5,034 research outputs found
Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?
OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. RESULTS: As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. CONCLUSION: In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow
Research needs for an improved primary care response to chronic non-communicable diseases in Africa.
With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa
The globalisation strategies of five Asian tobacco companies : a comparative analysis and implications for global health governance
The global tobacco industry, from the 1960s to mid 1990s, saw consolidation and eventual domination by a small number of transnational tobacco companies (TTC). This paper draws together comparative analysis of five case studies in the special issue on \u27The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.\u27 The cases suggest that tobacco industry globalisation is undergoing a new phase, beginning in the late 1990s, with the adoption of global business strategies by five Asian companies. The strategies were prompted foremost by external factors, notably market liberalisation, competition from TTCs and declining domestic markets. State protection and promotion enabled the industries in Japan, South Korea and China to rationalise their operations ahead of foreign market expansion. The TTM and TTL will likely remain domestic or perhaps regional companies, JTI and KT&G have achieved TTC status, and the CNTC is poised to dwarf all existing companies. This global expansion of Asian tobacco companies will increase competition which, in turn, will intensify marketing, exert downward price pressures along the global value chain, and encourage product innovation. Global tobacco control requires fuller understanding of these emerging changes and the regulatory challenges posed by ongoing globalisation
Rising Level of Public Exposure to Mobile Phones: Accumulation through Additivity and Reflectivity
A dramatic development occurring in our daily life is the increasing use of
mobile equipment including mobile phones and wireless access to the Internet.
They enable us to access several types of information more easily than in the
past. Simultaneously, the density of mobile users is rapidly increasing. When
hundreds of mobile phones emit radiation, their total power is found to be
comparable to that of a microwave oven or a satellite broadcasting station.
Thus, the question arises: what is the public exposure level in an area with
many sources of electromagnetic wave emission? We show that this level can
reach the reference level for general public exposure (ICNIRP Guideline) in
daily life. This is caused by the fundamental properties of electromagnetic
field, namely, reflection and additivity. The level of exposure is found to be
much higher than that estimated by the conventional framework of analysis that
assumes that the level rapidly decreases with the inverse square distance
between the source and the affected person. A simple formula for the exposure
level is derived by applying energetics to the electromagnetic field. The
formula reveals a potential risk of intensive exposure.Comment: 5 pages, 1 fugure; to appear in J. Phys. Soc. Jpn. Vol.71 No.2 in Feb
200
Temporal Variation in the Association between Benzene and Leukemia Mortality
BackgroundBenzene is a human carcinogen. Exposure to benzene occurs in occupational and environmental settings.ObjectiveI evaluated variation in benzene-related leukemia with age at exposure and time since exposure.MethodsI evaluated data from a cohort of 1,845 rubber hydrochloride workers. Benzene exposure–leukemia mortality trends were estimated by applying proportional hazards regression methods. Temporal variation in the impact of benzene on leukemia rates was assessed via exposure time windows and fitting of a multistage cancer model.ResultsThe association between leukemia mortality and benzene exposures was of greatest magnitude in the 10 years immediately after exposure [relative rate (RR) at 10 ppm-years = 1.19; 95% confidence interval (CI), 1.10–1.29]; the association was of smaller magnitude in the period 10 to < 20 years after exposure (RR at 10 ppm-years = 1.05; 95% CI, 0.97–1.13); and there was no evidence of association ≥ 20 years after exposure. Leukemia was more strongly associated with benzene exposures accrued at ≥ 45 years of age (RR at 10 ppm-years = 1.11; 95% CI, 1.04–1.17) than with exposures accrued at younger ages (RR at 10 ppm-years = 1.01; 95% CI, 0.92–1.09). Jointly, these temporal effects can be efficiently modeled as a multistage process in which benzene exposure affects the penultimate stage in disease induction.ConclusionsFurther attention should be given to evaluating the susceptibility of older workers to benzene-induced leukemia
An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa
HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted
as an essential tool in scaling up and improving access to treatment, care and support especially in community settings.
Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT
coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-todoor
offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there
are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa,
including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT
trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores
comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic
observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and
post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous
score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%)
observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of
counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%)
clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned
about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the
service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor
quality of HCT after training
Progress towards the achievement of MDG4 in the Commonwealth of Independent States: uncertain data, clear priorities
Data on under five mortality in the twelve countries of the Commonwealth of Independent States show important fluctuations over time due to variations in quality of data, definitions of neonatal deaths and methods of mortality estimation. Despite the uncertainties regarding mortality trends, the analysis of health and social information from different sources offers clues to identify priority areas and key strategic directions for accelerating the achievement of the 4th Millennium Development Goal. Neonatal deaths represent from 40% to over 50% of under five deaths in all these countries. Maternal mortality was above 50 per 100,000 in 2005, despite the good coverage with antenatal care and births assisted by skilled birth attendants. The scanty information on quality of perinatal care indicates widespread substandard care at all levels. Stunting in children under five is above 10% in ten out of twelve countries and coexists with emerging overweight. Exclusivity and duration of breastfeeding fall short of what is recommended. There are important inequalities in child and maternal mortality, malnutrition and access and use of health services within countries. Taken as a whole, the available information clearly indicates that priority should be given to improvement of the health of women in reproductive age and of the quality of perinatal care, including the establishment of reliable data collection systems. To achieve this, action will need to focus on strengthening the capacity of the health system to improve the technical content of service provision, and on improving access and appropriate use of services by the most disadvantaged groups. The involvement of other sectors will be necessary to improve reproductive health and nutrition at community level and to tackle inequity. Comparisons between countries with similar socioeconomic background but different health policies seem to indicate that gradual progression towards universal coverage with essential health care through a national health insurance system is associated with larger reduction of child mortality than troubled transition towards a privatized and unregulated health system
Effects of global financial crisis on funding for health development in nineteen countries of the WHO African Region
<p>Abstract</p> <p>Background</p> <p>There is ample evidence in Asia and Latin America showing that past economic crises resulted in cuts in expenditures on health, lower utilization of health services, and deterioration of child and maternal nutrition and health outcomes. Evidence on the impact of past economic crises on health sector in Africa is lacking. The objectives of this article are to present the findings of a quick survey conducted among countries of the WHO African Region to monitor the effects of global financial crisis on funding for health development; and to discuss the way forward.</p> <p>Methods</p> <p>This is a descriptive study. A questionnaire was prepared and sent by email to all the 46 Member States in the WHO African Region through the WHO Country Office for facilitation and follow up. The questionnaires were completed by directors of policy and planning in ministries of health. The data were entered and analyzed in Excel spreadsheet. The main limitations of this study were that authors did not ask whether other relevant sectors were consulted in the process of completing the survey questionnaire; and that the overall response rate was low.</p> <p>Results</p> <p>The main findings were as follows: the response rate was 41.3% (19/46 countries); 36.8% (7/19) indicated they had been notified by the Ministry of Finance that the budget for health would be cut; 15.8% (3/19) had been notified by partners of their intention to cut health funding; 61.1% (11/18) indicated that the prices of medicines had increased recently; 83.3% (15/18) indicated that the prices of basic food stuffs had increased recently; 38.8% (7/18) indicated that their local currency had been devalued against the US dollar; 47.1% (8/17) affirmed that the levels of unemployment had increased since the onset of global financial crisis; and 64.7% (11/17) indicated that the ministry of health had taken some measures already, either in reaction to the global financing crisis, or in anticipation.</p> <p>Conclusion</p> <p>A rapid assessment, like the one reported in this article, of the effects of the global financial crisis on a few variables, is important to alert the Ministry of Health on the looming danger of cuts in health funding from domestic and external sources. However, it is even more important for national governments to monitor the effects of the economic crisis and the policy responses on the social determinants of health, health inputs, health system outputs and health system outcomes, e.g. health.</p
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