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1.
Parasit Vectors ; 13(1): 227, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375898

RESUMO

BACKGROUND: The safety and efficacy of a new spot-on formulation of selamectin plus sarolaner were evaluated for the treatment and control of natural flea infestations on cats in two non-randomised, multi-centre clinical trials conducted in 8 different locations in Queensland, Australia. METHODS: One hundred and four cats from 65 different households were enrolled across the two studies. Demographic characteristics of cats in the two studies were similar. The new spot-on formulation of selamectin and sarolaner was administered topically once a month for 3 consecutive months at a minimum dosage of 6 mg/kg selamectin (dose range 6-12 mg/kg) plus 1 mg/kg sarolaner (dose range 1-2 mg/kg). Cats were dosed on Days 0 (pre-treatment), 30 and 60 and physical examinations and flea counts were conducted on Days 0, 30, 60 and 90. Efficacy assessments were based on the percentage reduction in live flea counts post-treatment compared to Day 0. RESULTS: In Study A, at enrolment, primary cats had flea counts ranging from 6 to 107 (arithmetic mean 21.0). The selamectin and sarolaner spot-on formulation resulted in arithmetic mean efficacy of 98.0%, 100% and 100% on Days 30, 60 and 90, respectively. In Study B, at enrolment, primary cats had flea counts ranging from 6 to 22 (arithmetic mean 10.0). The selamectin and sarolaner spot-on formulation resulted in arithmetic mean efficacy of 99.7%, 100% and 100% on Days 30, 60 and 90, respectively. CONCLUSIONS: The new spot-on formulation of selamectin plus sarolaner topically administered at monthly intervals at the minimum dosage of 6.0 mg/kg selamectin and 1.0 mg/kg sarolaner was safe and highly effective against natural infestations of fleas under a range of geographical conditions, representative of both tropical and subtropical regions of Australia.

2.
Parasit Vectors ; 12(1): 509, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666109

RESUMO

BACKGROUND: Haemaphysalis longicornis is the major tick affecting dogs in most of the East Asia/Pacific region and has recently been detected in a number of areas of the USA. This tick is a vector for a number of pathogens of dogs, other mammals and humans. In this study, the efficacy of a single oral administration of sarolaner (Simparica®, Zoetis) at the minimum label dosage (2 mg/kg) was evaluated against an existing infestation of H. longicornis and subsequent weekly reinfestations for 5 weeks after treatment. METHODS: Sixteen dogs were ranked on pretreatment tick counts and randomly allocated to treatment on Day 0 with sarolaner at 2 mg/kg or a placebo. The dogs were infested with H. longicornis nymphs on Days - 2, 5, 12, 19, 26 and 33. Efficacy was determined at 48 hours after treatment and subsequent re-infestations based on live tick counts relative to placebo-treated dogs. RESULTS: There were no adverse reactions to treatment. A single dose of sarolaner provided 100% efficacy on Days 2, 7, 14 and 21; and ≥ 97.4% efficacy on Days 28 and 35. Considering only attached, live ticks, efficacy was 100% for the entire 35 days of the study. Geometric mean live tick counts for sarolaner were significantly lower than those for placebo on all days (11.62 ≤ t(df) ≤ 59.99, where 13.0 ≤ df ≤ 14.1, P < 0.0001). CONCLUSIONS: In this study, a single oral administration of sarolaner at 2 mg/kg provided 100% efficacy against an existing infestation of H. longicornis nymphs and ≥ 97.4% efficacy (100% against attached ticks) against weekly reinfestation for at least 35 days after treatment.


Assuntos
Antiparasitários/uso terapêutico , Vetores Aracnídeos , Azetidinas/uso terapêutico , Doenças do Cão/tratamento farmacológico , Ixodidae , Compostos de Espiro/uso terapêutico , Infestações por Carrapato/veterinária , Administração Oral , Animais , Antiparasitários/administração & dosagem , Azetidinas/administração & dosagem , Doenças do Cão/parasitologia , Doenças do Cão/prevenção & controle , Cães , Compostos de Espiro/administração & dosagem , Infestações por Carrapato/tratamento farmacológico , Infestações por Carrapato/prevenção & controle
3.
Vet Parasitol ; 270 Suppl 1: S12-S18, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30914264

RESUMO

The efficacy of a single application of a new topical formulation containing selamectin plus sarolaner (Revolution® Plus / Stronghold® Plus, Zoetis) was evaluated against fleas and ticks infesting cats enrolled as veterinary patients in two field studies conducted in Japan and against Haemaphysalis longicornis ticks on cats in a laboratory study. In the laboratory study, sixteen cats were ranked based on pre-treatment tick counts and allocated randomly to treatment on Day 0 with either selamectin plus sarolaner or placebo. Cats were infested with adult H. longicornis on Days -2, 5, 12, 19, 26 and 33. Efficacy relative to placebo was based on live attached tick counts conducted 48 h after treatment and subsequent re-infestations. Selamectin plus sarolaner reduced live, attached H. longicornis counts by 96.4% within 48 h of treatment, and by ≥91.7% within 48 h of weekly re-infestation for 35 days, based on arithmetic means. In the field studies, 67 client-owned cats harboring six or more live fleas and 63 cats harboring four or more live attached ticks were enrolled to evaluate selamectin plus sarolaner for efficacy and safety compared with a registered product. Cats were allocated randomly to treatment with selamectin plus sarolaner or fipronil plus (S)-methoprene based on order of presentation. Treatment was administered once on Day 0 and efficacy was assessed by parasite counts conducted on Days 14 and 30 compared to the pre-treatment count. In the flea field study, live flea counts on Days 14 and 30 were reduced by 99.5% and 99.9% in the selamectin plus sarolaner group, and by 97.6% and 98.6% in the fipronil plus (S)-methoprene group, based on least squares mean percentage reductions. Clinical signs typically associated with flea allergy dermatitis improved following treatment. In the tick field study, live tick counts on Days 14 and 30 were reduced by 97.5% and 97.7% in the selamectin plus sarolaner group, and by 91.5% and 93.4% in the fipronil plus (S)-methoprene group, based on least squares mean percentage reductions. Selamectin plus sarolaner was determined to be non-inferior to fipronil plus (S)-methoprene in both field studies. There were no treatment-related adverse events in any study. A single topical dose of Revolution® Plus / Stronghold® Plus providing a minimum dosage of 6.0 mg/kg selamectin and 1.0 mg/kg sarolaner was confirmed to be effective against H. longicornis ticks on cats for one month and safe and effective in the treatment of fleas and ticks on cats enrolled as veterinary patients in Japan.


Assuntos
Azetidinas/administração & dosagem , Doenças do Gato/tratamento farmacológico , Infestações por Pulgas/veterinária , Ivermectina/análogos & derivados , Compostos de Espiro/administração & dosagem , Controle de Ácaros e Carrapatos , Infestações por Carrapato/veterinária , Acaricidas/administração & dosagem , Administração Tópica , Animais , Doenças do Gato/prevenção & controle , Gatos , Composição de Medicamentos/veterinária , Feminino , Infestações por Pulgas/tratamento farmacológico , Infestações por Pulgas/prevenção & controle , Inseticidas/administração & dosagem , Ivermectina/administração & dosagem , Japão , Masculino , Metoprene/administração & dosagem , Pirazóis/administração & dosagem , Distribuição Aleatória , Sifonápteros/efeitos dos fármacos , Infestações por Carrapato/tratamento farmacológico , Infestações por Carrapato/prevenção & controle , Carrapatos/efeitos dos fármacos , Resultado do Tratamento
4.
Parasit Vectors ; 10(1): 387, 2017 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-28814332

RESUMO

BACKGROUND: The efficacy and safety of a novel isoxazoline compound, sarolaner (Simparica®, Zoetis) and spinosad (Comfortis®, Elanco) as a positive control were evaluated for the treatment and control of natural flea infestations on dogs in two randomised, blinded, multi-centric clinical trials conducted in 11 veterinary clinics in northeastern and southeastern states of Australia. METHODS: A total of 162 client-owned dogs (80 in northern study and 82 in southern study) from 105 households were enrolled. Each household was randomly allocated to receive either sarolaner (Simparica®, Zoetis) or spinosad (Comfortis®, Elanco). Dogs were dosed on Days 0, 30 and 60 and physical examinations and flea counts were conducted on Days 0, 14, 30, 60 and 90. Efficacy assessments were based on the percentage reduction in live flea counts post-treatment compared to Day 0. RESULTS: In the northern study, at enrolment, primary dogs had flea counts ranging from 5 to 772. At the first efficacy assessment on Day 14, sarolaner resulted in 99.3% mean reduction in live flea counts relative to Day 0, compared to 94.6% in the spinosad group. On Day 30, the sarolaner-treated group had mean efficacy of 99.2% compared to 95.7% in the spinosad-treated group, and on days 60 and 90, both groups had mean efficacies of ≥ 98.8%. In the southern study, at enrolment, primary dogs had flea counts ranging from 5 to 156. Both sarolaner and spinosad resulted in ≥ 96.7% mean reduction in live flea counts on Day 14. On Day 30, the sarolaner-treated group had mean efficacy of 99.5% compared to 89.7% in the spinosad-treated group, and on days 60 and 90, both groups had mean efficacies of ≥ 98.6%. No treatment-related adverse events were observed in either study. CONCLUSIONS: A single monthly dose of sarolaner (Simparica®) administered orally at 2-4 mg/kg for three consecutive months was well tolerated and provided excellent efficacy against natural infestations of fleas under a range of Australian field conditions including different climatic and housing conditions. Similar efficacy was observed with spinosad (Comfortis®) after the second and third monthly treatments.


Assuntos
Azetidinas/uso terapêutico , Doenças do Cão/tratamento farmacológico , Infestações por Pulgas/veterinária , Inseticidas/uso terapêutico , Sifonápteros/efeitos dos fármacos , Compostos de Espiro/uso terapêutico , Administração Oral , Animais , Azetidinas/administração & dosagem , Azetidinas/efeitos adversos , Ensaios Clínicos como Assunto , Doenças do Cão/parasitologia , Cães , Combinação de Medicamentos , Infestações por Pulgas/tratamento farmacológico , Inseticidas/administração & dosagem , Inseticidas/efeitos adversos , Macrolídeos/administração & dosagem , Macrolídeos/uso terapêutico , Carga Parasitária , Compostos de Espiro/administração & dosagem , Compostos de Espiro/efeitos adversos , Resultado do Tratamento
5.
Parasit Vectors ; 10(1): 98, 2017 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-28222813

RESUMO

BACKGROUND: The Australian paralysis tick, Ixodes holocyclus, causes paralysis predominantly in dogs and cats in the Eastern coastal regions of Australia. Rapid onset of effect of a parasiticide is critical to minimize the deleterious effects of these tick infestations, especially tick paralysis caused by the salivary neurotoxin. The speed of kill of a novel orally administered isoxazoline parasiticide, sarolaner chewable tablets (Simparica®), against I. holocyclus on dogs was evaluated and compared with afoxolaner (NexGard®) for 5 weeks after a single oral dose. METHODS: Twenty-four (24) dogs were randomly allocated to treatment with either placebo, sarolaner (label dose of 2 to 4 mg/kg as per dosing table), or afoxolaner (label dose of 2.7 to 6.9 mg/kg) based on pre-treatment body weights. Following artificial infestation on Day -1, dogs were examined and live ticks counted at 8, 12, 24 and 48 h after treatment on Day 0, and at 12, 24 and 48 h after subsequent re-infestations on Days 7, 14, 21, 28 and 35. Efficacy was determined at each time point relative to counts for placebo dogs based on geometric means. RESULTS: At 8 and 12 h time points on Day 0, sarolaner-treated dogs had significantly lower geometric mean tick counts compared to the dogs treated with afoxolaner (P ≤ 0.0303). Efficacy of sarolaner against an existing infestation was 86.2 and 96.9% compared with that of afoxolaner which had efficacy of 21.3 and 85.0% at 8 and 12 h time points, respectively. Against subsequent weekly re-infestations at 12 h time points, treatment with sarolaner resulted in significantly lower geometric mean tick counts than afoxolaner-treated dogs on all days (P ≤ 0.0077) with the efficacy ranging from 60.2 to 92.2%, compared to 5.8 to 61.0% in the afoxolaner-treated dogs. Against subsequent weekly re-infestations at the 24 h time points on Days 22 and 36, efficacy of sarolaner was significantly higher at 99.2 and 97.9%, respectively, compared with afoxolaner which had efficacy of 92.4 and 91.9% (P ≤ 0.0356). At the 48 h time points following each of the five weekly re-infestations, the mean efficacy results of sarolaner and afoxolaner treated dogs were similar on most occasions. There were no adverse reactions to treatments. CONCLUSIONS: In this controlled laboratory evaluation, a single dose of sarolaner had a significantly faster speed of kill against an existing infestation of I. holocyclus, than afoxolaner at 8 and 12 h post-treatment. The rapid and consistent kill of ticks provided by sarolaner within 24 h after a single oral dose and following weekly re-infestations over 35 days suggests this treatment will provide highly effective, rapid and reliable control of ticks over the entire treatment interval, thereby minimizing the risk of tick paralysis in dogs.


Assuntos
Azetidinas/farmacologia , Doenças do Cão/tratamento farmacológico , Isoxazóis/farmacologia , Ixodes/efeitos dos fármacos , Naftalenos/farmacologia , Compostos de Espiro/farmacologia , Infestações por Carrapato/veterinária , Animais , Austrália , Azetidinas/administração & dosagem , Cães , Isoxazóis/administração & dosagem , Ixodes/fisiologia , Naftalenos/administração & dosagem , Carga Parasitária , Placebos/administração & dosagem , Distribuição Aleatória , Compostos de Espiro/administração & dosagem , Análise de Sobrevida , Infestações por Carrapato/tratamento farmacológico , Fatores de Tempo
6.
PLoS One ; 11(12): e0167268, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27911935

RESUMO

OBJECTIVES: In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD). In this study, we examine the impact that recent reforms expanding health insurance coverage have had on FBD. RESULTS: Data from the most recent Philippines 2013 Demographic Health Survey was employed. This study applies quasi-experimental methods using propensity scores along with alternative matching techniques and weighted regression to control for self-selection and investigate the impact of health insurance on the utilization of FBD. FINDINGS: Our findings reveal that the likelihood of FBD for women who are insured is between 5 to 10 percent higher than for those without insurance. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD. CONCLUSIONS: We conclude that increasing health insurance coverage is likely to be an effective approach to increase women's access to FBD. Our findings suggest that when such coverage is subsidized, as it is the case in the Philippines, women from poor and rural populations are likely to benefit the most.


Assuntos
Parto Obstétrico , Acesso aos Serviços de Saúde , Seguro Saúde , Parto , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Filipinas
7.
Health Policy Plan ; 31(10): 1530-1547, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27371550

RESUMO

Growing evidence suggests that early life investments in health are associated with improved human capital and economic outcomes. Various recent global studies have simulated the expected economic returns from alternative packages of interventions in reproductive, maternal, newborn and child health (RMNCH). However, very little is known about the comparability of estimates of the economic returns of RMNCH interventions across studies in low and middle income countries. Our study aims to fill this gap. We performed a comprehensive scoping review of the recent literature (2000-2013) on the economic returns (i.e. benefit-cost ratios) of RMNCH-related interventions, conducted in low and middle income countries. A total of 36 studies were identified. They were read in full and information was abstracted on both the estimates of benefit-cost ratios, the methodological approach and assumptions used. The estimated economic returns fluctuated considerably across settings as the associated costs of disease patterns, social behaviours and health systems varied. Yet, greater sources of variation stemmed from differences in methodology. The observed methodological inconsistencies limit the accuracy and comparability of the estimated returns across various contexts. The reviewed studies suggest that the benefit-cost ratios are favourable in the majority of cases, providing further support to a growing body of economic literature that suggests investments early in life, such as those interventions related to RMNCH, are good investments. Beyond advocacy purposes, for the reviewed literature to be used by policymakers to inform their decisions on investments, a consistent methodological approach should be adopted.


Assuntos
Saúde da Criança , Análise Custo-Benefício , Saúde do Lactente , Saúde Materna , Saúde Reprodutiva , Assistência à Saúde/economia , Países em Desenvolvimento , Saúde Global , Humanos , Serviços de Saúde Materno-Infantil/economia
8.
PLoS One ; 11(6): e0157110, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27362354

RESUMO

BACKGROUND: One of the greatest obstacles facing efforts to address quality of care in low and middle income countries is the absence of relevant and reliable data. This article proposes a methodology for creating a single "Quality Index" (QI) representing quality of maternal and neonatal health care based upon data collected as part of the Demographic and Health Survey (DHS) program. METHODS: Using the 2012 Indonesian Demographic and Health Survey dataset, indicators of quality of care were identified based on the recommended guidelines outlined in the WHO Integrated Management of Pregnancy and Childbirth. Two sets of indicators were created; one set only including indicators available in the standard DHS questionnaire and the other including all indicators identified in the Indonesian dataset. For each indicator set composite indices were created using Principal Components Analysis and a modified form of Equal Weighting. These indices were tested for internal coherence and robustness, as well as their comparability with each other. Finally a single QI was chosen to explore the variation in index scores across a number of known equity markers in Indonesia including wealth, urban rural status and geographical region. RESULTS: The process of creating quality indexes from standard DHS data was proven to be feasible, and initial results from Indonesia indicate particular disparities in the quality of care received by the poor as well as those living in outlying regions. CONCLUSIONS: The QI represents an important step forward in efforts to understand, measure and improve quality of MNCH care in developing countries.


Assuntos
Serviços de Saúde da Criança/normas , Cuidado Pós-Natal/normas , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde/normas , Países em Desenvolvimento , Pesquisas sobre Serviços de Saúde , Humanos , Indonésia , Recém-Nascido
9.
BMC Public Health ; 16: 523, 2016 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-27383189

RESUMO

BACKGROUND: Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. METHODS: Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. RESULTS: The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. CONCLUSIONS: This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Adolescente , Adulto , Criança , Serviços de Saúde da Criança/economia , Feminino , Acesso aos Serviços de Saúde/economia , Parto Domiciliar/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/economia , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Filipinas , Gravidez , Classe Social , Fatores Socioeconômicos , Adulto Jovem
10.
Vet Parasitol ; 222: 18-22, 2016 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-26935820

RESUMO

The efficacy of a single oral dose of a novel isoxazoline, sarolaner (Simparica™, Zoetis), for the treatment and control of flea infestations on dogs was confirmed in five laboratory studies. The studies were conducted using adult purpose-bred Beagles and/or mixed breed dogs. All animals were individually identified and housed, and were allocated randomly to treatment with either placebo or sarolaner (eight to 10 per group) based on pretreatment parasite counts. Three studies used cat flea (Ctenocephalides felis felis) strains recently isolated from the field from the US, EU, or Australia; in the fourth study a laboratory strain (KS1) with documented tolerance to a number of insecticides such as fipronil, imidacloprid, and permethrin was used. In the fifth study, dogs were infested with dog fleas, Ctenocephalides canis. Dogs were treated orally on Day 0 with a placebo or a sarolaner tablet providing a minimum dose of 2mg/kg. Dogs were infested with approximately 100 unfed, adult fleas prior to treatment and at weekly intervals post-treatment. Comb counts were conducted to determine the numbers of viable fleas at 24h after treatment and after each subsequent infestation. Efficacy against C. felis and C. canis was 99.8-100% from treatment through Day 35. In all five studies, elimination of existing infestations was achieved within 24h after dosing, with only a single live C. felis found on one dog on Day 1. Similarly, control of flea challenges was achieved within 24h after infestation throughout the 35day study periods, with only single live C. felis found on two dogs on Day 28 in one study, and on a single dog on Day 35 in another study. There were no adverse reactions to treatment with sarolaner. These studies confirmed that a single oral dose of sarolaner at 2mg/kg provided highly effective treatment of existing C. felis infestations and persistent control of C. felis on dogs for 35days after treatment. Efficacy equivalent to that seen with C. felis was confirmed against C. canis and a known insecticide-tolerant strain of C. felis.


Assuntos
Doenças do Cão/tratamento farmacológico , Composição de Medicamentos/veterinária , Infestações por Pulgas/veterinária , Isoxazóis/administração & dosagem , Isoxazóis/normas , Administração Oral , Animais , Doenças do Cão/prevenção & controle , Cães , Composição de Medicamentos/normas , Feminino , Infestações por Pulgas/tratamento farmacológico , Infestações por Pulgas/prevenção & controle , Inseticidas/administração & dosagem , Inseticidas/normas , Masculino , Resultado do Tratamento
11.
PLoS One ; 10(10): e0139458, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26431409

RESUMO

BACKGROUND: Health-related within-country inequalities continue to be a matter of great interest and concern to both policy makers and researchers. This study aims to assess the level and the distribution of child mortality outcomes in the Philippines across geographical and socioeconomic indicators. METHODOLOGY: Data on 159,130 children ever borne were analysed from five waves of the Philippine Demographic and Health Survey. Direct estimation was used to construct under-five and neonatal mortality rates for the period 1980-2013. Rate differences and ratios, and where possible, slope and relative indices of inequality were calculated to measure disparities on absolute and relative scales. Stratification was undertaken by levels of rural/urban location, island groups and household wealth. FINDINGS: National under-five and neonatal mortality rates have shown considerable albeit differential reductions since 1980. Recently released data suggests that neonatal mortality has declined following a period of stagnation. Declines in under-five mortality have been accompanied by decreases in wealth and geography-related absolute inequalities. However, relative inequalities for the same markers have remained stable over time. For neonates, mixed evidence suggests that absolute and relative inequalities have remained stable or may have risen. CONCLUSION: In addition to continued reductions in under-five mortality, new data suggests that the Philippines have achieved success in addressing the commonly observed stagnated trend in neonatal mortality. This success has been driven by economic improvement since 2006 as well as efforts to implement a nationwide universal health care campaign. Yet, such patterns, nonetheless, accorded with persistent inequalities, particularly on a relative scale. A continued focus on addressing universal coverage, the influence of decentralisation and armed conflict, and issues along the continuum of care is advocated.


Assuntos
Mortalidade da Criança , Mortalidade Infantil , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Filipinas , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
13.
Matern Child Health J ; 19(11): 2429-37, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26108400

RESUMO

BACKGROUND: Many priority countries in the countdown to the millennium development goals deadline are lagging in progress towards maternal and child health (MCH) targets. Papua New Guinea (PNG) is one such country beset by challenges of geographical inaccessibility, inequity and health system weakness. Several countries, however, have made progress through focused initiatives which align with the burden of disease and overcome specific inequities. This study identifies the potential impact on maternal and child mortality through increased coverage of prioritised interventions within the PNG health system. METHODS: The burden of disease and health system environment of PNG was documented to inform prioritised MCH interventions at community, outreach, and clinical levels. Potential reductions in maternal and child mortality through increased intervention coverage to close the geographical equity gap were estimated with the lives saved tool. RESULTS: A set community-level interventions, with highest feasibility, would yield significant reductions in newborn and child mortality. Adding the outreach group delivers gains for maternal mortality, particularly through family planning. The clinical services group of interventions demands greater investment but are essential to reach MCH targets. Cumulatively, the increased coverage is estimated to reduce the rates of under-five mortality by 19 %, neonatal mortality by 26 %, maternal mortality ratio by 10 % and maternal mortality by 33 %. CONCLUSIONS: Modest investments in health systems focused on disadvantaged populations can accelerate progress in maternal and child survival even in fragile health systems like PNG. The critical approach may be to target interventions and implementation appropriately to the sensitive context of lagging countries.


Assuntos
Serviços de Saúde da Criança/organização & administração , Saúde da Criança , Prioridades em Saúde , Disparidades em Assistência à Saúde , Saúde Materna , Criança , Mortalidade da Criança/etnologia , Assistência à Saúde/organização & administração , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/etnologia , Papua Nova Guiné , Vigilância da População , Valor Preditivo dos Testes
14.
Matern Child Health J ; 19(9): 2038-47, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25652066

RESUMO

A rapid reduction in under-five mortality has put Bangladesh on-track to reach Millennium Development Goal 4. Little research, however, has been conducted into neonatal reductions and sub-national rates in the country, with considerable disparities potentially masked by national reductions. The aim of this paper is to estimate national and sub-national rates of neonatal mortality to compute relative and absolute inequalities between sub-national groups and draw comparisons with rates of under-five mortality. Mortality rates for under-five children and neonates were estimated directly for 1980-1981 to 2010-2011 using data from six waves of the Demographic and Health Survey. Rates were stratified by levels of rural/urban location, household wealth and maternal education. Absolute and relative inequalities within these groups were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. National mortality was shown to have decreased dramatically although at differential rates for under-fives and neonates. Across all equity markers, a general pattern of declining absolute but constant relative inequalities was found. For mortality rates stratified by education and wealth mixed evidence suggests that relative inequalities may have also fallen. Although disparities remain, Bangladesh has achieved a rare combination of substantive reductions in mortality levels without increases in relative inequalities. A coalescence of substantial increases in coverage and equitable distribution of key child and neonatal interventions with widespread health sectoral and policy changes over the last 30 years may in part explain this exceptional pattern.


Assuntos
Mortalidade da Criança , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Infantil , População Rural/estatística & dados numéricos , Bangladesh/epidemiologia , Pré-Escolar , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Fatores Socioeconômicos
15.
Matern Child Health J ; 19(3): 566-77, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24927787

RESUMO

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Criança , Estudos Transversais , Parto Obstétrico , Feminino , Geografia , Pesquisa sobre Serviços de Saúde/métodos , Disparidades em Assistência à Saúde , Humanos , Pessoa de Meia-Idade , Mães/psicologia , Nepal , Gravidez , Características de Residência , Fatores Socioeconômicos , Adulto Jovem
16.
PLoS One ; 9(10): e109044, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25295528

RESUMO

BACKGROUND: Cambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities. METHODS: Mortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth. FINDINGS: Since 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed. CONCLUSION: Despite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child health care and on the social determinants of health will be essential in narrowing inequalities.


Assuntos
Mortalidade Infantil , Adolescente , Adulto , Camboja , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem
17.
Malar J ; 13: 325, 2014 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-25130064

RESUMO

BACKGROUND: The goal of malaria elimination faces numerous challenges. New tools are required to support the scale up of interventions and improve national malaria programme capacity to conduct detailed surveillance. This study investigates the cost factors influencing the development and implementation of a spatial decision support system (SDSS) for malaria elimination in the two elimination provinces of Isabel and Temotu, Solomon Islands. METHOD: Financial and economic costs to develop and implement a SDSS were estimated using the Solomon Islands programme's financial records. Using an ingredients approach, verified by stakeholders and operational reports, total costs for each province were quantified. A budget impact sensitivity analysis was conducted to investigate the influence of variations in standard budgetary components on the costs and to identify potential cost savings. RESULTS: A total investment of US$ 96,046 (2012 constant dollars) was required to develop and implement the SDSS in two provinces (Temotu Province US$ 49,806 and Isabel Province US$ 46,240). The single largest expense category was for computerized equipment totalling approximately US$ 30,085. Geographical reconnaissance was the most expensive phase of development and implementation, accounting for approximately 62% of total costs. Sensitivity analysis identified different cost factors between the provinces. Reduced equipment costs would deliver a budget saving of approximately 10% in Isabel Province. Combined travel costs represented the greatest influence on the total budget in the more remote Temotu Province. CONCLUSION: This study provides the first cost analysis of an operational surveillance tool used specifically for malaria elimination in the South-West Pacific. It is demonstrated that the costs of such a decision support system are driven by specialized equipment and travel expenses. Such factors should be closely scrutinized in future programme budgets to ensure maximum efficiencies are gained and available resources are allocated effectively.


Assuntos
Sistemas de Apoio a Decisões Administrativas/economia , Técnicas de Apoio para a Decisão , Métodos Epidemiológicos , Malária/epidemiologia , Malária/prevenção & controle , Custos e Análise de Custo , Humanos , Melanesia/epidemiologia
18.
PLoS One ; 9(8): e106234, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25171152

RESUMO

BACKGROUND: Over recent years there has been a strong movement towards the improvement of vital statistics and other types of health data that inform evidence-based policies. Collecting such data is not cost free. To date there is no systematic framework to guide investment decisions on methods of data collection for vital statistics or health information in general. We developed a framework to systematically assess the comparative costs and outcomes/benefits of the various data methods for collecting vital statistics. METHODOLOGY: The proposed framework is four-pronged and utilises two major economic approaches to systematically assess the available data collection methods: cost-effectiveness analysis and efficiency analysis. We built a stylised example of a hypothetical low-income country to perform a simulation exercise in order to illustrate an application of the framework. FINDINGS: Using simulated data, the results from the stylised example show that the rankings of the data collection methods are not affected by the use of either cost-effectiveness or efficiency analysis. However, the rankings are affected by how quantities are measured. CONCLUSION: There have been several calls for global improvements in collecting useable data, including vital statistics, from health information systems to inform public health policies. Ours is the first study that proposes a systematic framework to assist countries undertake an economic evaluation of DCMs. Despite numerous challenges, we demonstrate that a systematic assessment of outputs and costs of DCMs is not only necessary, but also feasible. The proposed framework is general enough to be easily extended to other areas of health information.


Assuntos
Conjuntos de Dados como Assunto/economia , Estatísticas Vitais , Custos e Análise de Custo , Conjuntos de Dados como Assunto/normas , Humanos
19.
PLoS One ; 9(7): e103597, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25061950

RESUMO

BACKGROUND: Considerable improvements in life expectancy and other human development indicators in Indonesia are thought to mask considerable disparities between populations in the country. We examine the existence and extent of these disparities by measuring trends and inequalities in the under-five mortality rate and neonatal mortality rate across wealth, education and geography. METHODOLOGY: Using data from seven waves of the Indonesian Demographic and Health Surveys, direct estimates of under-five and neonatal mortality rates were generated for 1980-2011. Absolute and relative inequalities were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. Disparities were assessed by levels of rural/urban location, island groups, maternal education and household wealth. FINDINGS: Declines in national rates of under-five and neonatal mortality have accorded with reductions of absolute inequalities in clusters stratified by wealth, maternal education and rural/urban location. Across these groups, relative inequalities have generally stabilised, with possible increases with respect to mortality across wealth subpopulations. Both relative and absolute inequalities in rates of under-five and neonatal mortality stratified by island divisions have widened. CONCLUSION: Indonesia has made considerable gains in reducing under-five and neonatal mortality at a national level, with the largest reductions happening before the Asian financial crisis (1997-98) and decentralisation (2000). Hasty implementation of decentralisation reforms may have contributed to a slowdown in mortality rate reduction thereafter. Widening inequities between the most developed provinces of Java-Bali and those of other island groupings should be of particular concern for a country embarking on an ambitious plan for universal health coverage by 2019. A focus on addressing the key supply side barriers to accessing health care and on the social determinants of health in remote and disadvantaged regions will be essential for this plan to be realised.


Assuntos
Mortalidade da Criança , Mortalidade Infantil , Pré-Escolar , Humanos , Indonésia , Lactente , Recém-Nascido , Fatores Socioeconômicos
20.
Vet Parasitol ; 204(3-4): 269-78, 2014 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-24933468

RESUMO

Results from worm egg counts (WECs) of cattle from across Australia over an 11 year period have been analysed to provide contemporary data on WEC and worm genus distribution in Australian cattle. A sampling kit consisted of ten sample containers. Faecal samples were collected into each sampling kit from groups of cattle and WEC and larval cultures were conducted using standard procedures. A submission form was completed for each kit with data requested including date of sampling, property address, age, average estimated weight and production type of cattle, last drench used and date of drenching. Regional analysis was done by postcode region and postcode regions were grouped into bioclimatic regions. A total of 5069 submissions were received from 2002 to the end of 2012 representing over 50,000 individual faecal samples. Seventy-seven percent of cattle sampled were no more than 2 years of age with the remainder representing a range of age groups. Samples were collected from all of the significant cattle producing regions of Australia. There was a tendency for higher geometric mean WEC in cattle in northern Australia and in high rainfall areas along the east coast of Australia. Geometric mean WEC for bioclimatic regions varied seasonally with a peak in autumn in regions with summer dominant rainfall, but little seasonal variation in regions with winter dominant rainfall patterns. Worm genera cultured varied throughout Australia with Cooperia spp. being most prevalent across the country, followed by Haemonchus spp. and Oesophagostomum spp. in summer rainfall dominant regions and Ostertagia spp. and Trichostrongylus spp. in winter rainfall regions. In the coastal, tablelands, and temperate rangelands regions of NSW, Haemonchus spp. were as prevalent as Cooperia spp. during autumn months and levels of Haemonchus spp. found in south-western Western Australia were higher than previously documented. These data provide an up-to-date summary of internal parasites in Australian cattle. Regional differences in WEC between northern and southern Australia are evident and should be further explored. These data suggest that there has been a move to Cooperia spp. being the predominant worm genus in Australian cattle, with increasing levels of Haemonchus spp. being evident in southern temperate regions of Australia.


Assuntos
Doenças dos Bovinos/epidemiologia , Helmintíase/epidemiologia , Trichostrongyloidea/isolamento & purificação , Tricostrongiloidíase/epidemiologia , Animais , Austrália/epidemiologia , Bovinos , Doenças dos Bovinos/parasitologia , Bases de Dados Factuais , Haemonchus/isolamento & purificação , Larva , Ostertagia/isolamento & purificação , Contagem de Ovos de Parasitas/veterinária , Estações do Ano , Tricostrongiloidíase/parasitologia , Trichostrongylus/isolamento & purificação
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