Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh

We examine the impact of micro health insurance placement on health awareness, healthcare utilization and health status of microcredit members in rural Bangladesh, using data from 329 households in the operating areas of Grameen Bank. The results are based on econometric analysis conditioned on placement of the scheme, and show that placement has a positive association with all of the outcomes. The results are statistically significant for health awareness and healthcare utilization, but not for heath status. Our study makes an important contribution to the literature as it provides evidence on the impact of MHI on a broad set of health outcomes.Microcredit, Micro Health Insurance, Grameen Bank, Bangladesh

Assessment of risks to human health associated with meat from different value chains in Nigeria: Using the example of the beef value chain

The study built on a series of logical steps starting with a stakeholders’ workshop which was followed by an extensive review of available literature on key meat-borne hazards in Nigeria; with both activities indicating greater concern over the risk of consuming contaminated beef. Beef value chain and hospital surveys were then conducted for hazard identification, understanding the socioeconomic aspects of beef safety and determining costs associated with treatment of diarrhoea. Information from these primary and secondary sources fed into the quantitative risk assessment (QRA) model to estimate the risk of illness associated with the consumption of contaminated beef by people differentiated by sex, age class and health status. Finally and based on inputs from the foregoing, the cost of treatment and lost productivity was estimated using Monte Carlo stochastic simulation to take into account uncertainty and variability that might have been introduced by the quality of data. We then used data from the Global Burden of Disease (GBD) to estimate additional costs from loss of statistical lives based on the concept of Disability-adjusted life years (DALY).The study estimated the total cost associated with food-borne diarrhoea at US$3.6 billion; and the cost associated with beef-borne diarrhoea at US$156 million. DALY lost from diarrhoea are estimated at 67,712, corresponding to a statistical value of US$2.7 billion; while the DALYs lost from beef-associated disease correspond to 13,542 with a statistical value of US$542 million. We discuss the other aspects of cost of beef-borne illness which were not captured because of inadequate data but which are likely to be similar or greater to the costs calculated. Chronic and non-gastrointestinal illness associated with food-borne disease is less common than gastrointestinal illness but more severe, and experts consider it to have an equivalent cost. Other costs of beef-borne disease, which were not quantified, include reduced animal productivity, costs of control and trade impacts. This initial estimate suggests beef-borne disease is costing Nigeria US$854 million per year. Furthermore, a reduction of between 20-70% in beef-borne disease is feasible. Recommendations are then given on risk-based approaches for reducing beef-borne disease in Nigeria

Directing diarrhoeal disease research towards disease-burden reduction

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions, the efficacy and effectiveness of the intervention resulting from the research, the maximal potential for disease-burden reduction of the interventions derived from the research, the affordability, deliverability, and sustainability of the intervention supported by the research, and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015

Cost-Effective Prevention of Diarrheal Diseases: A Critical Review

This paper critically reviews the existing research on the cost-effective prevention and treatment of diarrheal diseases, and identifies research priorities in this area aimed at finding ways to reduce the diarrheal disease burden. In contrast to the empirical knowledge base that exists for traditional child health programs to reduce diarrheal morbidity and mortality, evidence on the relative effectiveness and costeffectiveness of various environmental health interventions is limited and subject to significant methodological concerns. There is a limited understanding of the determinants of longterm water and sanitation technology adoption and behavior change at the individual level. Even less is known about how collective action problems in water and sanitation infrastructure maintenance can be overcome. An agenda for future research includes evaluating alternative transmission interruption mechanisms, improving understanding of the determinants of individual-level technology adoption in the water and sanitation sector, and assessing the quality of infrastructure maintenance under different management schemes.Diarrheal Diseases, Global Health,

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.

BACKGROUND: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS: Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING: Bill & Melinda Gates Foundation

AN INVESTIGATION OF DIARRHOEAL DISEASE OUTBREAK AT DILATE MILITARY TRAINING CENTRE

ABSTRACT: This study was conducted to investigate a reported diarrhoeal diseaseboutbreak among higher education students recruits in Bilate Military Training Centre, Sidamo Administrative Region, Out of the total patients of 5,248 who visited at the out-patient department 1,616 (30.1% ) were patients with diarrhoea. There were 99 patients admitted to the hospital out of which 27 (27.2 % ) were diarrhoeal patients. There ere no deaths reported. A total of 965 (75.6%) were treated with antimicrobial, mainly Tetracyclines, Chloramphenicol, Metronidazole and Chloroquine. Only 114 (8.9% ) were treated with Oral Rehydration Salts (ORS) while 86 (7.11 % ) with Anti-diarrhoeal (Charcoal) and ORS. There was no proper excreta disposal and the water source was found to be bacteriologically non-potable. Among the 34 stool specimens collected for culture and sensitivity tests, the genus Shigella was isolated in 6 patients; where 4 were higellaflexneri (Group B) and 2 were Shigella dysenteriae (Group A) one type 1 (Shiga's Bacillus) and the other type 2 (Schmittz's Bacillus). Shigella dysenteriae serogroups 1 and 2 showed resistance to eight and seven drugs including Trimethoprim Sulpha-Methoxazole (TSM) respectively. This study highlights the importance of safe water and improvement of general hygiene and environmental sanitation for prevention and control of epidemics and indicates the importance of continuous surveillance of drug resistant Shigella for the control of outbreaks of Shigellosis

An HSI Report: The Public Health Implications of Intensive Farm Animal Production in South Asia

Intensive farm animal production (IFAP) is being increasingly implemented to meet the rising demand for animal source foods in South Asia. The siting of IFAP facilities in urban or peri-urban areas leads to large proximate animal populations, increasing human exposure to pollutants and pathogens. Improperly managed wastes from IFAP facilities and abattoirs can contaminate water with excess nutrients, pathogens, veterinary pharmaceuticals, antibiotics, heavy metals, and hormones, and can release ammonia, hydrogen sulfide, volatile organic compounds, bioaerosols, and particulate matter into the air compartment. The unregulated nature of IFAP in South Asia creates a risk for zoonotic transmission, including anthrax, brucellosis, Campylobacter, Cryptosporidium, cysticercosis, E. coli, Giardia, Highly Pathogenic Avian Influenza, leptospirosis, Salmonella and Nipah Virus. Recommendations to mediate adverse human health consequences include improved veterinary care, prohibition of confinement facilities that facilitate pathogen transmission and evolution, prohibition of nontherapeutic use of antibiotics, implementation of proper management of animal wastes, zoning for IFAP and abattoir facilities, and surveillance of slaughtering facilities to limit carcass contamination and reduce the burden of foodborne disease in South Asia

Prevalence and health care–seeking behavior for childhood diarrheal disease in Bangladesh

In Bangladesh, the burden of diarrheal diseases is significant among children <5 years old. The objective of this study is to capture the prevalence of and health care–seeking behavior for childhood diarrheal diseases (CDDs) and to identify the factors associated with CDDs at a population level in Bangladesh. We use a logistic regression approach to model careseeking based on individual characteristics. The overall diarrhea prevalence among children <5 years old was found to be 5.71%. Some factors found to significantly influence the health care–seeking pattern were age and sex of the children, nutritional score, age and education of mothers, wealth index, and access to electronic media. The health care service could be improved through working in partnership with public facilities, private health care practitioners, and community-based organizations, so that all strata of the population get equitable access in cases of childhood diarrhoea