 vs.11.4 years, p<0.001). Overall, 25.4% of patients underwent neurosurgical intervention (60.7% for benign vs. 20.3% for malignant tumors, p<0.001). Inpatient mortality was stable across time at approximately 1.9%, but was lower among patients treated surgically (0.96%) vs. those without surgery (2.2%) (p<0.001). Mean hospitalization was 6.7 days, and hospital charges averaged

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update

41,733 (95%CI

Evaluation of health in pregnancy grants in Scotland: a natural experiment using routine data

39,231-

Assessment of the Health in Pregnancy Grant policy in Scotland: a natural experiment

44,235). Aggregated annual inpatient charges for treatment of PBT were

ARIA Update 2008: die allergische Rhinitis und ihr Einfluss auf das Asthma: In Zusammenarbeit mit der Weltgesundheitsorganisation, GA2LEN und AllerGen

1,101,545,208 in 2010. Conclusion: Pediatric brain tumors constitute a significant healthcare burden. Inpatient mortality has remained stable over the past decade; however, death was more common among patients with malignant tumors and those for whom surgery was not indicated/performed.