Mean values for weighted case fatality rate, male to female ratio, age and length of hospital stay by region in studies published from 1991 to 2011.

<p>N = sample size, NA = not applicable,</p><p>* weighted mean,</p>§<p>region comparison by Kruskal-Wallis test.</p

Case fatality rate (CFR) in hospitalized typhoid intestinal perforation cases by study (1991–2011).

<p>Note: Studies are listed in the table by descending order of publication year.</p

Case Fatality Rate and Length of Hospital Stay among Patients with Typhoid Intestinal Perforation in Developing Countries: A Systematic Literature Review

<div><p>Background</p><p>Typhoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies.</p><p>Objectives</p><p>To estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries.</p><p>Data Sources</p><p>Peer-reviewed publications listed in PubMed and Google Scholar.</p><p>Study Eligibility</p><p>The publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011.</p><p>Participants</p><p>Subjects with reported typhoid intestinal perforation.</p><p>Interventions</p><p>None, standard practice as reported in the publication.</p><p>Study Appraisal and Synthesis Methods</p><p>Systematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data.</p><p>Results</p><p>From 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%–17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6–21.1).</p><p>Limitations</p><p>Most typhoid intestinal perforation studies featured in this review were from a limited number of countries.</p><p>Conclusions</p><p>The CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality.</p><p>Implications</p><p>The quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.</p></div

Forest plot showing mean case fatality rate for intestinal perforation along with 95% confidence interval based on studies published from 1991 to 2011.

<p>Forest plot showing mean case fatality rate for intestinal perforation along with 95% confidence interval based on studies published from 1991 to 2011.</p

Length of hospital stay among typhoid intestinal perforation cases by study (1991–2011).

<p>SD = standard deviation, NA = not available. Note: Studies are listed in the table by descending order of publication year.</p

Box plot showing multiple comparisons between regions for case fatality rate, male to female ratio, mean age and mean length of hospital stay based on studies published from 1991 to 2011.

<p>Box plot showing multiple comparisons between regions for case fatality rate, male to female ratio, mean age and mean length of hospital stay based on studies published from 1991 to 2011.</p

Study selection flow diagram. CFR = case fatality rate.

<p>Study selection flow diagram. CFR = case fatality rate.</p

An Estimation of Private Household Costs to Receive Free Oral Cholera Vaccine in Odisha, India

<div><p>Background</p><p>Service provider costs for vaccine delivery have been well documented; however, vaccine recipients’ costs have drawn less attention. This research explores the private household out-of-pocket and opportunity costs incurred to receive free oral cholera vaccine during a mass vaccination campaign in rural Odisha, India.</p><p>Methods</p><p>Following a government-driven oral cholera mass vaccination campaign targeting population over one year of age, a questionnaire-based cross-sectional survey was conducted to estimate private household costs among vaccine recipients. The questionnaire captured travel costs as well as time and wage loss for self and accompanying persons. The productivity loss was estimated using three methods: self-reported, government defined minimum daily wages and gross domestic product per capita in Odisha.</p><p>Findings</p><p>On average, families were located 282.7 (SD = 254.5) meters from the nearest vaccination booths. Most family members either walked or bicycled to the vaccination sites and spent on average 26.5 minutes on travel and 15.7 minutes on waiting. Depending upon the methodology, the estimated productivity loss due to potential foregone income ranged from $0.15 to$0.29 per dose of cholera vaccine received. The private household cost of receiving oral cholera vaccine constituted 24.6% to 38.0% of overall vaccine delivery costs.</p><p>Interpretation</p><p>The private household costs resulting from productivity loss for receiving a free oral cholera vaccine is a substantial proportion of overall vaccine delivery cost and may influence vaccine uptake. Policy makers and program managers need to recognize the importance of private costs and consider how to balance programmatic delivery costs with private household costs to receive vaccines.</p></div

Productivity loss for receiving vaccines.

<p>Productivity loss for receiving vaccines.</p

Private costs to receive one dose of cholera vaccine in Odisha India in USD.

<p>Private costs to receive one dose of cholera vaccine in Odisha India in USD.</p