Cost analysis of large-scale implementation of the ‘Helping Babies Breathe’ newborn resuscitation-training program in Tanzania

Background: Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. Methods: We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Results: Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2$4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between$2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost$2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. Conclusion: HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention

Quality of Life During Pregnancy: Is There a Link with Breastfeeding at Birth?

International audienceBackground: In France, the proportion of children who are exclusively breastfed has been decreasing in recent years. The aim of the study is to assess the link between quality of life (QOL) in pregnant women from the first trimester to the end of pregnancy using the French version EQ5D-3L questionnaire and the feeding method at birth (breast or bottle).Materials and Methods: Five hundred pregnant adult women were monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly. After analyzing the QOL (EQ-5D-Index) and health status (EQ-5D-Visual Analogue Scale) for 1 month, we carried out a nine-group category analysis based on their QOL in the third month (low QOL [score 0.6 point), intermediate (low between 0.1 and 0.6 point), and slight reduction (low <0.1 points increase)].Results: Around1,847 questionnaires were collected and analyzed from 500 women. The monthly analysis did not highlight any link between QOL or health status reported during pregnancy and the feeding method at birth. As regard to the category analysis, following adjustment, the logistic regression model shows that breastfeeding is not linked to QOL in the third month of pregnancy (p = 0.171) or to changes in QOL during pregnancy (p = 0.426). However, there is less of a tendency to breastfeed in individuals with a high QOL in the third month of pregnancy compared to an intermediate QOL during the third month of pregnancy (p = 0.06).Conclusion: In this cohort of pregnant women for whom QOL was assessed throughout pregnancy, no link between QOL and feeding method was highlighted

Health‐related quality of life during pregnancy: A repeated measures study of changes from the first trimester to birth

International audienceIntroduction The objective was to evaluate the quality of life of pregnant women with a full‐term birth from ctthe first trimester to the 9th month using the EQ 5D‐3L questionnaire, comparing physiological, simple pathological, or complex pathological pregnancies. Material and methods A prospective cohort of 500 pregnant women over the age of 18 was monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly with an online report. Given that the decrease in quality of life was not linear during pregnancy, unadjusted and adjusted piecewise linear regression models were performed, considering 3 periods of time during pregnancy: 3‐4, 4‐8, and 8‐9 months. The 5 dimensions of the EQ 5D‐Index and perceived health status were also analyzed. Results In total, 1847 questionnaires were collected. Between the 4th and 8th months, the quality of life was lower for pathological pregnancies ( P < 0.001) than for physiological ones and decreased over time for each type of pregnancy (physiological: −0.08 points per month, P < 0.001; simple pathological: −0.12 points per month, P < 0.001; complex pathological: −0.11 points per month, P < 0.001). Interestingly, the perceived health status was lower at the 9th month than at the 3rd month of pregnancy, for physiological pregnancies (mean difference = −10.5 points, P < 0.001), pathological pregnancies (mean difference = −10.0 points, P < 0.002), and for complex pathological pregnancies (mean difference = −7.8 points, P = 0.058). Conclusions In our population, the quality of life decreased between the 4th and 8th months, and decreased to a greater degree in a pathological pregnancy

Glial Fibrillary Acidic Protein Autoimmunity A French Cohort Study

International audienceBackground and Objectives To report the clinical, biological, and imaging features and clinical course of a French cohort of patients with glial fibrillary acidic protein (GFAP) autoantibodies. Methods We retrospectively included all patients who tested positive for GFAP antibodies in the CSF by immunohistochemistry and confirmed by cell-based assay using cells expressing human GFAP alpha since 2017 from 2 French referral centers. Results We identified 46 patients with GFAP antibodies. Median age at onset was 43 years, and 65% were men. Infectious prodromal symptoms were found in 82%. Other autoimmune diseases were found in 22% of patients, and coexisting neural autoantibodies in 11%. Tumors were present in 24%, and T-cell dysfunction in 23%. The most frequent presentation was subacute meningoencephalitis (85%), with cerebellar dysfunction in 57% of cases. Other clinical presentations included myelitis (30%) and visual (35%) and peripheral nervous system involvement (24%). MRI showed perivascular radial enhancement in 32%, periventricular T2 hyperintensity in 41%, brainstem involvement in 31%, leptomeningeal enhancement in 26%, and reversible splenial lesions in 4 cases. A total of 33 of 40 patients had a monophasic course, associated with a good outcome at last follow-up (Rankin Score <= 2: 89%), despite a severe clinical presentation. Adult and pediatric features are similar. Thirty-two patients were treated with immunotherapy. A total of 11/22 patients showed negative conversion of GFAP antibodies. Discussion GFAP autoimmunity is mainly associated with acute/subacute meningoencephalomyelitis with prodromal symptoms, for which tumors and T-cell dysfunction are frequent triggers. The majority of patients followed a monophasic course with a good outcome

Sempre los camps auràn segadas resurgantas

Professeur émérite de l’Université de Toulouse-Le Mirail, ancien directeur de recherches au CNRS. Xavier RAVIER est d’abord un dialectologue. Disciple de Jean Séguy, il a réalisé l’Allas linguistique et ethnographique du Languedoc occidental. Auteur de 1res nombreuses publications, il a toujours manifesté une curiosité scientifique et un esprit d’ouverture remarquables. Ses recherches l'ont ainsi conduit, au-delà de la linguistique, vers l’ethnolinguistique et plus particulièrement l'ethnolittérature, mais aussi l’onomastique, l’édition et l’étude de textes occitans non littéraires du Moyen Age, la littérature occitane et française, la poétique enfin. Ces Mélanges sont une occasion de rendre hommage à la richesse et à la diversité de la production scientifique d’un chercheur qui a toujours privilégié l’innovation et le dialogue entre disciplines