Using economic evidence to set healthcare priorities in low-income and lower-middle-income countries: a systematic review of methodological frameworks

Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks - which incorporate economic evaluation evidence - for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence

Artificial neural network analysis of factors controling ecosystem metabolism in coastal systems

Knowing the metabolic balance of an ecosystem is of utmost importance in determining whether the system is a net source or net sink of carbon dioxide to the atmosphere. However, obtaining these estimates often demands significant amounts of time and manpower. Here we present a simplified way to obtain an estimation of ecosystem metabolism. We used artificial neural networks (ANNs) to develop a mathematical model of the gross primary production to community respiration ratio (GPP:CR) based on input variables derived from three widely contrasting European coastal ecosystems (Scheldt Estuary, Randers Fjord, and Bay of Palma). Although very large gradients of nutrient concentration, light penetration, and organic-matter concentration exist across the sites, the factors that best predict the GPP:CR ratio are sampling depth, dissolved organic carbon (DOC) concentration, and temperature. We propose that, at least in coastal ecosystems, metabolic balance can be predicted relatively easily from these three predictive factors. An important conclusion of this work is that ANNs can provide a robust tool for the determination of ecosystem metabolism in coastal ecosystems

Size at birth and cognitive function among rural adolescents:a life course epidemiology study protocol of the Kisalaya cohort in Mysuru, South India

Introduction: It is proven that adverse intrauterine environment results in 'early life programming,' alterations in metabolism and physiological development of the fetus, often termed as 'Developmental Origins of Health and Disease' (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.Methods and analysis: Kisalaya cohort was established in 2008, to provide integrated antenatal care and HIV testing using mobile clinics to improve maternal and child health outcomes. This cohort included pregnant women residing in 144 villages of Mysuru Taluk (rural) who received antenatal care through mobile clinics and delivered their children between 2008 and 2011. Data related to mother-infant dyads for all pregnant women who received care in the Kisalaya programme are available for this study. Presently, children born to women who received care through Kisalaya are adolescents between 10 and 12 years. At this point, information would be collected on sociodemographic data and assessments of mental health, stressful life events, cognition, vision, speech, language, hearing and anthropometric measures would be done and relevant maternal data and child data, available from the cohort would be retracted for analysis. We plan to retrace as many adolescents as possible out of 1544 adolescents who are currently available for study excluding twins, abortions, stillbirths and postdelivery deaths. Analyses will be extended to construct a life course pathway for cognition using structural equation modelling.</p

Cost-Effective Strategies for Mitigating a Future Influenza Pandemic with H1N1 2009 Characteristics

Background: We performed an analysis of the cost-effectiveness of pandemic intervention strategies using a detailed, individual-based simulation model of a community in Australia together with health outcome data of infected individuals gathered during 2009–2010. The aim was to examine the cost-effectiveness of a range of interventions to determine the most cost-effective strategies suitable for a future pandemic with H1N1 2009 characteristics. Methodology/Principal Findings: Using transmissibility, age-stratified attack rates and health outcomes determined from H1N1 2009 data, we determined that the most cost-effective strategies involved treatment and household prophylaxis using antiviral drugs combined with limited duration school closure, with costs ranging from $632 to$777 per case prevented. When school closure was used as a sole intervention we found the use of limited duration school closure to be significantly more cost-effective compared to continuous school closure, a result with applicability to countries with limited access to antiviral drugs. Other social distancing strategies, such as reduced workplace attendance, were found to be costly due to productivity losses. Conclusion: The mild severity (low hospitalisation and case fatality rates) and low transmissibility of H1N1 2009 meant that health treatment costs were dominated by the higher productivity losses arising from workplace absence due to illness and childcare requirements following school closure. Further analysis for higher transmissibility but with the same, mild severit

Atmospheric sampling of Supertyphoon Mireille with NASA DC-8 aircraft on September 27,1991, during PEM-West A

The DC-8 mission of September 27, 1991, was designed to sample air flowing into Typhoon Mireille in the boundary layer, air in the upper tropospheric eye region, and air emerging from the typhoon and ahead of the system, also in the upper troposphere. The objective was to find how a typhoon redistributes trace constituents in the West Pacific region and whether any such redistribution is important on the global scale. The boundary layer air (300 m), in a region to the SE of the eye, contained low mixing ratios of the tracer species O3, CO, C2H6, C2H2, C3H8, C6H6and CS2 but high values of dimethylsulfide (DMS). The eye region relative to the boundary layer, showed somewhat elevated levels of CO, substantially increased levels of O3, CS2 and all nonmethane hydrocarbons (NMHCs), and somewhat reduced levels of DMS. Ahead of the eye, CO and the NMHCs remained unchanged, O3 and CS2 showed a modest decrease, and DMS showed a substantial decrease. There was no evidence from lidar cross sections of ozone for the downward entrainment of stratospheric air into the eye region; these sections show that low ozone values were measured in the troposphere. The DMS data suggest substantial entrainment of boundary layer air into the system, particularly into the eye wall region. Estimates of the DMS sulphur flux between the boundary layer and the free troposphere, based on computations of velocity potential and divergent winds, gave values of about 69 μg S m−2 d−1 averaged over a 17.5° grid square encompassing the typhoon. A few hours after sampling with the DC-8, Mireille passed over Oki Island, just to the north of Japan, producing surface values of ozone of 5.5 ppbv. These O3 levels are consistent with the low tropospheric values found by lidar and are more typical of equatorial regions. We suggest that the central eye region may act like a Taylor column which has moved poleward from low latitudes. The high-altitude photochemical environment within Typhoon Mireille was found to be quite active as evidenced by significant levels of measured gas phase H2O2 and CH3OOH and model-computed levels of OH

Geographically touring the eastern bloc: British geography, travel cultures and the Cold War

This paper considers the role of travel in the generation of geographical knowledge of the eastern bloc by British geographers. Based on oral history and surveys of published work, the paper examines the roles of three kinds of travel experience: individual private travels, tours via state tourist agencies, and tours by academic delegations. Examples are drawn from across the eastern bloc, including the USSR, Poland, Romania, East Germany and Albania. The relationship between travel and publication is addressed, notably within textbooks, and in the Geographical Magazine. The study argues for the extension of accounts of cultures of geographical travel, and seeks to supplement the existing historiography of Cold War geography

Human papillomavirus vaccine introduction in low-income and middle-income countries: guidance on the use of cost-effectiveness models

BACKGROUND: The World Health Organization (WHO) recommends that the cost effectiveness of introducing human papillomavirus (HPV) vaccination is considered before such a strategy is implemented. However, developing countries often lack the technical capacity to perform and interpret results of economic appraisals of vaccines. To provide information about the feasibility of using such models in a developing country setting, we evaluated models of HPV vaccination in terms of their capacity, requirements, limitations and comparability. METHODS: A literature review identified six HPV vaccination models suitable for low-income and middle-income country use and representative of the literature in terms of provenance and model structure. Each model was adapted by its developers using standardised data sets representative of two hypothetical developing countries (a low-income country with no screening and a middle-income country with limited screening). Model predictions before and after vaccination of adolescent girls were compared in terms of HPV prevalence and cervical cancer incidence, as was the incremental cost-effectiveness ratio of vaccination under different scenarios. RESULTS: None of the models perfectly reproduced the standardised data set provided to the model developers. However, they agreed that large decreases in type 16/18 HPV prevalence and cervical cancer incidence are likely to occur following vaccination. Apart from the Thai model (in which vaccine and non-vaccine HPV types were combined), vaccine-type HPV prevalence dropped by 75% to 100%, and vaccine-type cervical cancer incidence dropped by 80% to 100% across the models (averaging over age groups). The most influential factors affecting cost effectiveness were the discount rate, duration of vaccine protection, vaccine price and HPV prevalence. Demographic change, access to treatment and data resolution were found to be key issues to consider for models in developing countries. CONCLUSIONS: The results indicated the usefulness of considering results from several models and sets of modelling assumptions in decision making. Modelling groups were prepared to share their models and expertise to work with stakeholders in developing countries. Please see related article: http://www.biomedcentral.com/1741-7007/9/55

Loneliness of Older Immigrant Groups in Canada: Effects of Ethnic-Cultural Background

This study aimed to explore the loneliness of several groups of older immigrants in Canadacompared to native-born older adults. Data from the Canadian General Social Survey, Cycle 22 (Nolder adults = 3,692) were used. The dependent variable is the 6 item De Jong Gierveld lonelinessscale. Determinants of loneliness included country of birth, ethnic background (cultural context);belongingness (community context) and social networks (social context). Results showed that onlysome immigrant groups are significantly lonelier than older adults born in Canada. Immigrants withsimilar language and culture are not lonelier; while those from countries that differ in nativelanguage/culture are significantly higher on loneliness. Multivariate analyses showed the importanceof cultural background, of composition of the network of relatives and friends, and of localparticipation and feelings of belonging to the Canadian society in explaining loneliness of olderimmigrants