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1.
Parasit Vectors ; 13(1): 102, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103783

RESUMO

School-based deworming programmes are currently the main approach used to control the soil-transmitted helminths (STHs). A key unanswered policy question is whether mass drug administration (MDA) should be targeted to the whole community instead, and several trials in this area have been conducted or are currently on-going. A recent well-conducted trial demonstrated that successful community-wide treatment is a feasible strategy for STH control and can be more effective than school-based treatment in reducing prevalence and intensity of hookworm infection. However, we would argue that it is vital that these findings are not taken out of context or over generalised, as the additional health benefits gained from switching to community-wide treatment will vary depending on the STH species and baseline endemicity. Moreover, community-wide treatment will typically be more expensive than school-based treatment. The epidemiological evidence for an additional benefit from a switch to community-wide treatment has yet to be proven to represent "good value for money" across different settings. Further work is needed before changes in policy are made regarding the use of community-wide treatment for STH control, including comprehensive assessments of its additional public health benefits and costs across a range of scenarios, accounting for the presence of alternative treatment delivery platforms.

2.
Lancet Infect Dis ; 19(9): e330-e336, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31160190

RESUMO

Neglected tropical diseases afflict more than 1 billion of the world's poorest people. Pharmaceutical donations of preventive chemotherapy for neglected tropical diseases enable the largest en masse treatment campaigns globally with respect to the number of people targeted for treatment. However, the blanket distribution of medicines at no cost to individuals in need of treatment does not guarantee that those individuals are treated. In this Personal View, we aim to examine the next steps that need to be taken towards ensuring equitable treatment access, including health system integration and the role of endemic countries in ensuring medicines are delivered to patients. We argue that the expansion of medicine donation programmes and the development of new medicines are not the primary solutions to sustaining and expanding the growth of neglected tropical disease programmes. Treatment is often not verified by a medical professional, independent surveyor, or national programme officer. Additionally, access to medicines might not be equitable across at-risk populations, and treatment targets for disease control remain largely unmet within many endemic countries. To enable equitable access and efficient use of existing medicines, research is needed now on how best to integrate the treatment of neglected tropical diseases into local health systems. A comprehensive approach should be used, which combines mass drug administration with on-demand access to treatment. Increased commitment by endemic countries, when possible, around the ownership of treatment campaigns is essential to improve access to medicines for neglected tropical diseases.

3.
Parasit Vectors ; 12(1): 273, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138266

RESUMO

The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.


Assuntos
Helmintíase/prevenção & controle , Higiene , Saneamento/métodos , Solo/parasitologia , Água/parasitologia , Animais , Ensaios Clínicos como Assunto , Controle de Doenças Transmissíveis/estatística & dados numéricos , Controle de Doenças Transmissíveis/tendências , Fezes/parasitologia , Helmintos/fisiologia , Humanos , Saneamento/normas , Instituições Acadêmicas
4.
Trop Med Int Health ; 24(7): 788-816, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31013395

RESUMO

OBJECTIVE: To provide a systematic review of economic evaluations that has been conducted for onchocerciasis interventions, to summarise current key knowledge and to identify research gaps. METHOD: A systematic review of the literature was conducted on the 8th of August 2018 using the PubMed (MEDLINE) and ISI Web of Science electronic databases. No date or language stipulations were applied to the searches. RESULTS: We identified 14 primary studies reporting the results of economic evaluations of onchocerciasis interventions, seven of which were cost-effectiveness analyses. The studies identified used a variety of different approaches to estimate the costs of the investigated interventions/programmes. Originally, the studies only quantified the benefits associated with preventing blindness. Gradually, methods improved and also captured onchocerciasis-associated skin disease. Studies found that eliminating onchocerciasis would generate billions in economic benefits. The majority of the cost-effectiveness analyses evaluated annual mass drug administration (MDA). The estimated cost per disability-adjusted life year (DALY) averted of annual MDA varies between US$3 and US$30 (cost year variable). CONCLUSIONS: The cost benefit and cost effectiveness of onchocerciasis interventions have consistently been found to be very favourable. This finding provides strong evidential support for the ongoing efforts to eliminate onchocerciasis from endemic areas. Although these results are very promising, there are several important research gaps that need to be addressed as we move towards the 2020 milestones and beyond.

6.
Adv Parasitol ; 100: 127-154, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29753337

RESUMO

For more than 100 years, countries have used mass drug administration as a public health response to soil-transmitted helminth infection. The series of analyses published as Disease Control Priorities is the World Bank's vehicle for exploring the cost-effectiveness and value for money of public health interventions. The first edition was published in 1993 as a technical supplement to the World Bank's World Development Report Investing in Health where deworming was used as an illustrative example of value for money in treating diseases with relatively low morbidity but high prevalence. Over the second (2006) and now third (2017) editions deworming has been an increasingly persuasive example to use for this argument. The latest analyses recognize the negative impact of intestinal worm infection on human capital in poor communities and document a continuing decline in worm infection as a result of the combination of high levels of mass treatment and ongoing economic development trends in poor communities.


Assuntos
Anti-Helmínticos/uso terapêutico , Política de Saúde/economia , Política de Saúde/tendências , Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/prevenção & controle , Animais , Anti-Helmínticos/normas , Efeitos Psicossociais da Doença , Helmintíase/economia , Humanos , Enteropatias Parasitárias/economia
7.
Lancet ; 391(10121): 687-699, 2018 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-29153316

RESUMO

The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5-9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10-14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15-19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.


Assuntos
Saúde do Adolescente/economia , Saúde da Criança/economia , Serviços Preventivos de Saúde/economia , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Análise Custo-Benefício , Assistência à Saúde/economia , Humanos
8.
Lancet ; 391(10125): 1108-1120, 2018 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-29179954

RESUMO

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.


Assuntos
Assistência à Saúde/organização & administração , Saúde Global , Prioridades em Saúde , Cobertura Universal do Seguro de Saúde , Humanos
10.
BMJ Open ; 6(9): e011586, 2016 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-27670517

RESUMO

BACKGROUND: High levels of maternal mortality and large associated inequalities exist in low-income and middle-income countries. Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty. We examined the distribution across socioeconomic groups of maternal deaths and impoverishment among adolescent girls (15-19 years old) in Niger, which has the highest total fertility rate globally, and India, which has the largest number of maternal deaths. METHODS: In Niger and India, among adolescent girls, we estimated the distribution per income quintile of: the number of maternal deaths; and the impoverishment, measured by calculating the number of cases of catastrophic health expenditure incurred, caused by complicated pregnancies. We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year. We used epidemiological and cost inputs sourced from surveys and the literature. RESULTS: The number of maternal deaths would be larger among the poorer adolescents than among the richer adolescents in Niger and India. Impoverishment would largely incur among the richer adolescents in Niger and among the poorer adolescents in India. Increasing educational attainment of adolescent girls might avert both a large number of maternal deaths and a significant number of cases of catastrophic health expenditure in the 2 countries. CONCLUSIONS: Adolescent pregnancies can lead to large equity gaps and substantial impoverishment in low-income and middle-income countries. Increasing female education can reduce such inequalities and provide financial risk protection and poverty alleviation to adolescent girls.

15.
PLoS Negl Trop Dis ; 7(1): e2032, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23383355

RESUMO

BACKGROUND: Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015. METHODS AND FINDINGS: With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million. CONCLUSIONS: Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.


Assuntos
Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Oncocercose/epidemiologia , Oncocercose/prevenção & controle , Adolescente , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Filaricidas/administração & dosagem , Filaricidas/economia , Humanos , Ivermectina/administração & dosagem , Ivermectina/economia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Adulto Jovem
16.
Trends Parasitol ; 29(3): 142-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23332661

RESUMO

For those of us who have had worms, getting rid of them seems a good idea, and multiple studies demonstrate the simplicity and benefit of deworming children. In the past decade or so, there has been a dramatic increase in efforts to provide inexpensive deworming medications, but at the same time there have been calls to re-evaluate the impact of deworming programs. In this review, we examine the history of deworming and explore the evidence for effects of deworming on health, on child development, and on economic returns. Important policy conclusions include that a paucity of randomized trial data suggesting benefit does not equate to a lack of benefit and that a greater emphasis on documenting such benefit should be pursued.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Animais , Anti-Helmínticos/história , Helmintíase/história , Helmintíase/mortalidade , História do Século XX , Humanos , Saúde Pública/economia , Saúde Pública/tendências , Fatores Socioeconômicos
17.
Public Health Nutr ; 16(6): 1012-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23116617

RESUMO

OBJECTIVE: An analysis undertaken jointly in 2009 by the UN World Food Programme, The Partnership for Child Development and the World Bank was published as Rethinking School Feeding to provide guidance on how to develop and implement effective school feeding programmes as a productive safety net and as part of the efforts to achieve Education for All. The present paper reflects on how understanding of school feeding has changed since that analysis. DESIGN: Data on school feeding programme outcomes were collected through a literature review. Regression models were used to analyse relationships between school feeding costs (from data that were collected), the per capita costs of primary education and Gross Domestic Product per capita. Data on the transition to national ownership, supply chains and country examples were collected through country case studies. RESULTS: School feeding programmes increase school attendance, cognition and educational achievement, as well as provide a transfer of resources to households with possible benefits to local agricultural production and local market development. Low-income countries exhibit large variations in school feeding costs, with concomitant opportunities for cost containment. Countries are increasingly looking to transition from externally supported projects to national programmes. CONCLUSIONS: School feeding is now clearly evident as a major social programme in most countries with a global turnover in excess of $US 100 billion. This argues for a continuing focus on the evidence base with a view to helping countries ensure that their programmes are as cost-effective as possible. Clear policy advice has never been more important.


Assuntos
Dieta/economia , Serviços de Alimentação/economia , Abastecimento de Alimentos/economia , Promoção da Saúde/economia , Política Nutricional/economia , Saúde Pública/economia , Instituições Acadêmicas/economia , Agricultura , Criança , Cognição , Análise Custo-Benefício , Países em Desenvolvimento/economia , Escolaridade , Características da Família , Humanos , Cooperação Internacional , Política , Pobreza
18.
PLoS One ; 7(11): e42909, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23173030

RESUMO

BACKGROUND: We set out to estimate, for the three geographical regions with the highest HIV prevalence, (sub-Saharan Africa [SSA], the Caribbean and the Greater Mekong sub-region of East Asia), the human resource and economic impact of HIV on the supply of education from 2008 to 2015, the target date for the achievement of Education For All (EFA), contrasting the continuation of access to care, support and Antiretroviral therapy (ART) to the scenario of universal access. METHODOLOGY/PRINCIPAL FINDINGS: A costed mathematical model of the impact of HIV and ART on teacher recruitment, mortality and absenteeism (Ed-SIDA) was run using best available data for 58 countries, and results aggregated by region. It was estimated that (1) The impact of HIV on teacher supply is sufficient to derail efforts to achieve EFA in several countries and universal access can mitigate this. (2) In SSA, the 2008 costs to education of HIV were about half of those estimated in 2002. Providing universal access for teachers in SSA is cost-effective on education returns alone and provides a return of $3.99 on the dollar. (3) The impacts on education in the hyperendemic countries in Southern Africa will continue to increase to 2015 from its 2008 level, already the highest in the world. (4) If treatment roll-out is successful, numbers of HIV positive teachers are set to increase in all the regions studied. CONCLUSIONS/SIGNIFICANCE: The return on investing in care and support is also greater in those areas with highest impact. SSA requires increased investment in teacher support, testing and particularly ART if it is to achieve EFA. The situation for teachers in the Caribbean and East Asia is similar but on a smaller scale proportionate to the lower levels of infection and greater existing access to care and support.


Assuntos
Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Ensino/economia , Absenteísmo , Criança , Análise Custo-Benefício , Infecções por HIV/economia , Infecções por HIV/mortalidade , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Internacionalidade , Modelos Estatísticos , Seleção de Pessoal/economia , Seleção de Pessoal/estatística & dados numéricos , Prevalência , Recursos Humanos
20.
PLoS Med ; 7(5): e1000255, 2010 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-20502599

RESUMO

This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expense of attention to the social determinants of disease. Burton Singer argues that this represents another example of the inappropriate "overmedicalization" of contemporary tropical disease control. Peter Hotez and colleagues, in contrast, argue that the best return on investment will continue to be mass drug administration for NTDs.


Assuntos
Doenças Transmissíveis , Assistência à Saúde/métodos , Medicina Tropical , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/transmissão , Humanos , Prevenção Primária
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