Cost-effectiveness analysis of point-of-care rapid testing versus laboratory-based testing for antenatal screening of syphilis in Brazil

Objectives Severe consequences of mother-to-child transmission of syphilis and high increasing incidence of congenital syphilis remains an important public health problem in Brazil. Our objective was to assess the cost-effectiveness of a rapid point-of-care test (RT) and treatment of positive mothers immediately compared with a laboratory-based standard test (ST) with treatment at next follow-up visit. Methods A decision analytic model was developed to estimate the incremental cost-effectiveness ratio (ICER) between antenatal syphilis screening strategies. The model was built with lifetime horizon from Brazilian health system perspective using 3% and 5% discount rates. A hypothetical cohort of pregnant women at reproductive age were used in the model. Health outcomes: low birth weight, stillbirths, neonatal deaths and congenital syphilis were estimated in disability-adjusted life-years (DALYs) lost. Microcosting study and secondary data provided parameters of direct medical costs. Probabilistic sensitivity analysis was undertaken. Results For base case, the mean cost per pregnant woman screened was $2.63 (RT) and$2.48 (ST), respectively. Maternal syphilis was associated with a loss of 0.0043 DALYs (RT) and 0.0048 DALYs (ST) per mother screened. Expected value of incremental cost per DALY averted was $298.08. After 10 000 probabilistic sensitivity analysis model runs, incremental cost and health benefits were$0.15 (95% credible interval –1.56 to 1.92) and 0.00042 DALYs (95% credible interval –0.0036 to 0.0044), respectively, with a mean ICER of $357.44 per DALY. Screening with RT has a 58$3,200 per DALY. Conclusions In Brazil, antenatal screening with syphilis RT and immediate treatment is likely to be cost-effective compared with standard screening and must be prioritized in local settings

Social marketing including financial incentive programs at worksite cafeterias for preventing obesity: a systematic review

Abstract Background As with food-taxation strategies, such interventions as discounted healthy menus, point-of-purchase advertisements, and sugar-free beverages for employees at worksites could help prevent obesity. This study assessed the effectiveness of food environment interventions incorporating financial incentive or social marketing strategies at workplace cafeterias, vending machines, and kiosks toward preventing obesity and improving dietary habits. Methods We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO databases. The study designs included were randomized control trials (RCTs) and cluster RCTs. We evaluated the effectiveness of financial incentive or social marketing strategies interventions (such as discounts) on health outcomes or food intake behavior. Two reviewers independently screened the studies for inclusion. We assessed the risk of bias using the Cochrane Collaboration’s tool. This protocol was published in 2014. Results We included three trials, with a combined total of 3013 participants. There were limited available data from RCTs on changes in body weight. No eligible social marketing studies were retrieved. In some cases, a meta-analysis could not be conducted owing to differences in the analytic methods for the outcomes. Conclusions Lack of evidence made it difficult to draw any conclusions. In future surveys, it will be necessary to conduct interventions focusing only on financial incentive intervention versus no intervention in order to determine whether the incentive strategy has a clear impact. Systematic review registration PROSPERO CRD420140105

Point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review protocol

Objective: This review will explore how point-of-care tests for sexually transmitted infections have been implemented into health care systems in low- and middle-income countries, and the facilitators and barriers to implementation. Introduction: Sexually transmitted infections contribute to significant global morbidity. In low- and middle-income countries, syndromic management of sexually transmitted infections is recommended. However, due to the limitations of syndromic management, there is increasing interest in the potential for point-of-care tests to be incorporated into models of care for sexually transmitted infections in low-resource settings. It is therefore important to explore how point-of-care tests for sexually transmitted infections have been used in these settings previously, and the facilitators and barriers to implementation on a wider scale. Inclusion criteria: This scoping review will consider studies that explore the use of point-of-care-testing for chlamydia, gonorrhea, trichomoniasis, or syphilis, and how they are implemented into models of care in low- and middle-income countries. Study participants may be those receiving sexually transmitted infection testing or health care professionals providing testing. HIV testing will not be covered. Quantitative, qualitative, and mixed methods study designs, as well as review papers will be considered for inclusion. Methods: The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. The authors will search databases including MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, African Index Medicus, and the Cochrane library from 1998 onwards. Results will be screened by two independent reviewers and data extracted using a data extraction tool developed by the reviewers. Data will be presented both narratively and in tabular form

Hospitalization risk factors for children's lower respiratory tract infection: A population-based, cross-sectional study in Mongolia.

This study aimed to assess the potential risk factors for lower respiratory tract infection (LRTI)-related hospital admissions in Mongolian children. A population-based cross-sectional study was conducted in rural Mongolia in 2013, and 1, 013 mother–child pairs were included. Of the participating children, 38. 9% were admitted to hospital with LRTIs. Home smoking, low birthweight, being a male child, exclusive breastfeeding and healthcare-seeking behaviour showed substantial association with LRTI-related hospital admissions. Number of cigarettes smoked by family members showed a dose-response relationship and increased hospital admissions. Strategies to prevent second-hand-smoke exposure from adult smokers, especially inside the home, are crucial to preventing LRTI-related hospital admissions for children in Mongolia. Improving rates of exclusive breastfeeding and increasing birthweight have great potential to decrease the likelihood of children acquiring a LRTI. Educational initiatives are also necessary for women who are less likely to seek out care for their children's symptoms