Predicting Geographic Variation in Cutaneous Leishmaniasis, Colombia

Predicting Geographic Variation in ACL, Colombi

The costs of preventing and treating chagas disease in Colombia

Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between$46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is$1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.Wellcome Trus

Climate Change and Developing-Country Cities: Implications For Environmental Health and Equity

Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity

A continental risk map for malaria mosquito (Diptera: Culicidae) vectors in Europe.

Although malaria was officially declared eradicated from Europe in 1975, its former vectors, mainly members of the Anopheles maculipennis (Meigen) complex, are still distributed throughout the continent. The present situation of Anophelism without malaria indicates that current socio-economic and environmental conditions maintain the basic case reproduction number, Ro, below 1. Recently, it has been speculated that predicted climate changes may increase anopheline abundance and biting rates (as well as reduce the Plasmodium parasite extrinsic incubation period), allowing the reemergence of malaria transmission in Europe. As a preliminary step toward predicting future scenarios, we have constructed models to test whether the current distribution of the five former European malaria vectors [An. atroparvus (Van Thiel),An. labranchiae (Falleroni), An. messeae (Swellengrebel & De Buck), An. sacharovi (Favr) and An. superpictus (Grassi)] can be explained by environmental parameters, including climate. Multivariate logistic regression models using climate surfaces derived from interpolation of meteorological station data (resolution 0.5 x 0.5 degrees) and remotely sensed land cover (resolution 1 x 1 km) were fitted to 1,833 reported observations of the presence and absence of each species across Europe. These relatively crude statistical models predicted presence and absence with a sensitivity of 74-85.7% and specificity of 73.4-98.1% (with climate a significantly better predictor than land cover type). A geographically independent validation of the models gave a sensitivity of 72.9-88.5% and a specificity of 72.7-99.6%. This allowed us to generate risk maps for each species across Europe. Assuming that high risk equates with the potential for high abundance, these models should permit the development of risk maps for European mosquitoes under future climate scenarios. These techniques would be equally useful for estimating the risk of reemergence in other nonendemic areas such as the United States and Australia, as well as changes to risk within endemic areas

Urban Environmental Health Hazards and Health Equity

Abstract available at publisher's web site

Impact of regional climate change on human health.

The World Health Organisation estimates that the warming and precipitation trends due to anthropogenic climate change of the past 30 years already claim over 150,000 lives annually. Many prevalent human diseases are linked to climate fluctuations, from cardiovascular mortality and respiratory illnesses due to heatwaves, to altered transmission of infectious diseases and malnutrition from crop failures. Uncertainty remains in attributing the expansion or resurgence of diseases to climate change, owing to lack of long-term, high-quality data sets as well as the large influence of socio-economic factors and changes in immunity and drug resistance. Here we review the growing evidence that climate-health relationships pose increasing health risks under future projections of climate change and that the warming trend over recent decades has already contributed to increased morbidity and mortality in many regions of the world. Potentially vulnerable regions include the temperate latitudes, which are projected to warm disproportionately, the regions around the Pacific and Indian oceans that are currently subjected to large rainfall variability due to the El Niño/Southern Oscillation sub-Saharan Africa and sprawling cities where the urban heat island effect could intensify extreme climatic events

The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future

The Lancet Countdown is an international collaboration that independently monitors the health consequences of a changing climate. Publishing updated, new, and improved indicators each year, the Lancet Countdown represents the consensus of leading researchers from 43 academic institutions and UN agencies. The 44 indicators of this report expose an unabated rise in the health impacts of climate change and the current health consequences of the delayed and inconsistent response of countries around the globe—providing a clear imperative for accelerated action that puts the health of people and planet above all else. The 2021 report coincides with the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26), at which countries are facing pressure to realise the ambition of the Paris Agreement to keep the global average temperature rise to 1·5°C and to mobilise the financial resources required for all countries to have an effective climate response. These negotiations unfold in the context of the COVID-19 pandemic—a global health crisis that has claimed millions of lives, affected livelihoods and communities around the globe, and exposed deep fissures and inequities in the world’s capacity to cope with, and respond to, health emergencies. Yet, in its response to both crises, the world is faced with an unprecedented opportunity to ensure a healthy future for all