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8.
Sci Adv ; 7(6)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33547077

RESUMO

Despite numerous journalistic accounts, systematic quantitative evidence on economic conditions during the ongoing COVID-19 pandemic remains scarce for most low- and middle-income countries, partly due to limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. We assemble evidence from over 30,000 respondents in 16 original household surveys from nine countries in Africa (Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone), Asia (Bangladesh, Nepal, Philippines), and Latin America (Colombia). We document declines in employment and income in all settings beginning March 2020. The share of households experiencing an income drop ranges from 8 to 87% (median, 68%). Household coping strategies and government assistance were insufficient to sustain precrisis living standards, resulting in widespread food insecurity and dire economic conditions even 3 months into the crisis. We discuss promising policy responses and speculate about the risk of persistent adverse effects, especially among children and other vulnerable groups.


Assuntos
/economia , Países em Desenvolvimento/economia , Emprego/tendências , Renda/tendências , Pandemias/economia , Adulto , África/epidemiologia , Agricultura/economia , Ásia/epidemiologia , Criança , Colômbia/epidemiologia , Violência Doméstica , Recessão Econômica , Características da Família , Feminino , Programas Governamentais/economia , Humanos , Masculino , Estações do Ano , Inquéritos e Questionários
10.
J Prev Med Public Health ; 54(1): 73-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33618502

RESUMO

OBJECTIVES: Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran. METHODS: Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI. RESULTS: The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC. CONCLUSIONS: The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.


Assuntos
Aglomeração , Características da Família , Saúde Pública/métodos , Adolescente , Adulto , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Mapeamento Geográfico , Humanos , Renda/estatística & dados numéricos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Value Health ; 24(1): 61-66, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431154

RESUMO

OBJECTIVES: Cost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 years against human papillomavirus (HPV), but over half the world's countries have not introduced it. This study aimed to investigate whether country-level decisions about HPV vaccine introduction are consistent with a particular cost-effectiveness threshold, and to estimate what that threshold may be. METHODS: The cost-effectiveness of vaccinating 12-year-old girls was estimated in 179 countries using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model, together with vaccine price data from World Health Organization's Market Information for Access to Vaccines database. In each year from 2006 to 2018, countries were categorized based on (1) whether they had introduced HPV vaccination, and (2) whether the incremental cost-effectiveness ratio for HPV vaccine introduction fell below a certain cost-effectiveness threshold. RESULTS: A cost-effectiveness threshold of 60% to 65% of GDP per capita has the best ability to discriminate countries that introduced vaccination, with a diagnostic odds ratio of about 7. For low-income countries the optimal threshold was lower, at 30% to 40% of GDP per capita. CONCLUSIONS: A cost-effectiveness threshold has some ability to discriminate between HPV vaccine introducer and non-introducer countries, although the average threshold is below the widely used threshold of 1 GDP per capita. These results help explain the current pattern of HPV vaccine use globally. They also inform the extent to which cost-effectiveness thresholds proposed in the literature reflect countries' actual investment decisions.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/economia , Países em Desenvolvimento/economia , Saúde Global , Humanos , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Modelos Econômicos , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
14.
Value Health ; 24(1): 70-77, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431156

RESUMO

OBJECTIVES: Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. METHOD: We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. RESULTS: The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. CONCLUSION: Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Saúde Global , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Países em Desenvolvimento/economia , Recursos em Saúde/organização & administração , Humanos , Modelos Econômicos , Vacinas/economia , Vacinas/provisão & distribução
15.
Value Health ; 24(1): 78-85, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431157

RESUMO

OBJECTIVES: Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As Gavi, other organizations, and country governments look to the future, we aimed to estimate the economic benefits of immunization programs made from 2011 to 2020 and potential gains in the future decade. METHODS: We used estimates of cases and deaths averted by vaccines against 10 pathogens in 94 LMICs to estimate the economic value of immunization. We applied 3 approaches-cost of illness averted (COI), value of statistical life (VSL), and value of statistical life-year (VSLY)-to estimate observable and unobservable economic benefits between 2011 and 2030. RESULTS: From 2011 to 2030, immunization would avert $1510.4 billion ($674.3-$2643.2 billion) (2018 USD) in costs of illness in the 94 modeled countries, compared with the counterfactual of no vaccination. Using the VSL approach, immunization would generate $3436.7 billion ($1615.8-$5657.2 billion) in benefits. Applying the VSLY approach, $5662.7 billion ($2547.2-$9719.4) in benefits would be generated. CONCLUSION: Vaccination has generated significant economic benefits in LMICs in the past decade. To reach predicted levels of economic benefits, countries and international donor organizations need to meet coverage projections outlined in the Gavi Operational Forecast. Estimates generated using the COI, VSL, or VSLY approach may be strategically used by donor agencies, decision makers, and advocates to inform investment cases and advocacy campaigns.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Países em Desenvolvimento/economia , Saúde Global , Humanos , Modelos Econômicos , Vacinas/economia , Vacinas/provisão & distribução
17.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431439

RESUMO

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/economia , Coledocolitíase/terapia , Tratamento Conservador/economia , Acesso aos Serviços de Saúde/economia , Icterícia Obstrutiva/terapia , Coledocolitíase/complicações , Coledocolitíase/diagnóstico , Coledocolitíase/economia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Tratamento Conservador/métodos , Países em Desenvolvimento/economia , Progressão da Doença , Feminino , Mão de Obra em Saúde/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Humanos , Icterícia Obstrutiva/economia , Icterícia Obstrutiva/etiologia , Pessoa de Meia-Idade , Paquistão , Cuidados Paliativos , Índice de Gravidade de Doença , Tempo para o Tratamento/economia , Ultrassonografia
19.
Epilepsy Behav ; 115: 107491, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33323340

RESUMO

OBJECTIVE: Epilepsy is a neurologic disease that carries a high disease burden and likely, a huge treatment gap especially in low-to-middle income countries (LMIC) such as the Philippines. This review aimed to examine the treatment gaps and challenges that burden Philippine epilepsy care. MATERIALS & METHODS: Pertinent data on epidemiology, research, health financing and health systems, pharmacologic and surgical treatment options, cost of care, and workforce were obtained through a literature search and review of relevant Philippine government websites. RESULTS: The estimated prevalence of epilepsy in the Philippines is 0.9%. Epilepsy research in the Philippines is low in quantity compared with the rest of Southeast Asia (SEA). Inequities in quality and quantity of healthcare services delivered to local government units (LGUs) have arisen because of devolution. Programs for epilepsy care by both government and nongovernment institutions have been implemented. Healthcare expenditure in the Philippines is still largely out-of-pocket, with only partial coverage from the public sector. There is limited access to antiseizure medications (ASMs), mainly due to cost. Epilepsy surgery is an underutilized treatment option. There are only 20 epileptologists in the Philippines, with one epileptologist for every 45,000 patients with epilepsy. In addition, epilepsy care service delivery has been further impeded by the coronavirus disease of 2019 (COVID-19) pandemic. CONCLUSION: There is a large treatment gap in epilepsy care in the Philippines in terms of high epilepsy disease burden, socioeconomic limitations and inadequate public support, sparse clinico-epidemiologic research on epilepsy, inaccessibility of health care services and essential pharmacotherapy, underutilization of surgical options, and lack of specialists capable of rendering epilepsy care. Acknowledgment of the existence of these treatment gaps and addressing such are expected to improve the overall survival and quality of life of patients with epilepsy in the Philippines.


Assuntos
/prevenção & controle , Efeitos Psicossociais da Doença , Epilepsia/terapia , Acesso aos Serviços de Saúde/tendências , Programas Nacionais de Saúde/tendências , Anticonvulsivantes/economia , Anticonvulsivantes/uso terapêutico , /epidemiologia , Países em Desenvolvimento/economia , Epilepsia/economia , Epilepsia/epidemiologia , Serviços de Saúde/economia , Serviços de Saúde/tendências , Acesso aos Serviços de Saúde/economia , Humanos , Programas Nacionais de Saúde/economia , Filipinas/epidemiologia , Qualidade de Vida
20.
BMJ ; 371: m4750, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323376

RESUMO

OBJECTIVE: To analyze the premarket purchase commitments for coronavirus disease 2019 (covid-19) vaccines from leading manufacturers to recipient countries. DESIGN: Cross sectional analysis. DATA SOURCES: World Health Organization's draft landscape of covid-19 candidate vaccines, along with company disclosures to the US Securities and Exchange Commission, company and foundation press releases, government press releases, and media reports. ELIGIBILITY CRITERIA AND DATA ANALYSIS: Premarket purchase commitments for covid-19 vaccines, publicly announced by 15 November 2020. MAIN OUTCOME MEASURES: Premarket purchase commitments for covid-19 vaccine candidates and price per course, vaccine platform, and stage of research and development, as well as procurement agent and recipient country. RESULTS: As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world's population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries-less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility-the vaccines pillar of the World Health Organization's Access to COVID-19 Tools (ACT) Accelerator-has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines. CONCLUSIONS: This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain. Governments and manufacturers might provide much needed assurances for equitable allocation of covid-19 vaccines through greater transparency and accountability over these arrangements.


Assuntos
/economia , Saúde Global/economia , Acesso aos Serviços de Saúde/economia , Financiamento da Assistência à Saúde , /imunologia , Estudos Transversais , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Acesso aos Serviços de Saúde/organização & administração , Humanos
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