Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study

<p>Abstract</p> <p>Background</p> <p>The average annual reported dengue incidence in Cambodia is 3.3/1,000 among children < 15 years of age (2002–2007). To estimate the economic burden of dengue, accurate cost-of-illness data are essential. We conducted a prospective, community-based, matched case-control study to assess the cost and impact of an episode of dengue fever and other febrile illness on households in rural Cambodia.</p> <p>Methods</p> <p>In 2006, active fever surveillance was conducted among a cohort of 6,694 children aged ≤ 15 years in 16 villages in Kampong Cham province, Cambodia. Subsequently, a case-control study was performed by individually assigning one non-dengue febrile control from the cohort to each laboratory-confirmed dengue case. Parents of cases and controls were interviewed using a standardized questionnaire to determine household-level, illness-related expenditures for medical and non-medical costs, and estimated income loss (see Additional file <supplr sid="S1">1</supplr>). The household socio-economic status was determined and its possible association with health seeking behaviour and the ability to pay for the costs of a febrile illness.</p> <suppl id="S1"> <title> <p>Additional File 1</p> </title> <text> <p><b>2006 cost study survey questionnaire, Cambodia</b>. the questionnaire represents the data collection instrument that was developed and used during the present study.</p> </text> <file name="1471-2458-9-155-S1.pdf"> <p>Click here for file</p> </file> </suppl> <p>Results</p> <p>Between September and November 2006, a total of 60 household heads were interviewed: 30 with dengue-positive and 30 with dengue-negative febrile children. Mean total dengue-related costs did not differ from those of other febrile illnesses (31.5 vs. 27.2 US$, p = 0.44). Hospitalization almost tripled the costs of dengue (from 14.3 to 40.1 US$) and doubled the costs of other febrile illnesses (from 17.0 to 36.2 US$). To finance the cost of a febrile illness, 67$ and higher debt was associated with hospitalization compared to outpatient treatment (US$23.1 vs. US$ 4.5, p < 0.001). These costs compared to an average one-week expenditure on food of US$ 9.5 per household (range 2.5–21.3). In multivariate analysis, higher socio-economic status (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4–13.2), duration of fever (OR 2.1; 95%CI 1.3–3.5), and age (OR 0.8; 95%CI 0.7–0.9) were independently associated with hospitalization.</p> <p>Conclusion</p> <p>In Cambodia, dengue and other febrile illnesses pose a financial burden to households. A possible reason for a lower rate of hospitalization among children from poor households could be the burden of higher illness-related costs and debts.</p

Dengue Incidence in Urban and Rural Cambodia: Results from Population-Based Active Fever Surveillance, 2006–2008

Dengue is a major public health problem in South-East Asia. Several dengue vaccine candidates are now in late-stage development and are being evaluated in clinical trials. Accurate estimates of true dengue disease burden will become an important factor in the public-health decision-making process for endemic countries once safe and effective vaccines become available. However, estimates of the true disease incidence are difficult to make, because national surveillance systems suffer from disease under-recognition and reporting. Dengue is mainly reported among children, and in some countries, such as Cambodia, the national case definition only includes hospitalized children. This study used active, community-based surveillance of febrile illness coupled with laboratory testing for DENV infection to identify cases of dengue fever in rural and urban populations. We found a high burden of dengue in young children and late adolescents in both rural and urban communities at a magnitude greater than previously described. The study also confirmed the previously observed focal nature of dengue virus transmission

Spread of artemisinin resistance in Plasmodium falciparum malaria.

BACKGROUND: Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and now poses a threat to the control and elimination of malaria. Mapping the geographic extent of resistance is essential for planning containment and elimination strategies. METHODS: Between May 2011 and April 2013, we enrolled 1241 adults and children with acute, uncomplicated falciparum malaria in an open-label trial at 15 sites in 10 countries (7 in Asia and 3 in Africa). Patients received artesunate, administered orally at a daily dose of either 2 mg per kilogram of body weight per day or 4 mg per kilogram, for 3 days, followed by a standard 3-day course of artemisinin-based combination therapy. Parasite counts in peripheral-blood samples were measured every 6 hours, and the parasite clearance half-lives were determined. RESULTS: The median parasite clearance half-lives ranged from 1.9 hours in the Democratic Republic of Congo to 7.0 hours at the Thailand-Cambodia border. Slowly clearing infections (parasite clearance half-life >5 hours), strongly associated with single point mutations in the "propeller" region of the P. falciparum kelch protein gene on chromosome 13 (kelch13), were detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar. The incidence of pretreatment and post-treatment gametocytemia was higher among patients with slow parasite clearance, suggesting greater potential for transmission. In western Cambodia, where artemisinin-based combination therapies are failing, the 6-day course of antimalarial therapy was associated with a cure rate of 97.7% (95% confidence interval, 90.9 to 99.4) at 42 days. CONCLUSIONS: Artemisinin resistance to P. falciparum, which is now prevalent across mainland Southeast Asia, is associated with mutations in kelch13. Prolonged courses of artemisinin-based combination therapies are currently efficacious in areas where standard 3-day treatments are failing. (Funded by the U.K. Department of International Development and others; ClinicalTrials.gov number, NCT01350856.)

An atlas of over 90.000 conserved noncoding sequences provides insight into crucifer regulatory regions

Despite the central importance of noncoding DNA to gene regulation and evolution, understanding of the extent of selection on plant noncoding DNA remains limited compared to that of other organisms. Here we report sequencing of genomes from three Brassicaceae species (Leavenworthia alabamica, Sisymbrium irio and Aethionema arabicum) and their joint analysis with six previously sequenced crucifer genomes. Conservation across orthologous bases suggests that at least 17% of the Arabidopsis thaliana genome is under selection, with nearly one-quarter of the sequence under selection lying outside of coding regions. Much of this sequence can be localized to approximately 90,000 conserved noncoding sequences (CNSs) that show evidence of transcriptional and post-transcriptional regulation. Population genomics analyses of two crucifer species, A. thaliana and Capsella grandiflora, confirm that most of the identified CNSs are evolving under medium to strong purifying selection. Overall, these CNSs highlight both similarities and several key differences between the regulatory DNA of plants and other species

Susceptibility of two cambodian population of Aedes aegypti mosquito larvae to temephos during 2001

Two population of Aedes aegypti, i.e Phnom Penh (temephos-treated area) and Kampong Cham (area untreated with temephos) were evaluated for their susceptibility to temephos. Larval bioassays were carried out in accordance with QHO standard methods. Results showed that, when compared with the WHO diagnostic dosage of 0.02 mg/l, the Phnom Penh population was resistant (LC95: 0.034mg/l) whereas that of Kampong Cham was susceptible (LC95: 0.015mg/l). 95% confidence intervals of 0.0298 - 0.0382 and 0.0115 - 0.0193, respectively, did not overlap, indicating that the difference in susceptibility between thw two populations was significant. Resistant of Ae. aegypti to temephos appears to be incipient in Camboida. More studies are reuqired with wider representations of localities

The use of ovitraps baited with hay infusion as a surveillance tool for Aedes aegypti mosquitoes in Cambodia

This study was conducted to test (a) if a modified version of the CDC-enhanced would attract more gravid female Aedes aegypti mosquitoes than standard ovitraps for more frequent monitoring of oviposition activity, and (b) the placement of ovitraps indoors or outdoors affected their performance. Paired ovitraps were placed in 25 strategically houses in Toul Kouk, a village on the outskirts of Phnom Penh, Cambodia's capital city. Each pair consisted of one ovitrap with 10% hay infusion and the other with plain tap water, one pair placed inside each house and the other outside the same house. Collections were made every other day for four weeks. The number of positive ovitraps was recorded and egg counts made. Thirteen collections made over a 4-week period yielded a total of 7758 eggs, of which 5396 were collected in ovitraps with hay infusion. Ovitraps with hay infusion had a higher positivity (weekly range 15.56-54.55%) than ovitraps with plain water (weekly range 6.67 - 34.88%) (t = 4.92; df 12; p 0.5 and t = 0.06; df 12; p >0.5, respectively) or for plain water traps (t= 1.97; df 12; 0.05 < p < 0.1 and t = 1.03; df 12; 0.2 < p < 0.5, respectively). Overall results indicate that, in the study site (a) hay infusion-baited ovitraps are a more sensitive indicator of the presence and numbers of Aedes aegypti than those with plain water and are suitable for frequent monitoring of Aedes aegypti oviposition activity, and (b) the location of ovitraps, indoors or outdoors, does not influence the performance of the traps

Rôles des réserves N et C durant la repousse foliaire printanière ou après une coupe chez les espèces fourragères

National audienc

Genetic diversity and lineage dynamic of dengue virus serotype 1 (DENV-1) in Cambodia

In Cambodia, dengue virus (DENV) was first isolated in 1963 and has become endemic with peak epidemic during raining season. Since 2000, the Dengue National Control Program has reported from 10,000 to 40,000 cases per year with fatality rates ranging from 0.7 to 1.7. All four dengue serotypes are found circulating in Cambodia with alternative predominance of serotypes DENV-2 and DENV-3. The DENV-1 represents from 5% to 20% of all circulating viruses, depending upon the year. In this work, 79 clinical strains of DENV-1 were isolated between 2000 and 2009 and their genome fully sequenced. Four distinct lineages with different dynamics were identified. The main evolutionary drive was negative selective pressure but each lineage was characterized by the presence of specific mutations acquired through evolution. Coexistence, extinction and replacement of lineages occurred over the 10-year period. Lineages 1, 2 and 3 were all detected since 2000–2002 and disappeared in 2003, 2004–2005 and 2007, respectively. Lineages 1 and 2 displayed different dynamics. Lineage 1 was very diverse whereas lineage 2 was very homogeneous. Lineage 4 which derived from lineage 3 in 2003 remained the only one at the end of the sampling period in 2008–2009 owing to a selective sweep. The lineages dynamic of DENV-1 viruses and consequences for molecular epidemiology are discussed. </p