The economic burden of overseas medical treatment: a cross sectional study of Maldivian medical travelers.

BACKGROUND: Access to tertiary care is a problem common to many small states, especially island ones. Although medical treatment overseas (MTO) may result in cost savings to high income countries, it can be a relatively high cost for low and middle income source countries. The purpose of this study was to estimate the costs of overseas medical treatment incurred by the households of medical travelers from Maldives and assess the burden of medical treatment overseas on the government and on households. METHODS: A survey was conducted of inbound Maldivian medical travelers who traveled during the period June - December 2013. Participants were stratified by the source of funds used for treatment abroad. Three hundred and forty four government-subsidized and 471 privately funded Maldivians were interviewed. Self-reported data on the utilization and expenses incurred during the last visit abroad, including both expenses covered by the government and borne by the household, were collected using a researcher administered structured questionnaire. RESULTS: The median per capita total cost of a medical travel episode amounted to $1,470. Forty eight percent of the cost was spent on travel. Twenty six percent was spent on direct medical costs, which were markedly higher among patients subsidized by the government than self-funded patients (p = <0.001). The two highest areas of spending for public funds were neoplasms and diseases of the circulatory system in contrast to diseases of the musculoskeletal system and nervous system for privately funded patients. Medical treatment overseas imposed a considerable burden on households as 43$68.9 million was spent to obtain treatment for Maldivians in overseas health facilities ($204 per capita), representing 4.8% of the country's GDP. CONCLUSIONS: Overseas medical treatment represents a substantial economic burden to the Maldives in terms of lost consumer spending in the local economy and catastrophic health spending by households. Geographical inequality in access to public funds for MTO and the disproportionate travel cost borne by travelers from rural areas need to be addressed in the existing Universal Health Care programme to minimize the burden of MTO. Increased investment to create more capacity in the domestic health infrastructure either through government, private or by foreign direct investment can help divert the outflow on MTO

The use of antimicrobials in global pig production: A systematic review of methods for quantification.

BACKGROUND: Overuse of antimicrobials in both humans and animals is recognized as one of the main drivers of Antimicrobial Resistance (AMR); and the optimisation of their use has been advocated as a key strategy for dealing with AMR. The measurement of antimicrobial use is vital for the design, monitoring and evaluation of such strategies. This systematic review describes and compares methods and measurements used to quantify antimicrobial use in pigs in order to inform efforts to standardize measurement. METHODS: The peer-reviewed literature was systematically searched using four online databases: MEDLINE, ScienceDirect, Scopus and Web of Science. Eligibility criteria for inclusion in the review included: articles published in English, involving pigs of any age and types of production, providing quantitative data on antimicrobial use, containing a clear description of the methodology, and having moderate to high rank in the quality assessment. RESULTS: Of 2,362 abstracts reviewed, a total of 25 studies were included based on the eligibility criteria. All studies were published between 2001 and 2017. Twenty of the studies were conducted in eight European countries. Twelve studies estimated antimicrobial use and eight studies were primarily methodological papers comparing different methods or variables, or developing new methods. The two main sources of antimicrobial use data were farm surveys and national sales data. A large variety of units of measurement was found. In this review, the ten measurements identified were categorized into four groups: 1) antimicrobials use measured by milligrams of active substance per animal weight; 2) antimicrobials use measured by daily dose per weight at treatment; 3) antimicrobial use measured by daily dose per treatment period; and 4) antimicrobials use measured by daily dose per period at risk of treatment. CONCLUSION: There is no global standardized measurement of antimicrobial use in pigs. Given the importance of monitoring the use antimicrobials, we recommend that at a minimum, all countries should develop macro-level monitoring using national sales data and report use by milligram of active ingredients per Population Correcting Unit. Monitoring in specific animal species requires the development of systems to capture prescription at national or farm level. Findings from monitoring antimicrobial use may help to guide effective interventions for optimising use of antimicrobials, as recommended by the WHO Global Action Plan on AMR

Patterns of antibiotic use in global pig production: A systematic review.

This review assesses the evidence for patterns of antibiotic use in pig on the basis of papers published in peer-reviewed journals in English between 2000 and 2017. Thirty-six articles were identified and reviewed, of which more than 85% of studies were conducted in Europe and North America. Penicillins and Tetracyclines groups were the most commonly used antibiotics in many countries. Oral medication in suckling and post-weaning periods were the most common applications of antibiotic administration in pig production. Antibiotic use is driven by age-specific diseases and the common pathogens causing these conditions where epidemiological profiles varied greatly across countries. In addition, the type and size of farm were associated with antibiotic use with finisher and larger farms using more antibiotics than farrow-to-finish and smaller farms. There is variation in the use of the highest priority critically important antimicrobials in humans across studies. However, this review indicates that they are still commonly used in pig production, for treatment and prevention of infection. This evidence calls for global efforts on the prudent use of antibiotics in response to the emergence of antimicrobial resistance (AMR) in the agricultural sector

Commentary : Thailand; sexual and reproductive health before and after universal health coverage in 2002

Comprehensive sexuality education, including for out-of-school youth, is urgently needed to reverse the trend of unintended pregnancies among girls, violence against women, and an apparent increase in marriage before 18. The adolescent birth rate has sharply increased from 31 per 1000 women aged 15–19 years in 2000 to 53 in 2012. The under-15 pregnancy rate has increased threefold, from 0.5 per 1000 in 2000 to 1.8 in 2012