Suchergebnisse

Background Armenia has an upward trend in cesarean sections (CS); the CS rate increased from 7.2% in 2000 to 31.0% in 2017. The purpose of this study was to investigate potential factors contributing to the rapidly increasing rates of CS in Armenia and identify the actual costs of CS and vaginal birth (VB), which are different from the reimbursement rates by the Obstetric Care State Certificate Program of the Ministry of Health. Methods This was a partially mixed concurrent quantitative-qualitative equal status study. The research team collected qualitative data via in-depth interviews (IDI) with obstetrician-gynecologists (OBGYN) and policymakers and focus group discussions (FGD) with women. The quantitative phase of the study utilized the bottom-up cost accounting (considering only direct variable costs) from the perspective of providers, and it included self-administered provider surveys and retrospective review of mother and child hospital records. The survey questionnaire was developed based on IDIs with providers of different medical services. Results The mean estimated direct variable cost per case was 35,219 AMD (94.72 USD) for VB and 80,385 AMD (216.19 USD) for CS. The ratio of mean direct variable costs for CS vs. VB was 2.28, which is higher than the government's reimbursement ratio of 1.64. The amount of bonus payments to OBGYNs was 11 fold higher for CS than for VB indicating that OBGYNs may have significant financial motivation to perform CS without a medical necessity. The qualitative study analysis revealed that financial incentives, maternal request and lack of regulations could be contributing to increasing the CS rates. While OBGYNs did not report that higher reimbursement for CS could lead to increasing CS rates, the policymakers suggested a relationship between the high CS rate and the reimbursement mechanism. The quantitative phase of the study confirmed the policymakers' concern. Conclusion The study suggested an important relationship between the increasing CS rates and the current health care reimbursement system.

INTRODUCTION: Armenia and Georgia have high rates of smoking and secondhand smoke exposure (SHSe). Greater progress in recent smoke-free legislation in Georgia and Armenia provides a pivotal time for examining the impact on smokers' and non-smokers' experiences and interactions regarding SHSe. METHODS: Surveys were conducted in 28 communities in Armenia (n=705) and Georgia (n=751) in 2018 and assessed past 30-day SHSe and smoking in different contexts, as well as attitudes toward and interactions regarding SHSe. RESULTS: In this sample (mean age 43.4 years, SD=13.5; 60.5% female; 27.3% smokers), SHSe among non-smokers was usually in homes (42.7%), cars (42.4%), and outdoor public places (38.2%); smokers also reported smoking usually in these places (70.0%, 62.1%, and 60.0%, respectively). Smokers indicated greater likelihood of putting out cigarettes and non-smokers indicated greater likelihood of asking smokers to put them out in places where smoking was prohibited versus allowed (76.5% vs 57.3%, and 46.6% vs 30.7%, respectively). Moreover, 89.9% of smokers indicated being very likely to put out cigarettes around small children if asked and 75.8% indicated trying to minimize SHSe. While 39.7% of participants reported seeing requests to smokers to put out cigarettes in the past 6 months, only 23.3% of smokers reported being asked to do so. Non-smokers in Georgia versus Armenia reported greater likelihood of engaging in behaviors to lower SHSe (p<0.001). CONCLUSIONS: Smoke-free legislation may catalyze more behaviors to lower SHSe, particularly among non-smokers; however, private settings (e.g. homes) remain prominent SHSe sources. Public health efforts must consider implications of such policies on SHSe in private settings.

OBJECTIVES: Given high prevalence of smoking and secondhand smoke exposure in Armenia and Georgia and quicker implementation of tobacco legislation in Georgia versus Armenia, we examined correlates of having no/partial versus complete smoke-free home (SFH) restrictions across countries, particularly smoking characteristics, risk perceptions, social influences and public smoking restrictions. DESIGN: Cross-sectional survey study design. SETTING: 28 communities in Armenia and Georgia surveyed in 2018. PARTICIPANTS: 1456 adults ages 18–64 in Armenia (n=705) and Georgia (n=751). MEASUREMENTS: We used binary logistic regression to examine aforementioned correlates of no/partial versus complete SFH among non-smokers and smokers in Armenia and Georgia, respectively. RESULTS: Participants were an average age of 43.35, 60.5% women and 27.3% smokers. In Armenia, among non-smokers, having no/partial SFHs correlated with being men (OR=2.63, p=0.001) and having more friend smokers (OR=1.23, p=0.002); among smokers, having no/partial SFHs correlated with being unmarried (OR=10.00, p=0.001), lower quitting importance (OR=0.82, p=0.010) and less favourable smoking attitudes among friends/family/public (OR=0.48, p=0.034). In Georgia, among non-smokers, having no/partial SFHs correlated with older age (OR=1.04, p=0.002), being men (OR=5.56, p<0.001), lower SHS risk perception (OR=0.43, p<0.001), more friend smokers (OR=1.49, p=0.002) and fewer workplace (indoor) restrictions (OR=0.51, p=0.026); among smokers, having no/partial SFHs correlated with being men (OR=50.00, p<0.001), without children (OR=5.88, p<0.001), daily smoking (OR=4.30, p=0.050), lower quitting confidence (OR=0.81, p=0.004), more friend smokers (OR=1.62, p=0.038) and fewer community restrictions (OR=0.68, p=0.026). CONCLUSIONS: Private settings continue to lack smoking restrictions in Armenia and Georgia. Findings highlight the importance of social influences and comprehensive tobacco legislation, particularly smoke-free policies, in changing ...