Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Treatment non-compliance and government aided health schemes : a boon or a curse

Purpose: In this study we tried to analyze the prevalence of non-adherence to radiation treatment, the factors behind the unplanned breaks and the evaluation of strategies to overcome such breaks. Materials and Methods: Between January 2017 to October 2017, 486 patients were registered for radical radiotherapy of which 91 patients with unplanned treatment break were identified. We analyzed the social, economic, educational, and therapeutic barriers that led to treatment interruptions. Results: 91 patients of 486 patients registered for radical radiotherapy with unplanned treatment break were identified. The age of such patients ranged from 30 to 85 years with a median age of 52.5 years. 61 were males and 30 were females. 39 patients were from urban areas and 52 belonged to rural area. Of these 91 patients 85 patients were receiving cashless treatment based on BPL cards and 6 were cash paying patients. 52 Patients had Head and neck, 23 had gynecological, 7 with breast and 4 patients had esophageal cancers. Majority of patients in our study had treatment breaks during the mid to end phase of a radical radiotherapy schedule with the onset of Grade II or III acute reactions. Conclusion: As majority of patients were supported by government schemes without any binding factor, some compelling factors like blocking the BPL cards to avail other benefits, or to impose some kind of penalties to avoid wastage of government efforts and resources

Altered Fractionation Intensity Modulated Radiotherapy with concurrent chemotherapy in head and neck cancer : a feseability study

Purpose: To assess the loco regional response and toxicity of patients to concurrent chemo-radiation with 6 fractions/week using Intensity Modulated Radiotherapy in locally advanced head and neck cancers. (oropharynx and hypopharynx). Materials and Methods: 20 patients with Stage III and stage IV , squamous cell carcinoma of Head and neck were enrolled. Target Volume Delinetion was done in accordence with Danish Head and Neck cancer group (DAHANCA) contouring guidelines. Differential radiation dose of 70 Gy, 63Gy and 56Gy in 35 fractions using IMRT, delivered to GTV, CTV1 and CTV2 with weekly cisplatin with weekly assessment of response and toxicity. Results: The median age of the patients was 54 years ranging from 40 to 65 years. 14 and 6 patients had Hypopharyngeal and Oropharyngeal malignancy of squamous cell origin. 95 % of patients received 70 Gy in 35 fractions with 4 cycles of concurrent Cisplatin. 18 patients completed treatemnt within 45 days of OTT. 16 patients had complete response and 4 had partial response. Grade I, II dermatitis was observed in 70% and 30% of patients, respectively. 5 patienst developed Grade 2 and 1 patinet developed grade 3 leucopenia. 2 patients had weight loss of more than 10%. 85% oforopharyngeal cancers and 67% of hypopharyngeal cancers showed complete response. Nodal response was 100% complete in N1 & N2a, 92% and 0% in N2b and N3 lesions respicyively. TNM stage group wise the complete response rates were 100% in stage III, 92% & 0 % IVA & IVB. Conclusion: Accelerated fractionation with IMRT and concurrent chemotherapy is a feasible in locoregionally adanced head and neck cancers with acceptable toxicities and good locoregional response rates

Volumetric modulated arc therapy and concurrent chemotherapy for esophageal cancers: Dosimetric comparison with 3D conformal radiotherapy and early clinical results

Purpose: Despite Intensity Modulated Radiotherapy being the standard of care for most sites, 3D conformal radiotherapy (3DCRT) is still more widely used in esophageal cancers. This study compares dosimetric results of volumetric modulated arc therapy (RA) with that of 3DCRT and evaluates early clinical results of the patients treated with RA and chemotherapy. Materials and Methods: Evaluation of clinical outcomes in 10 patients treated definitively with RA and concurrent chemotherapy for esophageal cancer were included in the study. These patients were retrospectively planned with 3DCRT using antero-posterior portals till 3960cGy followed by obliques to a total dose of 5940cGy. The dose and target in each phase were kept same in both the plans. Dosimetric parameters were compared between the two plans using paired T-test or a Wilcoxon sign-rank based tests of normality on data distribution. Results: With a minimum follow-up of 4 months, all the patients tolerated the treatment without grade IV toxicities and treatment interruptions. 7 patients had a complete response and 3 had a partial response of which one patient underwent surgery and is disease free. RA resulted in higher conformity to the target compared to 3DCRT (mean conformity index 1.1 vs.1.8 respectively (p=0.002). RA plans significantly spared lung V15 (32%vs.40.2%, p=0.003), V20 (22.7%vs.29.7%, p=0.003), mean lung dose (13.8Gy vs.17.1Gy, p=0.003), heart V30 (46.8%vs.55.2% p=0.002), mean heart dose (24.3Gy vs.28.1Gy, p=0.003), and spinal cord maximum dose (44Gy vs.46.9Gy, p=0.002). The mean V5 and V10 values were similar with either technique. Conclusion: Irrespective of site of involvement, the RA resulted in better conformity and better sparing of heart, spinal cord and lungs beyond 15Gy. The dosimetric advantage gained with RA may become clinically relevant in reducing cardio-pulmonary complications especially in multimodality setting

CHARACTERISTICS OF MIDGUT AMAYLASE IN BOMBYX MORI L. : A COMPARATIVE ANALYSIS IN MULTIVOLTINE RACES, PURE MYSORE AND KOLAR GOLD

Assays of midgut amylase activity in two different multivoltine races i.e. Pure Mysore and crossbreed Kolar gold larvae of Bombyx mori were arranged to make the comparisons in their characterization. Optimum pH 9.2 and optimum temperature 60°C was recorded for Pure Mysore and for Kolar gold registered an optimum pH 8.8 at the temperature optima is same as in Pure Mysore. The linear period of enzyme activity was found at 10 minutes in both the races under study and Km values recorded 2.0% and 0.286% in Pure Mysore and Kolar gold respectively. The 50% inhibition at higher temperature (70°C) was found at 3 minutes in both the races. The specific activity of Pure Mysore was 34.56 ug glucose/ug protein/h, while that of Kolar gold was 86.41g glucose/ Lug protein/h