human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting OBJECTIVES The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country . METHODS The intervention comprised inspections of the pharmacies , information , and distribution of documents to drug sellers and sanctions . It was implemented at two different intensity levels , active and regular intervention . The methods used to assess the effect of the interventions were interviews with the district drug inspectors , drug sellers and customers , inspection of drug purchases , and indicator surveys of pharmacies . Indicators for pharmacy-specific quality as well as for dispensing quality were developed . RESULTS The main finding was one of strong overall improvements from initially low levels . The improvements were particularly marked by increases in the availability of essential material s for dispensing by 34 % and in order in the pharmacy by 19 % . Information given to customers increased from 35 % to 51 % and the mixing of different drugs in the same package went down from 17 % to 9 % . The pharmacies in the active intervention districts showed greater improvements for four of the six indicators , although statistically significant compared with the regular intervention districts only for the essential material s indicator . CONCLUSIONS It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements . It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting SETTING Rural and urban areas of Maharashtra , a large state in Western India . OBJECTIVE To underst and tuberculosis ( TB ) management practice s among  private medical practitioners ( PPs )  and the treatment behaviour of the patients they manage . DESIGN Prospect i ve study of help-seeking patterns and treatment behaviour among 173 pulmonary TB patients diagnosed in private clinics , and the TB management practice s of 122 PPs treating these patients . RESULTS The first source of help for 86 % of patients was a PP . The diagnostic and treatment practice s of PPs were inadequate ; 15 % did not consider sputum examination to be necessary , and 79 different treatment regimens were prescribed by 105 reporting PPs . Sixty-seven percent of the patients diagnosed in private clinics remained with the private sector , and the rest shifted to public health services within six months of treatment . The treatment adherence rate among the patients in private clinics was 59 % . There were discrepancies between the reported management practice s of the PPs and what their patients actually followed . CONCLUSION The study identifies and highlights the need to educate PPs and their TB patients , and indicates ways in which PPs could be meaningfully involved in efforts to revitalize the national TB control programme In just a few years , oral rehydration therapy ( ORT ) has become the st and ard treatment to reduce infant diarrhoeal disease mortality in the developing world . The paper describes an ORT intervention campaign in a rural area in Western Kenya ( Kakamega District ) . After about a year of careful preparation , the campaign was launched in January 1986 and compared the use of a value-added product ( flavoured sachets ) sold through private outlets in addition to primary care distribution of an unflavoured sachet in an experimental cell ( Bukura Division ) . In a control cell ( Novakholo Division ) , only unflavoured sachets were distributed free of charge through primary health care facilities . Using local perceptions of diarrhoeal disease management , the campaign in the experimental cell was carefully design ed and mass communication techniques employed and adapted accordingly . Outcome assessment s of the campaign , which lasted until March 1987 , included the overall ORT utilisation over time . Changes in perceptions towards diarrhoeal disease management , direct assessment s of mixing a ' safe and effective ' solution accurately and other relevant process parameters were evaluated . Comparing several recent ORT intervention projects , the paper concludes that a combination of a commercial approach and mass communication techniques can further ORS use . If a proper incentive system for shopkeepers is installed and message design and ORS product are fully tailored to the perception and preferences of the target population , the commercial availability of ORS will create an extra dem and of the product . However , this will not replace distribution of ORS salts delivered free of charge through primary care sources Objectives : To evaluate the training of  pharmacists in Accra , Ghana , in the syndromic management of STIs . Methods : We r and omly selected 50 pharmacy outlets that had received the training ( intervention ) and 50 outlets that had not received the training ( no intervention ) . Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a st and ardised question naire after each encounter . Results : Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low ( no intervention 18 % ; intervention 39 % ; p < 0.05 ) . More encouraging , treatment for gonorrhoea was usually correct without the intervention ( 64 % ) and improved further in the intervention outlets ( 76 % ) . The treatment for chlamydia was less often appropriate but also improved ( 31 % and 41 % ) . Condom promotion was poor , with almost no outlets offering condoms . Conclusions : The current training led to improvements in the treatment of urethral discharge . Future training needs to be improved , especially with regard to condom promotion . Moreover , since less than one third of simulated clients were seen by pharmacists , the training should be exp and ed to other pharmacy staff . With enhanced training of all pharmacy staff , the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised OBJECTIVE To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health ( SRH ) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction . DESIGN A community-based quasi-experimental intervention study from 2000 to 2002 . SETTING Low-income areas of Managua . INTERVENTION Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics ; training and support for health care providers . STUDY PARTICIPANTS A r and om sample of 3009 girls from 12 to 20 years completed self-administered question naires : 700 respondents had used this care in the last 15 months , 221 with voucher ( users-with-voucher ) and 479 without voucher ( users-without-voucher ) . MAIN OUTCOME MEASURES User satisfaction ; Satisfaction with clinic reception ; Clarity of doctors ' explanations . RESULTS User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [ Adjusted odds-ratio ( AOR ) = 2.2 ; 95 % confidence interval ( 95 % CI ) = 1.2 - 4.0 ] . Voucher use was associated with more frequent satisfaction with clinic reception , especially among sexually active girls not yet pregnant or mother ( AOR = 6.9 ; 95 % CI = 1.5 - 31.8 ) . The clarity of doctors ' explanations was not perceived differently ( AOR = 1.4 ; 95 % CI = 0.9 - 2.2 ) . User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors ' explanations ( P < 0.001 ) . Longer consultation times , shorter waiting times , older age , and having a female doctor positively influenced user satisfaction . CONCLUSION Voucher use by teenage girls was associated with a better perceived SRH care . This is an important result , given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives . Though more research is needed , confidential and guaranteed access appear key factors to voucher success BACKGROUND The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care ( SRHC ) accessible to adolescents from disadvantaged areas of Managua . METHODS A quasi-experimental intervention study was performed in which 28,711 vouchers that gave free access to SRHC in 20 health centers , were distributed to adolescents . To evaluate the impact , community sampling took place in markets , neighborhoods , and outside schools where self-administered question naires were distributed . The study comprised a r and om sample of 3,009 female adolescents , ages 12 to 20 years old , 904 voucher receivers and 2,105 nonreceivers . Their use of SRHC , and knowledge and use of contraceptives and condoms were measured . RESULTS Voucher receivers had a significantly higher use of SRHC compared with nonreceivers , 34 % versus 19 % ( adjusted odds ratio , 3.1 ; 95 % confidence interval , 2.5 - 3.8 ) . The highest influence was seen among respondents at schools , where use was 24 % relative to 6 % in nonreceivers ( adjusted odds ratio , 5.9 ; 95 % confidence interval , 3.7 - 9.5 ) . Voucher receivers answered significantly more questions correctly that were related to knowledge of contraceptives and sexually transmitted infections than nonreceivers . At schools , sexually active voucher receivers had a significantly higher use of modern contraceptives than nonreceivers , 48 % versus 33 % ( adjusted odds ratio , 2.3 ; 95 % confidence interval , 1.2 - 4.4 ) ; and in neighborhoods , condom use during last sexual contact was significantly greater among voucher receivers than nonreceivers ( adjusted odds ratio , 2.5 ; 95 % confidence interval , 1.4 - 4.5 ) . CONCLUSION The voucher program succeeded in increasing access to SRHC for poor and underserved girls . The needs of adolescents were met with a relatively simple intervention through existing health facilities . Many adolescents appeared willing to protect themselves against the risks of sexual intercourse . This suggest that access to SRHC can play an important role in changing youth behavior and increase the use of contraceptives and condoms 
    Output:
    
agent
It was , however , evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting OBJECTIVES The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country . METHODS The intervention comprised inspections of the pharmacies , information , and distribution of documents to drug sellers and sanctions . It was implemented at two different intensity levels , active and regular intervention . The methods used to assess the effect of the interventions were interviews with the district drug inspectors , drug sellers and customers , inspection of drug purchases , and indicator surveys of pharmacies . Indicators for pharmacy-specific quality as well as for dispensing quality were developed . RESULTS The main finding was one of strong overall improvements from initially low levels . The improvements were particularly marked by increases in the availability of essential material s for dispensing by 34 % and in order in the pharmacy by 19 % . Information given to customers increased from 35 % to 51 % and the mixing of different drugs in the same package went down from 17 % to 9 % . The pharmacies in the active intervention districts showed greater improvements for four of the six indicators , although statistically significant compared with the regular intervention districts only for the essential material s indicator . CONCLUSIONS It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements . It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting SETTING Rural and urban areas of Maharashtra , a large state in Western India . OBJECTIVE To underst and tuberculosis ( TB ) management practice s among  private medical practitioners ( PPs )  and the treatment behaviour of the patients they manage . DESIGN Prospect i ve study of help-seeking patterns and treatment behaviour among 173 pulmonary TB patients diagnosed in private clinics , and the TB management practice s of 122 PPs treating these patients . RESULTS The first source of help for 86 % of patients was a PP . The diagnostic and treatment practice s of PPs were inadequate ; 15 % did not consider sputum examination to be necessary , and 79 different treatment regimens were prescribed by 105 reporting PPs . Sixty-seven percent of the patients diagnosed in private clinics remained with the private sector , and the rest shifted to public health services within six months of treatment . The treatment adherence rate among the patients in private clinics was 59 % . There were discrepancies between the reported management practice s of the PPs and what their patients actually followed . CONCLUSION The study identifies and highlights the need to educate PPs and their TB patients , and indicates ways in which PPs could be meaningfully involved in efforts to revitalize the national TB control programme In just a few years , oral rehydration therapy ( ORT ) has become the st and ard treatment to reduce infant diarrhoeal disease mortality in the developing world . The paper describes an ORT intervention campaign in a rural area in Western Kenya ( Kakamega District ) . After about a year of careful preparation , the campaign was launched in January 1986 and compared the use of a value-added product ( flavoured sachets ) sold through private outlets in addition to primary care distribution of an unflavoured sachet in an experimental cell ( Bukura Division ) . In a control cell ( Novakholo Division ) , only unflavoured sachets were distributed free of charge through primary health care facilities . Using local perceptions of diarrhoeal disease management , the campaign in the experimental cell was carefully design ed and mass communication techniques employed and adapted accordingly . Outcome assessment s of the campaign , which lasted until March 1987 , included the overall ORT utilisation over time . Changes in perceptions towards diarrhoeal disease management , direct assessment s of mixing a ' safe and effective ' solution accurately and other relevant process parameters were evaluated . Comparing several recent ORT intervention projects , the paper concludes that a combination of a commercial approach and mass communication techniques can further ORS use . If a proper incentive system for shopkeepers is installed and message design and ORS product are fully tailored to the perception and preferences of the target population , the commercial availability of ORS will create an extra dem and of the product . However , this will not replace distribution of ORS salts delivered free of charge through primary care sources Objectives : To evaluate the training of  pharmacists in Accra , Ghana , in the syndromic management of STIs . Methods : We r and omly selected 50 pharmacy outlets that had received the training ( intervention ) and 50 outlets that had not received the training ( no intervention ) . Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a st and ardised question naire after each encounter . Results : Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low ( no intervention 18 % ; intervention 39 % ; p < 0.05 ) . More encouraging , treatment for gonorrhoea was usually correct without the intervention ( 64 % ) and improved further in the intervention outlets ( 76 % ) . The treatment for chlamydia was less often appropriate but also improved ( 31 % and 41 % ) . Condom promotion was poor , with almost no outlets offering condoms . Conclusions : The current training led to improvements in the treatment of urethral discharge . Future training needs to be improved , especially with regard to condom promotion . Moreover , since less than one third of simulated clients were seen by pharmacists , the training should be exp and ed to other pharmacy staff . With enhanced training of all pharmacy staff , the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised OBJECTIVE To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health ( SRH ) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction . DESIGN A community-based quasi-experimental intervention study from 2000 to 2002 . SETTING Low-income areas of Managua . INTERVENTION Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics ; training and support for health care providers . STUDY PARTICIPANTS A r and om sample of 3009 girls from 12 to 20 years completed self-administered question naires : 700 respondents had used this care in the last 15 months , 221 with voucher ( users-with-voucher ) and 479 without voucher ( users-without-voucher ) . MAIN OUTCOME MEASURES User satisfaction ; Satisfaction with clinic reception ; Clarity of doctors ' explanations . RESULTS User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [ Adjusted odds-ratio ( AOR ) = 2.2 ; 95 % confidence interval ( 95 % CI ) = 1.2 - 4.0 ] . Voucher use was associated with more frequent satisfaction with clinic reception , especially among sexually active girls not yet pregnant or mother ( AOR = 6.9 ; 95 % CI = 1.5 - 31.8 ) . The clarity of doctors ' explanations was not perceived differently ( AOR = 1.4 ; 95 % CI = 0.9 - 2.2 ) . User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors ' explanations ( P < 0.001 ) . Longer consultation times , shorter waiting times , older age , and having a female doctor positively influenced user satisfaction . CONCLUSION Voucher use by teenage girls was associated with a better perceived SRH care . This is an important result , given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives . Though more research is needed , confidential and guaranteed access appear key factors to voucher success BACKGROUND The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care ( SRHC ) accessible to adolescents from disadvantaged areas of Managua . METHODS A quasi-experimental intervention study was performed in which 28,711 vouchers that gave free access to SRHC in 20 health centers , were distributed to adolescents . To evaluate the impact , community sampling took place in markets , neighborhoods , and outside schools where self-administered question naires were distributed . The study comprised a r and om sample of 3,009 female adolescents , ages 12 to 20 years old , 904 voucher receivers and 2,105 nonreceivers . Their use of SRHC , and knowledge and use of contraceptives and condoms were measured . RESULTS Voucher receivers had a significantly higher use of SRHC compared with nonreceivers , 34 % versus 19 % ( adjusted odds ratio , 3.1 ; 95 % confidence interval , 2.5 - 3.8 ) . The highest influence was seen among respondents at schools , where use was 24 % relative to 6 % in nonreceivers ( adjusted odds ratio , 5.9 ; 95 % confidence interval , 3.7 - 9.5 ) . Voucher receivers answered significantly more questions correctly that were related to knowledge of contraceptives and sexually transmitted infections than nonreceivers . At schools , sexually active voucher receivers had a significantly higher use of modern contraceptives than nonreceivers , 48 % versus 33 % ( adjusted odds ratio , 2.3 ; 95 % confidence interval , 1.2 - 4.4 ) ; and in neighborhoods , condom use during last sexual contact was significantly greater among voucher receivers than nonreceivers ( adjusted odds ratio , 2.5 ; 95 % confidence interval , 1.4 - 4.5 ) . CONCLUSION The voucher program succeeded in increasing access to SRHC for poor and underserved girls . The needs of adolescents were met with a relatively simple intervention through existing health facilities . Many adolescents appeared willing to protect themselves against the risks of sexual intercourse . This suggest that access to SRHC can play an important role in changing youth behavior and increase the use of contraceptives and condoms 
    Output:
    