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1.
BMJ ; 369: m1043, 2020 04 02.
Artículo en Inglés | MEDLINE | ID: mdl-32241761

RESUMEN

OBJECTIVES: To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. DESIGN: National surveillance studies, 2008-17. SETTING: 31 provinces in mainland China. PARTICIPANTS: 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. MAIN OUTCOME MEASURES: Diagnosis of, and deaths from, 44 notifiable infectious diseases. RESULTS: From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100 000 population in 2008 to 0.07 per 100 000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100 000 in 2008 to 162 per 100 000 in 2015, but rose again to 242 per 100 000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100 000 in 2008 to 7 per 100 000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. CONCLUSIONS: China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.


Asunto(s)
Control de Enfermedades Transmisibles , Programas de Inmunización , Vacunación , Enfermedades Prevenibles por Vacunación , Adolescente , Betacoronavirus , Niño , China/epidemiología , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/normas , Infecciones por Coronavirus , Brotes de Enfermedades , Femenino , Humanos , Incidencia , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/prevención & control , Malaria/economía , Malaria/prevención & control , Masculino , Pandemias , Neumonía Viral , Estudios Retrospectivos , Escarlatina/epidemiología , Escarlatina/prevención & control , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Enfermedades Prevenibles por Vacunación/prevención & control
2.
PLoS One ; 15(2): e0228469, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32074112

RESUMEN

INTRODUCTION: The decision-making process for malaria control and elimination strategies has become more challenging. Interventions need to be targeted at council level to allow for changing malaria epidemiology and an increase in the number of possible interventions. Models of malaria dynamics can support this process by simulating potential impacts of multiple interventions in different settings and determining appropriate packages of interventions for meeting specific expected targets. METHODS: The OpenMalaria model of malaria dynamics was calibrated for all 184 councils in mainland Tanzania using data from malaria indicator surveys, school parasitaemia surveys, entomological surveillance, and vector control deployment data. The simulations were run for different transmission intensities per region and five interventions, currently or potentially included in the National Malaria Strategic Plan, individually and in combination. The simulated prevalences were fitted to council specific prevalences derived from geostatistical models to obtain council specific predictions of the prevalence and number of cases between 2017 and 2020. The predictions were used to evaluate in silico the feasibility of the national target of reaching a prevalence of below 1% by 2020, and to suggest alternative intervention stratifications for the country. RESULTS: The historical prevalence trend was fitted for each council with an agreement of 87% in 2016 (95%CI: 0.84-0.90) and an agreement of 90% for the historical trend (2003-2016) (95%CI: 0.87-0.93) The current national malaria strategy was expected to reduce the malaria prevalence between 2016 and 2020 on average by 23.8% (95% CI: 19.7%-27.9%) if current case management levels were maintained, and by 52.1% (95% CI: 48.8%-55.3%) if the case management were improved. Insecticide treated nets and case management were the most cost-effective interventions, expected to reduce the prevalence by 25.0% (95% CI: 19.7%-30.2) and to avert 37 million cases between 2017 and 2020. Mass drug administration was included in most councils in the stratification selected for meeting the national target at minimal costs, expected to reduce the prevalence by 77.5% (95%CI: 70.5%-84.5%) and to avert 102 million cases, with almost twice higher costs than those of the current national strategy. In summary, the model suggested that current interventions are not sufficient to reach the national aim of a prevalence of less than 1% by 2020 and a revised strategic plan needs to consider additional, more effective interventions, especially in high transmission areas and that the targets need to be revisited. CONCLUSION: The methodology reported here is based on intensive interactions with the NMCP and provides a helpful tool for assessing the feasibility of country specific targets and for determining which intervention stratifications at sub-national level will have most impact. This country-led application could support strategic planning of malaria control in many other malaria endemic countries.


Asunto(s)
Antimaláricos/uso terapéutico , Simulación por Computador , Malaria/prevención & control , Administración Masiva de Medicamentos , Planificación Estratégica , Niño , Preescolar , Análisis Costo-Beneficio , Estudios de Factibilidad , Organizaciones de Planificación en Salud/organización & administración , Organizaciones de Planificación en Salud/normas , Indicadores de Salud , Humanos , Malaria/economía , Malaria/epidemiología , Administración Masiva de Medicamentos/economía , Administración Masiva de Medicamentos/métodos , Administración Masiva de Medicamentos/normas , Control de Mosquitos/economía , Control de Mosquitos/métodos , Control de Mosquitos/organización & administración , Control de Mosquitos/normas , Parasitemia/economía , Parasitemia/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Instituciones Académicas/economía , Instituciones Académicas/estadística & datos numéricos , Planificación Estratégica/economía , Planificación Estratégica/normas , Tanzanía/epidemiología
3.
BMC Public Health ; 20(1): 17, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910842

RESUMEN

BACKGROUND: A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. METHODS: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. RESULTS: Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. CONCLUSION: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.


Asunto(s)
Antimaláricos/economía , Antimaláricos/uso terapéutico , Transmisión de Enfermedad Infecciosa/economía , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Malaria/economía , Malaria/terapia , Malaria/transmisión , África del Sur del Sahara/epidemiología , Análisis Costo-Beneficio , Humanos , Incidencia , Malaria/epidemiología , Modelos Teóricos
4.
J Matern Fetal Neonatal Med ; 33(1): 92-95, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29886762

RESUMEN

Background: Malaria in pregnancy carries a proven huge health burden; however, the economic challenges have not been properly evaluated in Nigeria.Methodology: The study was a descriptive cross-sectional hospital-based approach. A structured questionnaire was used to collect microeconomic data from pregnant women, on the medical and nonmedical cost of malaria to them.Results: A total of 371 questionnaires were analyzed (93%; 371/400), of 400 respondents interviewed. The average direct medical cost was N3581.78 naira (N) (US$11.86) with SD of N177.9 and mean direct nonmedical cost of N5741.5 (US$18.97). Of the patients, 86.8% received artemisinin-based combination therapy (ACTs) for the treatment of malaria. Nigeria has an estimated population of women of child-bearing age of 40 million and, the fertility rate of 124 per 1000. On the basis of estimation of 56.5% of pregnant women receiving at least one intermittent preventive therapy (IPT), will approximate to 22.8 billion naira (US$75.5 million) national annual expenditure for malaria in pregnancy. This approximates to 0.016% of the Nigerian gross domestic product of 481 billion USD of 2015. The major mechanism that was used to pay for treatment was out-of-pocket (OOP).Conclusions: Malaria carries high-economic burden both on individual and national levels, especially in Nigeria where OOPs is the major payment mechanism. Scaling up malaria control measures will not only improve the lives of pregnant women but will also improve the economy of the nation.


Asunto(s)
Antimaláricos/economía , Malaria/tratamiento farmacológico , Malaria/economía , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Complicaciones Parasitarias del Embarazo/economía , Adulto , Antimaláricos/uso terapéutico , Artemisininas/administración & dosificación , Artemisininas/economía , Costo de Enfermedad , Estudios Transversales , Quimioterapia Combinada/economía , Quimioterapia Combinada/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Humanos , Recién Nacido , Malaria/epidemiología , Nigeria/epidemiología , Embarazo , Complicaciones Parasitarias del Embarazo/epidemiología , Encuestas y Cuestionarios , Adulto Joven
5.
Malar J ; 18(1): 360, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711489

RESUMEN

BACKGROUND: Malaria remains a leading cause of morbidity and mortality in Mozambique. Increased investments in malaria control have reduced the burden, but few studies have estimated the costs of malaria in the country. This paper estimates the economic costs associated with malaria care to households and to the health system in the high burden district of Mopeia in central Mozambique. METHODS: Malaria care-seeking and morbidity costs were routinely collected among 1373 households with at least one child enrolled in an active case detection (ACD) cohort in Mopeia, and through cross-sectional surveys with 824 families in 2017 and 805 families in 2018. Household costs included direct medical expenses, transportation and opportunity costs of the time lost due to illness. Structured questionnaires were used to estimate the health system costs associated with malaria care in all 13 district health facilities. Cost estimations followed an ingredient-based approach with a top-down allocation approach for health system expenses. RESULTS: Among participants in cross-sectional studies, households sought care for nine severe malaria cases requiring hospital admission and for 679 uncomplicated malaria cases. Median household costs associated with uncomplicated malaria among individuals of all ages were US$ 3.46 (IQR US$ 0.07-22.41) and US$ 81.08 (IQR US$ 39.34-88.38) per severe case. Median household costs were lower among children under five (ACD cohort): US$ 1.63 (IQR US$ 0.00-7.79) per uncomplicated case and US$ 64.90 (IQR US$ 49.76-80.96) per severe case. Opportunity costs were the main source of household costs. Median health system costs associated with malaria among patients of all ages were US$ 4.34 (IQR US$ 4.32-4.35) per uncomplicated case and US$ 26.56 (IQR US$ 18.03-44.09) per severe case. Considering household and health system costs, the overall cost of malaria care to society was US$ 7.80 per uncomplicated case and US$ 107.64 per severe case, representing an economic malaria burden of US$ 332,286.24 (IQR US$ 186,355.84-1,091,212.90) per year only in Mopeia. CONCLUSIONS: Despite the provision of free malaria services, households in Mopeia incur significant direct and indirect costs associated with the disease. Furthermore, the high malaria cost on the Mozambican health system underscores the need to strengthen malaria prevention to reduce the high burden and improve productivity in the region.


Asunto(s)
Costo de Enfermedad , Prestación de Atención de Salud/economía , Familia , Malaria/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Malaria/prevención & control , Masculino , Persona de Mediana Edad , Mozambique , Adulto Joven
7.
Pan Afr Med J ; 33: 152, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31558949

RESUMEN

Introduction: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. Methods: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). Results: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). Conclusion: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.


Asunto(s)
Antimaláricos/administración & dosificación , Política de Salud , Accesibilidad a los Servicios de Salud/economía , Malaria/tratamiento farmacológico , Antimaláricos/economía , Camerún , Cuidadores/estadística & datos numéricos , Preescolar , Estudios Transversales , Financiación Gubernamental/economía , Hospitalización/estadística & datos numéricos , Humanos , Malaria/economía , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Encuestas y Cuestionarios
8.
BMC Res Notes ; 12(1): 490, 2019 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-31391102

RESUMEN

OBJECTIVE: To investigate the influence of socioeconomic household characteristics on access to paediatric malaria treatment in Homa Bay County, Kenya. RESULTS: From univariate analysis, treatment with analgesics only in a community health center or a faith-based organization, self-employment, urban residence and residing in a sub-county other than Suba or Mbita showed significant association with access to paediatric antimalarial treatment. However, on multivariate analysis, urban residence, education, income of 10,000 to 30,000 and information from peers were the most statistically significant predictors of access to treatment. Urban households were 0.37 times more likely to access treatment than rural ones. Having primary, secondary or post-secondary education conferred 0.25, 0.14 and 0.28 higher chance of access to paediatric malaria treatment respectively compared to those with no formal education. Those with monthly income levels of 10,000 to 30,000 shillings had 0.32 higher chance of accessing treatment compared to those with less than 5000 shillings.


Asunto(s)
Analgésicos/economía , Antimaláricos/economía , Artemisininas/economía , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Malaria/economía , Adulto , Analgésicos/uso terapéutico , Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Niño , Preescolar , Centros Comunitarios de Salud , Estudios Transversales , Combinación de Medicamentos , Composición Familiar , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Kenia , Malaria/tratamiento farmacológico , Malaria/fisiopatología , Masculino , Análisis Multivariante , Población Rural , Factores Socioeconómicos , Población Urbana
9.
Glob Health Sci Pract ; 7(2): 258-272, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31249022

RESUMEN

INTRODUCTION: In the era of declining development assistance for health, transitioning externally funded programs to governments becomes a priority for donors. However, the process requires a careful approach not only to preserve the public health gains that have already been achieved but also to expand on them. In the Eastern Europe and Central Asia region, countries are expected to graduate from support from the Global Fund to Fight AIDS, Tuberculosis and Malaria in or before 2025. We aim to describe transition risks and identify possible means to address them. METHODS: Using a theory-based conceptual framework-Transition Preparedness Assessment of Tuberculosis and HIV/AIDS programs-we investigated transition-related challenges through a health systems lens in 10 countries of the Eastern Europe and Central Asia region during 2015-2017. Study findings were derived from systematic collection of quantitative data on socioeconomic indicators and disease epidemics as well as qualitative data from in-depth interviews with 264 stakeholders. These findings were then compared with other donor transition experiences documented elsewhere. RESULTS: We found numerous common transition challenges, such as poor monitoring of a country's macroeconomic performance along with weakness in estimating financial needs for successful transition; limited political will of governments to replace donor-funded programs; punitive legislation criminalizing certain behaviors and constraining the government's ability to allocate funds and contract civil society organizations essential to providing services for key populations; limited coordination function of governments and weak decision-making power of coordinating mechanisms obscuring the latter's future role; and inadequate function of national procurement and supply chain management systems undermining an uninterrupted supply of quality-assured drugs and commodities. These challenges are compounded by the risks related to health workforce management leading to specialist shortages and/or inadequately skilled and qualified professionals and by limited funding for critical surveillance activities. CONCLUSION: The complex and multidimensional transition process requires a multipronged approach through well-planned collective and coordinated responses from global, bilateral, and national partners in coming years. Other similar transition processes may provide guidance. Although no "one-size-fits-all" approach exists, previous experiences highlight a need for both early planning and monitoring of the transition along several key dimensions. Issues that could threaten the maintenance of health gains include ongoing stigma against key populations; continued heavy reliance on external funding in some countries, especially for preventive services; the institutional viability of the country coordinating mechanisms; and emerging difficulties with procurement of quality drugs at reasonable prices.


Asunto(s)
Prestación de Atención de Salud/economía , Administración Financiera , Gobierno , Infecciones por VIH/terapia , Financiación de la Atención de la Salud , Cooperación Internacional , Tuberculosis/terapia , Asia , Europa Oriental , Salud Global , Infecciones por VIH/economía , Humanos , Malaria/economía , Malaria/terapia , Encuestas y Cuestionarios , Tuberculosis/economía
10.
Afr J AIDS Res ; 18(2): 95-103, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31043120

RESUMEN

This paper examines the institutional management of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Botswana. We analyse the often contested roles of the state and non-governmental organisations (NGOs) as recipients of GFATM and partners in extending public health service provision to communities. Of importance is that Botswana's first GFATM grant had to be administratively closed, and the country was not awarded any other grant (especially for HIV/AIDS) until over a decade later. Following this, it is of interest to understand the ways in which institutions manage grant programmes. This article concludes that the "big brother" relationship of the state in relation to NGOs is crippling the critical and constructive effects of these organisations to deliver needed community-based health services in Botswana. GFTAM represents a window of opportunity for creating an effective civil society whose local activities will not be seen as being led covertly by the state. This article contributes to both theory and practice within the scholarship of development aid in Africa. Qualitative research methods were used, including in-depth interviews with public sector policy makers, all GFATM principal and sub-recipients, members of the Country Coordinating Mechanism (CCM) and NGOs.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/economía , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/organización & administración , Malaria/economía , Tuberculosis/economía , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Botswana , Prestación de Atención de Salud/tendencias , Organización de la Financiación , Humanos , Malaria/prevención & control , Organizaciones , Investigación Cualitativa , Tuberculosis/prevención & control
11.
Am J Trop Med Hyg ; 100(6): 1445-1453, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30994098

RESUMEN

After a dramatic decline in the annual malaria incidence in Thailand since 2000, the Thai government developed a National Malaria Elimination Strategy (NMES) to end local malaria transmission by 2024. This study examines the expected costs and benefits of funding the NMES (elimination scenario) versus not funding malaria elimination programming (resurgence scenario) from 2017 to 2036. Two case projection approaches were used to measure the number of malaria cases over the study period, combined with a set of Thailand-specific economic assumptions, to evaluate the cost of a malaria case and to quantify the cost-benefit ratio of elimination. Model A projects cases based on national historical case data using a log-normal regression and change-point analysis model. Model B projects cases based on periodic Yala Province-level outbreak cycles and incorporating NMES political and programmatic goals. In the base case, both models predict that elimination would prevent 1.86-3.11 million malaria cases from 2017 to 2036, with full NMES implementation proving to be cost-saving in all models, perspectives, and scenarios, except for the health system-only perspective in the Model A base case and all perspectives in the Model A worst case. From the societal perspective, every 1 US dollars (US$) spent on the NMES would-depending on case projections used-potentially result in a considerable return on investment, ranging from US$ 2 to US$ 15. Although the two case projection approaches resulted in different cost-benefit ratios, both models showed cost savings and suggest that ending local malaria transmission in Thailand would yield a positive return on investment.


Asunto(s)
Antimaláricos/economía , Antimaláricos/uso terapéutico , Erradicación de la Enfermedad/economía , Malaria/economía , Malaria/prevención & control , Adolescente , Adulto , Análisis Costo-Beneficio , Femenino , Política de Salud , Humanos , Malaria/parasitología , Masculino , Persona de Mediana Edad , Modelos Económicos , Embarazo , Complicaciones Parasitarias del Embarazo/economía , Complicaciones Parasitarias del Embarazo/prevención & control , Tailandia/epidemiología , Adulto Joven
12.
Infect Dis Poverty ; 8(1): 28, 2019 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-31030666

RESUMEN

Malaria-related mortality has a very high association with poverty rates, and the disease is most prevalent in low- and middle-income countries. To achieve the malaria-specific targets of the Sustainable Development Goals, malaria-endemic countries and development partners need to take concerted action to reduce malaria cases and deaths. Reaching all affected communities with malaria interventions requires strong political commitment and a significant expansion of international and domestic financial resources. World Malaria Day 2019 is an opportunity to review progress and challenges in this field.


Asunto(s)
Promoción de la Salud , Malaria/prevención & control , Práctica de Salud Pública , África/epidemiología , Asia/epidemiología , Salud Global , Promoción de la Salud/métodos , Humanos , Relaciones Interinstitucionales , Malaria/economía , Malaria/epidemiología , Política , Pobreza , Organización Mundial de la Salud
14.
Am J Trop Med Hyg ; 100(4): 861-867, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30793689

RESUMEN

Between 2012 and 2017, the U.S. President's Malaria Initiative-funded MalariaCare project supported national malaria control programs in sub-Saharan Africa to implement a case management quality assurance (QA) system for malaria and other febrile illnesses. A major component of the system was outreach training and supportive supervision (OTSS), whereby trained government health personnel visited health facilities to observe health-care practices using a standard checklist, to provide individualized feedback to staff, and to develop health facility-wide action plans based on observation and review of facility registers. Based on MalariaCare's experience, facilitating visits to more than 5,600 health facilities in nine countries, we found that programs seeking to implement similar supportive supervision schemes should consider ensuring the following: 1) develop a practical checklist that balances information gathering and mentorship; 2) establish basic competency criteria for supervisors and periodically assess supervisor performance in the field; 3) conduct both technical skills training and supervision skills training; 4) establish criteria for selecting facilities to conduct OTSS and determine the appropriate frequency of visits; and 5) use electronic data collection systems where possible. Cost will also be a significant consideration: the average cost per OTSS visit ranged from $44 to $333. Significant variation in costs was due to factors such as travel time, allowances for government personnel, length of the visit, and involvement of central level officials. Because the cost of conducting supportive supervision prohibits regularly visiting all health facilities, internal QA measures could also be considered as alternative or complementary activities to supportive supervision.


Asunto(s)
Manejo de Caso/economía , Personal de Salud/economía , Implementación de Plan de Salud/economía , Malaria/economía , África del Sur del Sahara , Manejo de Caso/legislación & jurisprudencia , Costos y Análisis de Costo , Personal de Salud/educación , Implementación de Plan de Salud/métodos , Humanos , Organización y Administración/economía , Atención Primaria de Salud/economía , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud
15.
Malar J ; 18(1): 5, 2019 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-30626380

RESUMEN

BACKGROUND: Global efforts to address the burden of malaria have stagnated in recent years with malaria cases beginning to rise. Substandard and falsified anti-malarial treatments contribute to this stagnation. Poor quality anti-malarials directly affect health outcomes by increasing malaria morbidity and mortality, as well as threaten the effectiveness of treatment by contributing to artemisinin resistance. Research to assess the scope and impact of poor quality anti-malarials is essential to raise awareness and allocate resources to improve the quality of treatment. A probabilistic agent-based model was developed to provide country-specific estimates of the health and economic impact of poor quality anti-malarials on paediatric malaria. This paper presents the methodology and case study of the Substandard and Falsified Antimalarial Research Impact (SAFARI) model developed and applied to Uganda. RESULTS: The total annual economic impact of malaria in Ugandan children under age five was estimated at US$614 million. Among children who sought medical care, the total economic impact was estimated at $403 million, including $57.7 million in direct costs. Substandard and falsified anti-malarials were a significant contributor to this annual burden, accounting for $31 million (8% of care-seeking children) in total economic impact involving $5.2 million in direct costs. Further, 9% of malaria deaths relating to cases seeking treatment were attributable to poor quality anti-malarials. In the event of widespread artemisinin resistance in Uganda, we simulated a 12% yearly increase in costs associated with paediatric malaria cases that sought care, inflicting $48.5 million in additional economic impact annually. CONCLUSIONS: Improving the quality of treatment is essential to combat the burden of malaria and prevent the development of drug resistance. The SAFARI model provides country-specific estimates of the health and economic impact of substandard and falsified anti-malarials to inform governments, policy makers, donors and the malaria community about the threat posed by poor quality medicines. The model findings are useful to illustrate the significance of the issue and inform policy and interventions to improve medicinal quality.


Asunto(s)
Antimaláricos/análisis , Antimaláricos/normas , Medicamentos Falsificados/análisis , Malaria/tratamiento farmacológico , Malaria/economía , Artemisininas , Preescolar , Medicamentos Falsificados/economía , Resistencia a Medicamentos , Femenino , Humanos , Lactante , Masculino , Modelos Teóricos , Sector Privado , Uganda
16.
J Infect Public Health ; 12(3): 424-433, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30630763

RESUMEN

BACKGROUND: Despite its elimination in the early 1950s, about 1700 cases of malaria are reported in the US every year. Few studies have quantified the direct and indirect costs of imported malaria in the US. METHODS: Disparities in the mean and total hospital days, hospital charges, and hospital costs for malaria-related hospitalizations in the US by demographic, clinical, species, financial, geographic, and institutional characteristics were examined using the 2000-2014 Nationwide Inpatient Sample (NIS). Trends and potential predictors for length of stay and hospital charges and costs were identified using negative binomial regression and linear regression, respectively. RESULTS: From 2000 to 2014, 22,029 malaria cases resulted in 95,948 hospital days for malaria-related hospitalizations, $176,391,466 in total hospital costs, and $555,435,849 in total charges. Mean charges increased significantly over the study period. Males, Blacks, and patients aged 25-44years accounted for the highest direct and indirect costs. Older age and having severe malaria was associated with a longer length of stay. Older age, severe malaria, HIV infection, and longer lengths of stay were associated with higher charges and costs. CONCLUSIONS: Malaria resulted in substantial direct and indirect costs in the US. Primary and secondary prevention measures should be prioritized among high-risk groups to reduce the economic burden.


Asunto(s)
Tiempo de Internación/economía , Malaria/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Costos de la Atención en Salud , Humanos , Malaria/economía , Masculino , Registros Médicos , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
17.
Am J Trop Med Hyg ; 100(5): 1149-1157, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30675851

RESUMEN

Substandard and falsified medicines pose significant risks to global health, including increased deaths, prolonged treatments, and growing drug resistance. Antimalarials are one of the most common medications to be of poor quality in low- and middle-income countries. We assessed the health and economic impact of substandard and falsified antimalarials for children less than 5 years of age in the Democratic Republic of the Congo, which has one of the world's highest malaria mortality rates. We developed an agent-based model to simulate patient care-seeking behavior and medicine supply chain processes to examine the impact of antimalarial quality in Kinshasa province and Katanga region. We simulated the impact of potential interventions to improve medicinal quality, reduce stockouts, or educate caregivers. We estimated that substandard and falsified antimalarials are responsible for $20.9 million (35% of $59.6 million; 95% CI: $20.7-$21.2 million) in malaria costs in Kinshasa province and $130 million (43% of $301 million; $129-$131 million) in malaria costs in the Katanga region annually. If drug resistance to artemisinin were to develop, total annual costs of malaria could increase by $17.9 million (30%; $17.7-$18.0 million) and $73 million (24%; $72.2-$72.8 million) in Kinshasa and Katanga, respectively. Replacing substandard and falsified antimalarials with good quality medicines had a larger impact than interventions that prevented stockouts or educated caregivers. The results highlight the importance of improving access to good quality antimalarials to reduce the burden of malaria and mitigate the development of antimalarial resistance.


Asunto(s)
Antimaláricos/economía , Antimaláricos/normas , Costo de Enfermedad , Medicamentos Falsificados/economía , Malaria/economía , Modelos Económicos , Preescolar , República Democrática del Congo , Costos de la Atención en Salud , Humanos , Lactante , Malaria/tratamiento farmacológico , Aceptación de la Atención de Salud
19.
Acta Trop ; 190: 344-349, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30521804

RESUMEN

The cost burden of malaria at the household level, resulting from complex social, economic, and epidemiological factors, is enormous. This study was carried out to estimate the economic burden of malaria at the household level in low and high malaria transmission areas of central India. We conducted surveys with households in which at least one member had suffered from malaria in the three months preceding the survey. The human capital method was used to estimate the cost of malaria at the household level. We found that the total cost per episode of malaria was higher in high transmission areas than low transmission areas; direct costs were generally higher for adults than for children. Males spent more on diagnosis and treatment than females, and the mean work absenteeism due to malaria was higher among male adult patients than among females, though work time lost due to child illness was lower for male caregivers. Households belonging to high and middle socioeconomic status (SES) spent significantly more on malaria illness than those of low SES. However, the economic burden of malaria relative to annual incomes was highest among low SES households. Populations belonging to high transmission areas were more vulnerable to malarial infection due to geo-climatic, demographic, socioeconomic, and cultural factors, as well as the relatively poor access to health facilities that characterize these regions. Additionally, poor health-seeking practices not only increase the cost burden but also adversely affect patients' health and productivity, which lead to opportunity losses while imposing a greater economic burden on households.


Asunto(s)
Costo de Enfermedad , Gastos en Salud/estadística & datos numéricos , Malaria/economía , Absentismo , Adulto , Factores de Edad , Niño , Eficiencia , Composición Familiar , Femenino , Humanos , India , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Malaria/transmisión , Masculino , Factores de Riesgo , Factores Sexuales , Clase Social , Encuestas y Cuestionarios , Adulto Joven
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