ALBANIAN MEDICAL JOURNAL SUPPLEMENTHome visits to promote health and development ofRoma children <strong>in</strong> Tirana and DurrësGentiana Qirjako 1 , Genc Burazeri 1 , Erka Amursi 1 , Mar<strong>in</strong>a Ndrio 2 ,Donika Naqi 3 , Silva B<strong>in</strong>o 1 , Gazmend Bejtja 4 , Mirl<strong>in</strong>da Bushati 51Institute of Public Health, Tirana, <strong>Albania</strong>;2Faculty of Social Sciences, University of Tirana, Tirana, <strong>Albania</strong>;3Community Centre of Health and Wellbe<strong>in</strong>g, Tirana, <strong>Albania</strong>;4M<strong>in</strong>istry of Health, Tirana, <strong>Albania</strong>;5UNICEF - Country Office, Tirana, <strong>Albania</strong>.Context: The psychosocial development ofchildren 0-6 years old can be considered as aneglected part of growth and development of thehealth system <strong>in</strong> <strong>Albania</strong>. Little emphasis on this issuehas been made from the health staff. Nurses andother specialists have received only limited tra<strong>in</strong><strong>in</strong>gon this topic while the development milestones andtool for their assessment are lack<strong>in</strong>g <strong>in</strong> the well-babycl<strong>in</strong>ics. The situation is even worse for Romachildren. The aim of the project was to providepsychosocial support and at home health care formothers and children of Roma community <strong>in</strong>Durrës and Tirana while sett<strong>in</strong>g up a practice forthe health sector to provide support to thepsychosocial development of children.Methods: Based on the f<strong>in</strong>d<strong>in</strong>gs from a rapidassessment, two documents for home visits weredeveloped: a manual for parents regard<strong>in</strong>g thegrowth and development aspects for children aged0-6 years; and practical how to guidel<strong>in</strong>es fornurses and social workers <strong>in</strong>volved <strong>in</strong> home visits.The manual for parents <strong>in</strong>cludes all the basic<strong>in</strong>formation necessary for an appropriate developmentof the children (development milestonesaccord<strong>in</strong>g to age, nutrition, hygiene, safety, positiveparent<strong>in</strong>g, etc), which can be used from all parents<strong>in</strong> the population, <strong>in</strong>clud<strong>in</strong>g Roma community asbe<strong>in</strong>g developed based on the needs of the mostvulnerable groups. Check lists for the psychosocialdevelopment of the children, checklists for theevaluation of the security at home environment andchecklists for evaluation of the parent-childcommunication as well as for the mental wellbe<strong>in</strong>gof the parents were produced to be used from thehome visits specialists. The home visits were carriedout by the work<strong>in</strong>g groups each consist<strong>in</strong>g of twospecialists (psychologists/social workers and healthprofessionals pediatricians) and one Romacommunity leader, who facilitated the process.Results: A more comprehensive approach to earlylife of children was developed, build<strong>in</strong>g on exist<strong>in</strong>gchild survival programmes and extend<strong>in</strong>g <strong>in</strong>terventions<strong>in</strong> early life to <strong>in</strong>clude social/emotional andlanguage/cognitive development. The home visits<strong>in</strong>terventions have showcased of how the universalmodel of home visits can be upgraded for target<strong>in</strong>gvulnerable communities. A model<strong>in</strong>g and practice ofbehaviors have been created (there were visited 240families and 295 children, a series of assessments andhow to guides developed) and is be<strong>in</strong>g sharedamong well baby cl<strong>in</strong>ics. In 93% of the cases, thehome visits have <strong>in</strong>volved parents (ma<strong>in</strong>ly mothers)who have acquired better skills on healthy nutritionalhabits, development of their children, immunization,effective health care-seek<strong>in</strong>g behavior, psychosocialand social problems, and prevention of domesticviolence.Conclusion: Interventions for holistic developmentof the early age and target<strong>in</strong>g vulnerable groups aremost effective when they are conducted by aspecialized multidiscipl<strong>in</strong>ary team <strong>in</strong>clud<strong>in</strong>g bothhealth professionals and social workers.Keywords: children growth and development, homevisits, multidiscipl<strong>in</strong>aryteam, Roma children.114 ALBANIAN MEDICAL JOURNAL SUPPLEMENT
INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe cost of illness and adm<strong>in</strong>istrative dataset as anessential source A case study of diarrhoea <strong>in</strong><strong>Albania</strong>n childrenAlbana Ahmeti 1 , Silva B<strong>in</strong>o 1 , Artan Simaku 1 , Iria Preza 11Institute of Public Health, Tirana, <strong>Albania</strong>.Aim: Estimation of Cost-of-Illness (CoI) is anessential <strong>in</strong>dicator for measur<strong>in</strong>g the economicburden of disease and enables <strong>in</strong>-depth studies ofcost-effectiveness, cost-utility, or cost benefit. CoIstudies can estimate <strong>in</strong> monetary terms the cost ofthe disease from health services prospective as wellas the economic consequences of illness <strong>in</strong> terms oflost productivity to society. There are very fewstudies related the CoI for various diseases <strong>in</strong><strong>Albania</strong>. Here we aim to describe the mostimportant cost components of CoI for diarrhea <strong>in</strong>children, us<strong>in</strong>g the adm<strong>in</strong>istrative data as one of theessential sources.Methods: We m<strong>in</strong>ed and used the adm<strong>in</strong>istrativerecords of M<strong>in</strong>istry of Health, Health InsuranceInstitute and the ma<strong>in</strong> health service providers. Also,data from the National Institute of Statistics were<strong>in</strong>corporated with<strong>in</strong> the study.Results: After analyz<strong>in</strong>g diarrhoea data we foundout that the mean <strong>in</strong>patient cost per case of severediarrhea is estimated at US$ 233.39. The meanoutpatient cost per case is estimated at $7.37(95%CI=$2.37-$14.87) while the mean cost per case<strong>in</strong> emergency room was $15.97 (95%CI=$11.4-$29.33). The mean <strong>in</strong>direct cost per case of diarrheacases, as social productivity loss, was estimated at$46 (95%CI=$30-$121).Conclusion: The estimation of CoI for diarrhoeacases <strong>in</strong> children and especially the type of costs canhelp to make further economic analysis about costeffectivenessof an <strong>in</strong>tervention and better estimatesof the <strong>in</strong>tervention strategies. The advantage ofus<strong>in</strong>g the adm<strong>in</strong>istrative data is the low cost and thequick follow-up of patient records, but there areseveral limitations such as enrolment not based ondiagnoses or disease protocols.Keywords: cost-benefit analysis, cost-effectiveness analysis, cost of illness, economic analysis, cost-utility analysis.ALBANIAN MEDICAL JOURNAL SUPPLEMENT115
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