Estimating the Burden of Neurocysticercosis in Mexico

Neurocysticercosis (NCC) is a parasitic disease caused by the larva of the zoonotic cestode Taenia solium. The objectives of this study were to evaluate the distribution of presenting clinical manifestations of NCC, to evaluate the socio-demographic characteristics of NCC patients, to compare quality of life of individuals diagnosed with NCC with an age and sex matched control population and to estimate the non-monetary burden of NCC in Mexico. In order to accomplish these objectives, a case series of NCC patients was conducted in two neurology referral hospitals in Mexico City, Mexico during 2007-2008. Information on clinical manifestations associated with NCC was obtained via medical chart reviews of NCC patients. Information on socio-demographic characteristics of NCC patients was obtained through the administration of questionnaires. In addition, a cross-sectional study was conducted to compare the quality of life of NCC patients to an age and sex matched control population using the short form 12 v2 (SF-12 v2) survey. Non-monetary burden of NCC in Mexico was estimated using disability adjusted life years (DALYs), incorporating morbidity due to both NCC-associated epilepsy and severe headache and mortality due to NCC-associated epilepsy. NCC patients presented to the neurology referral hospitals with numerous clinical manifestations, with severe headache and epilepsy being the most common. Lack of knowledge of T. solium transmission was common among NCC patients, with 25 percent of patients not knowledgeable about tapeworm infections in humans. Of those that were aware that tapeworm infections do occur, 57 percent were not aware of how the worms were transmitted to humans. The SF-12 v2 general health survey showed that individuals with NCC had a significantly lower score for all eight domains of health evaluated (physical functioning, role physical, bodily pain, vitality, general health, social functioning, role emotional and mental health) compared with the age and sex matched population from the same region (p< 0.05). The mean total number of DALYs lost due to NCC in Mexico was estimated to be 99,866 (95 percent CR: 43,187 –189,182), with a mean of 0.95 (95 percent CR: 0.4–1.8) DALYs lost per thousand persons per year

Estimating the Non-Monetary Burden of Neurocysticercosis in Mexico

Neurocysticercosis (NCC) is a major public health problem caused by the larvae of the parasite Taenia solium. The condition occurs when humans ingest eggs of the pork tapeworm Taenia solium, which then develop into larvae in the central nervous system. The disease is predominantly found and considered important in Latin American, Asian, and African countries and is associated with a large social and economic burden. Very few studies have been conducted to evaluate the burden of NCC and there are no estimates from Mexico. We estimated the disability adjusted life years (DALYs) lost due to NCC in Mexico incorporating morbidity and mortality due to NCC-associated epilepsy, and morbidity due to NCC-associated severe chronic headaches. NCC-associated epilepsy and severe chronic headaches were estimated to cause a loss of approximately 0.25 healthy year of life per 1,000 persons annually in Mexico. This is the first estimate of DALYs associated with NCC in Mexico. However, this value is likely to be underestimated since only the clinical manifestations of epilepsy and severe chronic headaches were included

Nudging children toward healthier food choices: An experiment combining school and home gardens

School gardens have become a widely used approach to influence children's food knowledge, preferences and choices in low- and high-income countries alike. However, evidence indicates that such programs are more effective at influencing food knowledge and preferences than actual food choices. Such finding may occur because school gardens insufficiently influence the food behavior of parents and because healthy food items are not always available in children's homes. We tested this hypothesis using a one-year cluster randomized controlled trial in Nepal with 15 treatment and 15 control schools and a matched sample of 779 schoolchildren (aged 8–12) and their caregivers. Data were collected before and after the intervention during the 2018–2019 school year. In addition, children's food consumption was monitored using a monthly food logbook. Average treatment effects were quantified with a double-difference estimator. For caregivers, the intervention led to a 26% increase in their food and nutrition knowledge (p < 0.001), a 5% increase in their agricultural knowledge (p = 0.022), a 10% increase in their liking for vegetables (p < 0.001), and a 15% increase in home garden productivity (p = 0.073). For children, the intervention had no discernible effect on food and nutrition knowledge (p = 0.666) but led to a 6% increase in their liking for vegetables (p = 0.070), healthy food practices (p < 0.001), and vegetable consumption (October–December +15%; p = 0.084; January–March +26%; p = 0.017; April–June +26%; p = 0.088). The results therefore indicate both schools and parents matter for nudging children toward healthier food choices

Drivers of food choice among children and caregivers in post-earthquake Nepal

Food systems in many countries are experiencing a shift from traditional foods towards processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among children and parents in rural Nepal. It uses qualitative data collected through key informant interviews and focus group discussions with school children, parents and teachers. The study reveals substantial changes in food behavior during the past decade with increased consumption of rice, meat, and highly processed snack foods while an increased consumption of fruit and vegetables is not evident. It identifies cash availability is the main driver of increased rice, meat and snack food consumption. The second driver is the 2015 Nepal earthquake, which accelerated the transition from home-grown food to purchased food as people got habituated to eating more meat and snack foods while reconstruction tripled local wages and changed the food environment. This shows how humanitarian assistance in the wake of extreme shocks can unintentionally contribute to unhealthy eating habits. An integrated school and home garden intervention appears to contribute to healthier diets

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico

ABSTRACT The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$257 (95$ 2,576 (95% CI: 2,244 – 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$475 (95$ 228 (95% CI: 167 – 288), US$157 (95$ 150 (95% CI: 106 – 204), and US$ 91 (95% CI: 27 – 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization

The monetary burden of cysticercosis in Mexico.

BackgroundTaenia solium cysticercosis is a public health and agricultural problem in many low and middle-income countries where health education, sanitation, pig management practices and meat inspection infrastructure are insufficient. Cysticercosis affects both human and animal health and has important economic consequences. Very few studies have been conducted to evaluate the monetary burden of cysticercosis. This study aimed at estimating the 2015 costs associated with cysticercosis in humans and pigs in Mexico.MethodsThe monetary burden of human cysticercosis was estimated based on costs incurred by living with and treating epilepsy and severe chronic headaches associated with neurocysticercosis (NCC). The estimated cost of porcine cysticercosis took into consideration losses due to the reduction in the price of cysticercosis-infected animals. Epidemiologic and economic data were obtained from the published literature, government reports, and setting-specific questionnaires. Latin hypercube sampling methods were employed to sample the distributions of uncertain parameters and to estimate 95% credible regions (95% CRs). All results are reported in 2015 U.S.$.FindingsThe overall monetary burden associated with NCC morbidity was estimated at U.S.$215,775,056 (95% CR U.S.$109,309,560 -U.S.$361,924,224), with U.S.$436 (95$296 -U.S.$604) lost per patient. If loss of future years of income and productivity due to NCC-associated deaths was included, this value increased by U.S.$54.26 million, assuming that these individuals earned Mexico's median wage salary. An additional U.S.$19,507,171 (95$5,734,782 -U.S.$35,913,487) was estimated to be lost due to porcine cysticercosis.ConclusionsThis study suggests that T. solium cysticercosis results in considerable monetary losses to Mexico

Flowchart of study selection for the literature review of epilepsy prevalence in Mexico.

<p>Flowchart of study selection for the literature review of epilepsy prevalence in Mexico.</p

Annual number of DALYs lost due to NCC-associated epilepsy and severe chronic headaches in Mexico.

<p>(A) DALYs lost due to NCC-associated epilepsy. (B) DALYs lost due to NCC-associated severe chronic headaches. (C) DALYs lost due to NCC-associated epilepsy and severe chronic headaches. Note: The bar height in the figure represents the estimated number of DALYs lost. The plot whiskers represent the 95% CR.</p

Sensitivity analysis of the total NCC-associated DALYs estimate for Mexico.

<p>Note: DW = Disability Weight.</p