Biomedical subjects

David K Guilkey

Publications and source records attributed to David K Guilkey.

5 recordsLinked to original sources

PubMed2006

Cost-effectiveness analysis for health communication programs.

This article describes methods for analyzing the cost-effectiveness of health communication programs, focusing in particular on estimating program effectiveness with econometric methods that address experimental and quasi-experimental designs (and their absence), national or subnational program coverage, and endogenously targeting of programs. Experimental designs provide a gold standard for assessing effectiveness but are seldom feasible for large-scale health communication programs. Even in the absence of such designs, however, fairly simple methods can be used to examine intermediate objectives, such as program reach, which in turn can be linked to program costs to estimate cost effectiveness. When moving beyond program reach to behavioral or other outcome measures, such as contraceptive use or fertility, or when faced with full-coverage national programs, more elaborate data and methods are required. We discuss data requirements and assumptions necessary in each case, focusing on single-equation multiple regression models, structural equations models, and fixed effects estimators for use with longitudinal data, and then describing how cost information can be incorporated into econometric models so as to get measures of the cost-effectiveness of communication interventions.

Cost-Benefit Analysis↗

PubMed2006

Measuring the cost-effectiveness of a national health communication program in rural Bangladesh.

In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.

Adolescent↗

PubMed2004

The effect of participation in the WIC program on preschoolers' diets.

OBJECTIVE: To evaluate nutrient, food intake, and snacking behavior by participation in the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program. STUDY DESIGN: Secondary data analysis of a nationally representative cross-sectional survey conducted by USDA in 1994 to 1996 and 1998. METHODS: Statistical analysis was performed correcting for sample design effects and weighting for children in two income groups (<130%, n=1772 and 130% to 185% of poverty, n=689). RESULTS: Among WIC participants, the prevalence of snacking was significantly lower (68%) compared with nonparticipants (72%) (chi(2)=5.9, P=.01). For those <130% of poverty, WIC had a beneficial effect on the intake of fat, carbohydrates, added sugar, and fruit from the total diet as well as on added sugar from snacks. These were independent of food stamp participation. For those with higher incomes, the beneficial effects were limited to added sugar, iron density, and fruit intake for the total diet. A similar significant effect of decreased added sugar intake from snacks was also seen. CONCLUSIONS: Our results are in line with previous research showing beneficial effects of WIC participation among preschoolers, primarily for nutrients targeted by the program. This study shows that the effect can reach beyond those targeted nutrients.

Child Nutritional Physiological Phenomena↗

PubMed2003

Weekend eating in the United States is linked with greater energy, fat, and alcohol intake.

OBJECTIVES: To determine if macronutrient consumption for the U.S. population is greater on weekend days than weekdays. RESEARCH METHODS AND PROCEDURES: The nationally representative 1994 to 1996 Continuing Survey of Food Intakes by Individuals was used for this analysis. Dietary intake was assessed using two independent days of dietary recall data. Ordinary least squares multivariate analysis was used to analyze dietary outcome variables to explore the effect of weekend day vs. weekday intake. RESULTS: This study's results indicate that statistically significant dietary intake differences occur for different days of the week but not for all age groups--nor for all nutrients. The average American, 2 years and older, consumes 82 kcal more per day on each weekend day (Friday through Sunday) than they do on weekdays (Monday through Thursday). These overall increases in dietary intake are significant for the overall sample and are largest for the 19- to 50-year-old age group; among this age group, the weekend day increase (vs. weekday) is 115 kcal/d. The increased proportions of energy from fat and alcohol consumed on weekends are greater for this adult age group by 0.7% and 1.4%, respectively, whereas the proportion of energy from carbohydrate decreases 1.6%. DISCUSSION: The effects of weekend days on nutrient intake are substantial and should be considered in future clinical and population-based interventions and in dietary monitoring and research in the U.S.

Adolescent↗

PubMed2003

Determinants of contraceptive method choice in rural Tanzania between 1991 and 1999.

Four pooled Demographic and Health Survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania for the period from 1991 to 1999. The individual data are linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The focus of the study is an examination of the effect on method choice of the three major components of Tanzania's family planning program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of family planning message recall. Simulations are used to quantify the impact of the important policy variables. All three components of the program are shown to have had an impact on modern method choice.

Adolescent↗