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

Desarrollo de un método para monitoreo ambulatorio de picos depresión en el pie insensible y de alerta al paciente con miras a la prevención de ulceras plantares

IP 1204-04-1260

Supporting Enhancement of Stewardship in Small-Scale Fisheries: Perceptions of Governance Among Caribbean Coral Reef Fishers

Small-scale fishing livelihoods dependent on Caribbean coral reefs face an uncertain future with global climate change and mounting anthropogenic pressures threatening ecosystem integrity and resilience. In the context of future threats to coral reefs, improved governance is critical to enhance the efficacy of coral reef management. Recent research places increasing emphasis on identifying governance arrangements that enable participation and engagement, with the improved ‘social fit’ of institutions expected to engender stewardship among fishers. However, few studies have examined the perspectives of resource users in relation to a wide range of articulated principles for good governance processes. This study contributes to an improved understanding of how fisher perceptions relate to diverse governance arrangements in the Wider Caribbean Region. We quantify perceptions among 498 reef-dependent fishers in relation to principles of ‘good governance’ in 12 communities across four Caribbean countries: Barbados, Belize, Honduras, and St. Kitts and Nevis. We describe perceptions relating to two underlying governance themes – institutional acceptance (reflecting principles of legitimacy, transparency, fairness, and connectivity) and engagement in reef governance (reflecting principles of accountability and inclusiveness). In addition, we identify socio-demographic factors associated with each set of perceptions and explore the implications for future governance of small-scale Caribbean reef fisheries. The findings suggest that an understanding of heterogeneous perceptions within small-scale fisheries can inform more targeted interventions to improve the fit of governance arrangements for different groups. Governance may be more effective if perceptions are used to identify areas in which to pursue greater engagement of resource users in stewardship