1
|
Makhani LA, Moran V, Sadique Z, Singh NS, Revill P, Roberts B. Examining the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries: a systematic review. Health Policy Plan 2020; 35:210-218. [PMID: 31697373 DOI: 10.1093/heapol/czz144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
The costly nature of health sector responses to humanitarian crises and resource constraints means that there is a need to identify methods for priority setting and long-term planning. One method is economic evaluation. The aim of this systematic review is to examine the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries. This review used peer-reviewed literature published between January 1980 and June 2018 extracted from four main electronic bibliographic databases. The eligibility criteria were full economic evaluations (which compare the costs and outcomes of at least two interventions and provide information on efficiency) of health-related services in humanitarian crises in low- and middle-countries. The quality of eligible studies is appraised using the modified 36-question Drummond checklist. From a total of 8127 total studies, 11 full economic evaluations were identified. All economic evaluations were cost-effectiveness analyses. Three of the 11 studies used a provider perspective, 2 studies used a healthcare system perspective, 3 studies used a societal perspective and 3 studies did not specify the perspective used. The lower quality studies failed to provide 7information on the unit of costs and did not justify the time horizon of costs and discount rates, or conduct a sensitivity analysis. There was limited geographic range of the studies, with 9 of the 11 studies conducted in Africa. Recommendations include greater use of economic evaluation methods and data to enhance the microeconomic understanding of health interventions in humanitarian settings to support greater efficiency and transparency and to strengthen capacity by recruiting economists and providing training in economic methods to humanitarian agencies.
Collapse
Affiliation(s)
- Lizna A Makhani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Valerie Moran
- Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, 1445 Strassen, Luxembourg.,Luxembourg Institute of Socio-Economic Research, 11 Porte des Sciences, 4366 Esch-sur-Alzette, Luxembourg
| | - Zia Sadique
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Neha S Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Paul Revill
- Centre for Health Economics, University of York, Alcuin 'A' Block, University of York, Heslington, York YO10 5DD, UK
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| |
Collapse
|
2
|
Parvizi MM, Zare F, Handjani F, Nimrouzi M, Zarshenas MM. Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine. Dermatol Ther 2020; 33:e13566. [PMID: 32401415 DOI: 10.1111/dth.13566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 01/19/2023]
Abstract
This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhīra-yi Khārazmshāhī, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rīsh-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.
Collapse
Affiliation(s)
- Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Zare
- Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Nimrouzi
- Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad M Zarshenas
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.,Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Puett C. Assessing the cost-effectiveness of interventions within a humanitarian organisation. DISASTERS 2019; 43:575-590. [PMID: 31012136 PMCID: PMC6850649 DOI: 10.1111/disa.12344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cost-effectiveness analysis is increasingly relevant in humanitarian action. The cost of response has increased exponentially in the past decade, alongside concurrent donor budget restrictions. However, there remains limited comprehension and application of these methods in this field. This paper documents methods developed for use within Action Against Hunger, an international humanitarian organisation, in response to a lack of understanding of this topic within the humanitarian community and limited evidence of the cost-effectiveness of humanitarian action. These methods encompass costs to both implementing institutions and participating communities. Activity-based cost analyses are conducted to assess resources per programme activity. Cost-effectiveness is evaluated using successful programme outcomes, and uncertainty is appraised via sensitivity analysis. This paper aims to advance knowledge, stimulate discussion, and promote the adoption of cost-effectiveness methods for building the evidence base for humanitarian action, including consideration of community costs, to enable analytical outputs that are useful for managers and policymakers alike.
Collapse
Affiliation(s)
- Chloe Puett
- Senior Research AdvisorAction Against HungerUnited States
| |
Collapse
|
4
|
Abstract
INTRODUCTION Parasitic diseases that pose a threat to human life include leishmaniasis - caused by protozoan parasite Leishmania species. Existing drugs have limitations due to deleterious side effects like teratogenicity, high cost and drug resistance. This calls for the need to have an insight into therapeutic aspects of disease. Areas covered: We have identified different drug targets via. molecular, imuunological, metabolic as well as by system biology approaches. We bring these promising drug targets into light so that they can be explored to their maximum. In an effort to bridge the gaps between existing knowledge and prospects of drug discovery, we have compiled interesting studies on drug targets, thereby paving the way for establishment of better therapeutic aspects. Expert opinion: Advancements in technology shed light on many unexplored pathways. Further probing of well established pathways led to the discovery of new drug targets. This review is a comprehensive report on current and emerging drug targets, with emphasis on several metabolic targets, organellar biochemistry, salvage pathways, epigenetics, kinome and more. Identification of new targets can contribute significantly towards strengthening the pipeline for disease elimination.
Collapse
Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, UP, India
| | - Bhawana Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, UP, India
| |
Collapse
|
5
|
Marinho DS, Casas CNPR, Pereira CCDA, Leite IC. Health economic evaluations of visceral leishmaniasis treatments: a systematic review. PLoS Negl Trop Dis 2015; 9:e0003527. [PMID: 25723482 PMCID: PMC4344218 DOI: 10.1371/journal.pntd.0003527] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
Visceral leishmaniasis (VL) is a severe form of the leishmaniasis-disease complex. Its importance to public health relies on its high fatality rate in non-treated cases, the socio-economic impact related to its morbidity, and its endemicity on different continents. The estimated burden of disease of VL varies from 1,969,000 to 2,357,000 Disability Adjusted Life Years (DALYs). VL is classified as a Neglected Tropical Disease (NTD), and is strongly related to poverty and its consequences. Visceral leishmaniasis calls for the development of cost-effective technologies for diagnosis and treatment. Visceral leishmaniasis (VL), also known as kala azar, is a neglected tropical disease caused by parasitic protozoa of the genus Leishmania. VL is related to poverty and its consequences, which leads to its status of neglected disease. For that reason, cost-effective forms of diagnoses and treatment are very important and still needed. This research aimed at a better understanding of the publications about the technologies currently available, from the standpoint of their economic value. For that purpose, we conducted a systematic review of the literature in order to identify the papers that conducted economic evaluations of technologies used in VL. We initially retrieved 107 articles, which were inspected according to specific guidelines for systematic reviews. After that process, 14 articles matched the inclusion criteria in our review. We classified those studies according to the type of economic evaluation they made, and the methodology used in each one. We found evaluations about a variety of technologies, but the studies were geographically concentrated in Asia, more specifically in India. This concentration is not good because the disease also affects other continents and it is not possible to transfer the economic evaluation from one country or epidemiologic scenario to another.
Collapse
Affiliation(s)
- Daniel S. Marinho
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Carmen N. P. R. Casas
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Iuri C. Leite
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- * E-mail:
| |
Collapse
|
6
|
Abstract
Parasitic diseases present a considerable socio-economic impact to society. Zoonotic parasites can result in a considerable burden of disease in people and substantive economic losses to livestock populations. Ameliorating the effects of these diseases may consist of attempts at eradicating specific diseases at a global level, eliminating them at a national or local level or controlling them to minimise incidence. Alternatively with some parasitic zoonoses it may only be possible to treat human and animal cases as they arise. The choice of approach will be determined by the potential effectiveness of a disease control programme, its cost and the cost effectiveness or cost benefit of undertaking the intervention. Furthermore human disease burden is being increasingly measured by egalitarian non-financial measures which are difficult to apply to livestock. This adds additional challenges to the assessment of socio-economic burdens of zoonotic diseases. Using examples from the group of neglected zoonotic diseases, information regarding the socio-economic effects is reviewed together with how this information is used in decision making with regard to disease control and treatment.
Collapse
Affiliation(s)
- Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurestrasse 270, 8057 Zurich, Switzerland.
| |
Collapse
|
7
|
Boelaert M, Meheus F, Robays J, Lutumba P. Socio-economic aspects of neglected diseases: sleeping sickness and visceral leishmaniasis. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 104:535-42. [PMID: 21092391 DOI: 10.1179/136485910x12786389891641] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several tropical diseases that are essentially poverty-related have recently gained more attention under the label of 'neglected tropical diseases' or NTD. It is estimated that over 1000 million people currently suffer from one or more NTD. Here, the socio-economic aspects of two NTD - human African trypanosomiasis and human visceral leishmaniasis - are reviewed. Both of these diseases affect the poorest of the poor in endemic countries, cause considerable direct and indirect costs (even though the national control programmes tend to provide free care) and push affected households deeper into poverty.
Collapse
Affiliation(s)
- M Boelaert
- Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
| | | | | | | |
Collapse
|
8
|
Thornton SJ, Wasan KM, Piecuch A, Lynd LLD, Wasan EK. Barriers to treatment for visceral leishmaniasis in hyperendemic areas: India, Bangladesh, Nepal, Brazil and Sudan. Drug Dev Ind Pharm 2011; 36:1312-9. [PMID: 20545513 DOI: 10.3109/03639041003796648] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Visceral leishmaniasis (VL) is a severe and potentially fatal infection caused by the trypanosome parasite Leishmania sp. Over 90% of reported cases occur in India, Bangladesh, Nepal, Sudan, and Brazil, affecting mainly impoverished individuals and creating a significant economic burden through direct and indirect costs of treatment. OBJECTIVES To identify the direct and indirect costs of VL treatment, compare these costs to household income, and identify the barriers to treatment in each of the five VL-endemic countries. METHODS Articles obtained through PubMed (US National Library of Medicine), EMBASE, and Cochrane Library were selected for relevance to VL treatment, costs for all forms of amphotericin B, miltefosine, paromomycin, and antimony compounds, and healthcare costs in India, Bangladesh, Nepal, Brazil, and Sudan. Healthcare statistics were obtained from the World Health Organization Statistical Information System, Médecins Sans Frontieres, and each country's national health ministry. RESULTS Per capita GDP, per capita GNI, cost of drugs, and hospitalization expenses differ by up to 10-fold in each of the five countries where VL is hyperendemic, resulting in unequal barriers to treatment. We found that the cost of specific drugs influences the choice of therapy. CONCLUSIONS Poverty and VL treatment-related costs cause potential limitations in the provision of full and efficacious treatment, which may result in further dissemination of the disease. Effective nonparenteral antileishmania drugs would provide a significant advantage in reducing the barriers to VL treatment.
Collapse
Affiliation(s)
- Sheila J Thornton
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | | | | | | | | |
Collapse
|
9
|
|
10
|
Vanlerberghe V, Diap G, Guerin PJ, Meheus F, Gerstl S, Van der Stuyft P, Boelaert M. Drug policy for visceral leishmaniasis: a cost-effectiveness analysis. Trop Med Int Health 2007; 12:274-83. [PMID: 17300636 DOI: 10.1111/j.1365-3156.2006.01782.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first-line health services in (VL)-endemic areas, we compared in a formal decision analysis the cost and the cost-effectiveness of the different available options. METHODS We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected. RESULTS Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most cost-effective treatment was the miltefosine regimen, and the most expensive and the least cost-effective was AmBisome treatment. The cost of drug and medical care are the main determinants of the cost-effectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low-resistance regions. CONCLUSION In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost-effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost-effective option of treatment, but its use as a first-line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono- or combination therapy is too expensive to compete in cost-effectiveness with the other regimens.
Collapse
Affiliation(s)
- V Vanlerberghe
- Epidemiology and Disease Control Unit, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | | | | | | |
Collapse
|
11
|
Reithinger R, Coleman PG. Treating cutaneous leishmaniasis patients in Kabul, Afghanistan: cost-effectiveness of an operational program in a complex emergency setting. BMC Infect Dis 2007; 7:3. [PMID: 17263879 PMCID: PMC1790896 DOI: 10.1186/1471-2334-7-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 01/30/2007] [Indexed: 12/01/2022] Open
Abstract
Background Although Kabul city, Afghanistan, is currently the worldwide largest focus of cutaneous leishmaniasis (CL) with an estimated 67,500 cases, donor interest in CL has been comparatively poor because the disease is non-fatal. Since 1998 HealthNet TPO (HNTPO) has implemented leishmaniasis diagnosis and treatment services in Kabul and in 2003 alone 16,390 were treated patients in six health clinics in and around the city. The aim of our study was to calculate the cost-effectiveness for the implemented treatment regimen of CL patients attending HNTPO clinics in the Afghan complex emergency setting. Methods Using clinical and cost data from the on-going operational HNTPO program in Kabul, published and unpublished sources, and discussions with researchers, we developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability adjusted life year (DALY) averted for implemented CL treatment regimen. We calculated the cost-effectiveness of intralesional and intramuscular administration of the pentavalent antimonial drug sodium stibogluconate, HNTPO's current CL 'standard treatment'. Results The cost of the standard treatment was calculated to be US$ 27 (95% C.I. 20 – 36) per patient treated and cured. The cost per DALY averted per patient cured with the standard treatment was estimated to be approximately US$ 1,200 (761 – 1,827). Conclusion According to WHO-CHOICE criteria, treatment of CL in Kabul, Afghanistan, is not a cost-effective health intervention. The rationale for treating CL patients in Afghanistan and elsewhere is discussed.
Collapse
Affiliation(s)
- Richard Reithinger
- Clinical Trials Area, Westat, Rockville, USA
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Malaria and Leishmaniasis Control Program, HealthNet TPO, Kabul, Afghanistan
| | - Paul G Coleman
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Alvar J, Croft S, Olliaro P. Chemotherapy in the treatment and control of leishmaniasis. ADVANCES IN PARASITOLOGY 2006; 61:223-74. [PMID: 16735166 DOI: 10.1016/s0065-308x(05)61006-8] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Drugs remain the most important tool for the treatment and control of both visceral and cutaneous leishmaniasis. Although there have been several advances in the past decade, with the introduction of new therapies by liposomal amphotericin, oral miltefosine and paromomycin (PM), these are not ideal drugs, and improved shorter duration, less toxic and cheaper therapies are required. Treatments for complex forms of leishmaniasis and HIV co-infections are inadequate. In addition, full deployment of drugs in treatment and control requires defined strategies, which can also prevent or delay the development of drug resistance.
Collapse
Affiliation(s)
- Jorge Alvar
- Department for Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia CH-1211 Geneva 27, Switzerland
| | | | | |
Collapse
|
13
|
Alvar J, Yactayo S, Bern C. Leishmaniasis and poverty. Trends Parasitol 2006; 22:552-7. [PMID: 17023215 DOI: 10.1016/j.pt.2006.09.004] [Citation(s) in RCA: 489] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 08/30/2006] [Accepted: 09/21/2006] [Indexed: 12/01/2022]
Abstract
Leishmaniasis, a neglected tropical disease, has strong but complex links with poverty. The burden of leishmaniasis falls disproportionately on the poorest segments of the global population. Within endemic areas, increased infection risk is mediated through poor housing conditions and environmental sanitation, lack of personal protective measures and economically driven migration and employment that bring nonimmune hosts into contact with infected sand flies. Poverty is associated with poor nutrition and other infectious diseases, which increase the risk that a person (once infected) will progress to the clinically manifested disease. Lack of healthcare access causes delays in appropriate diagnosis and treatment and accentuates leishmaniasis morbidity and mortality, particularly in women. Leishmaniasis diagnosis and treatment are expensive and families must sell assets and take loans to pay for care, leading to further impoverishment and reinforcement of the vicious cycle of disease and poverty. Public investment in treatment and control would decrease the leishmaniasis disease burden and help to alleviate poverty.
Collapse
Affiliation(s)
- Jorge Alvar
- Communicable Diseases, Neglected Tropical Diseases Control, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland.
| | | | | |
Collapse
|
14
|
Ritmeijer K, Davidson RN. Royal Society of Tropical Medicine and Hygiene joint meeting with Médecins Sans Frontières at Manson House, London, 20 March 2003: field research in humanitarian medical programmes. Médecins Sans Frontières interventions against kala-azar in the Sudan, 1989-2003. Trans R Soc Trop Med Hyg 2006; 97:609-13. [PMID: 16134257 DOI: 10.1016/s0035-9203(03)80047-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Since 1989, Médecins Sans Frontières (MSF) has provided medical humanitarian assistance during outbreaks of visceral leishmaniasis (VL; kala-azar) in Sudan. First, in western Upper Nile in southern Sudan, where a VL epidemic occurred after the resumption of the civil war in Sudan in 1983, with an estimated 100,000 deaths. Later, MSF started interventions in eastern Upper Nile and Gedaref State. In these two endemic regions VL incidence has risen markedly since 2001, which could be the start of a new epidemic cycle. Outbreaks of VL in Sudan remain unpredictable, and access to affected populations in war-torn southern Sudan is often hampered by insecurity. Therefore, MSF takes a flexible approach, establishing treatment centres where patients can be accessed. From 1989 to 2002, MSF treated >51,000 VL cases in Sudan. Despite very basic field conditions, high cure rates of 95% are being achieved. Lack of diagnostics is a major obstacle to treatment, especially during epidemic situations. Therefore, development of simple and rapid technologies is required, allowing reliable diagnosis under field conditions. For treatment of VL there is a limited choice of effective, affordable drugs. There are strong indications of an emerging resistance to antimonials in Malakal. Introduction of combination therapies is urgently needed to prevent the further emergence and spread of resistance to antimonials, which are still the mainstay of VL treatment in eastern Africa. Experience with combination therapy with sodium stibogluconate (SSG) and paromomycin is promising, and combinations of SSg with liposomal amphotericin B and miltefosine are currently being explored.
Collapse
Affiliation(s)
- K Ritmeijer
- Médecins Sans Frontières-Holland, Max Euweplein 40, PO Box 10014, 1001 EA Amsterdam, The Netherlands.
| | | |
Collapse
|
15
|
Mubareka S, Al Khudhairy D, Bonn F, Aoun S. Standardising and mapping open-source information for crisis regions: the case of post-conflict Iraq. DISASTERS 2005; 29:237-54. [PMID: 16108990 DOI: 10.1111/j.0361-3666.2005.00289.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Painting an accurate picture of the situation on the ground in countries in crisis is vital for the efficiency of humanitarian aid and reconstruction agencies. This study describes a method for standardising and mapping the plethora of open-source information. The test site for the study is post-conflict Iraq. Important information on aid distribution, reconstruction and security in Iraq can be derived from the reports of humanitarian aid agencies and the media, before being formatted, inserted into a database and mapped. The product is a visual, cartographic structure of otherwise random information, showing which organisations are working in the country, which thematic and geographic areas are being prioritized in the field, and which areas most frequently experience security events. This type of mapping not only highlights the overall working environment within different parts of the country, but it may also serve as a decision-making tool for donors and humanitarian aid agencies planning to deploy personnel.
Collapse
Affiliation(s)
- Sarah Mubareka
- Center for Applications and Research in Remote Sensing, University of Sherbrooke, Quebec, Canada
| | | | | | | |
Collapse
|
16
|
Sondorp E, Bornemisza O. Primary health care and armed conflict. THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 2004; 124:251-2. [PMID: 15602987 DOI: 10.1177/146642400412400606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|
17
|
Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 2004; 27:305-18. [PMID: 15225981 DOI: 10.1016/j.cimid.2004.03.004] [Citation(s) in RCA: 1393] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2004] [Indexed: 10/26/2022]
Abstract
Leishmaniasis represents a complex of diseases with an important clinical and epidemiological diversity. Visceral leishmaniasis (VL) is of higher priority than cutaneous leishmaniasis (CL) as it is a fatal disease in the absence of treatment. Anthroponotic VL foci are of special concern as they are at the origin of frequent and deathly epidemics (e.g. Sudan). Leishmaniasis burden remains important: 88 countries, 350 million people at risk, 500,000 new cases of VL per year, 1-1.5 million for CL and DALYs: 2.4 millions. Most of the burden is concentrated on few countries which allows clear geographic priorities. Leishmaniasis is still an important public health problem due to not only environmental risk factors such as massive migrations, urbanisation, deforestation, new irrigation schemes, but also to individual risk factors: HIV, malnutrition, genetic, etc em leader Leishmaniasis is part of those diseases which still requires improved control tools. Consequently WHO/TDR research for leishmaniasis has been more and more focusing on the development of new tools such as diagnostic tests, drugs and vaccines. The ongoing effort has already produced significant results. The newly available control tools should allow a scaling up of control activities in priority areas. In anthroponotic foci, the feasibility of getting a strong impact on mortality, morbidity and transmission, is high.
Collapse
Affiliation(s)
- P Desjeux
- Department of Control, Prevention and Elimination (CDS/CPE), Cluster of Communicable Diseases, World Health Organization (WHO), Avenue Appia, 1211 Geneva 27, Switzerland.
| |
Collapse
|
18
|
Collin S, Davidson R, Ritmeijer K, Keus K, Melaku Y, Kipngetich S, Davies C. Conflict and kala-azar: determinants of adverse outcomes of kala-azar among patients in southern Sudan. Clin Infect Dis 2004; 38:612-9. [PMID: 14986243 DOI: 10.1086/381203] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 10/16/2003] [Indexed: 11/03/2022] Open
Abstract
We analyzed data obtained from 3365 patients with kala-azar (KA) or post-KA dermal leishmaniasis (PKDL) treated by Medecins Sans Frontieres-Holland in south Sudan from October 1998-May 2002. Patients were malnourished (median body mass index [BMI], 15.5; median weight for height [WFH], 75.5%) and anemic (median hemoglobin (Hb) level, 8.5 g/dL). The proportion of patients with primary KA who were children <5 years old increased from 2.5%, in 1998, to 19.8%, in 2002 (P<.0001). Therapy with sodium stibogluconate cured 91.9% of patients with primary KA, and dosages of >850 mg per day did not decrease the chances of survival. Risk factors for death among adults were age > or =45 years (odds ratio [OR], 4.6), malnutrition (BMI, <13; OR, 11.0), anemia (Hb level, <8 g/dL; OR, 4.0), and duration of illness (duration, > or =5 months; OR, 2.3). Risk factors for death among children and adolescents were age <2 years (OR, 5.4,), malnutrition (WFH, <60%; OR, 5.0), anemia (Hb level, <6 g/dL; OR, 3.7), and splenomegaly (OR, 2.9). A higher risk of death was associated with episodes of diarrhea (OR, 1.4), vomiting (OR, 2.7), and bleeding (OR, 2.9). Relapse and PKDL occurred in 3.9% and 10.0% of cases, respectively.
Collapse
Affiliation(s)
- Simon Collin
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
19
|
Boelaert M, Le Ray D, Van Der Stuyft P. How better drugs could change kala-azar control. Lessons from a cost-effectiveness analysis. Trop Med Int Health 2002; 7:955-9. [PMID: 12390602 DOI: 10.1046/j.1365-3156.2002.00959.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conditional on correct diagnosis and treatment, current drug regimens for visceral leishmaniasis (VL) will only prevent about 90% of deaths. Furthermore, the cost of pentavalent antimonials, the long duration of the regimen and its parenteral administration are major obstacles for patients. Poor patient compliance and the use of counterfeit drugs contribute to therapeutic failure, amplification of the reservoir and the appearance of drug resistance. We assessed the impact of potential improvements in chemotherapy on the cost-effectiveness of VL test-treatment strategies. Competing test-treatment strategies were compared in a formal decision analysis - from the viewpoint of the clinician facing a VL suspect -, with avoided VL-mortality and cost as outcomes of interest. Sensitivity analysis was done involving the following parameters: efficacy, toxicity and cost of treatment including patient care. When safer and more efficacious drugs are considered, they only result in a more cost-effective strategy if the total cost of treatment falls below US$ 390 per patient. A serological test-treatment strategy remains the optimal choice, also when better drugs become available.
Collapse
Affiliation(s)
- M Boelaert
- Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | |
Collapse
|
20
|
Sondorp E, Kaiser T, Zwi A. Beyond emergency care: challenges to health planning in complex emergencies. Trop Med Int Health 2001; 6:965-70. [PMID: 11737831 DOI: 10.1046/j.1365-3156.2001.00821.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- E Sondorp
- Conflict and Health Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | |
Collapse
|
21
|
VanRooyen MJ, Hansch S, Curtis D, Burnham G. Emerging issues and future needs in humanitarian assistance. Prehosp Disaster Med 2001; 16:216-22. [PMID: 12090201 DOI: 10.1017/s1049023x00043338] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
During the past two decades, there has been tremendous investment in the ability to intervene in disaster settings, and significant barriers remain to providing appropriate services to populations affected by natural and man-made calamities. Many of the barriers to providing effective assistance exist within the NGO community, and illustrate emerging needs for international agencies. These emerging needs include improving methods of recipient participation to promote the local health system, developing improved methods for quality assurance, enhancing options for personnel development, and addressing long-term needs of reconstruction and rehabilitation. Relief agencies face challenges on all levels to develop sound practices in providing humanitarian assistance that can lead to long-term benefits to populations affected by disaster.
Collapse
Affiliation(s)
- M J VanRooyen
- Johns Hopkins Center for International Emergency, Disaster and Refugee Studies, 1830 E. Monument Street, Suite 6-100, Baltimore, MD 21305, USA.
| | | | | | | |
Collapse
|
22
|
Hutubessy RC, Bendib LM, Evans DB. Critical issues in the economic evaluation of interventions against communicable diseases. Acta Trop 2001; 78:191-206. [PMID: 11311183 DOI: 10.1016/s0001-706x(00)00176-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Economic appraisal seeks to provide policy-makers with guidance about how scarce resources can be used to derive the greatest possible social benefit. Its use in the health sector has increased dramatically over the last decade although much of it has been focused on the problems of the more developed countries. The relatively sparse literature on communicable diseases has been dominated by interventions related to HIV/AIDS, hepatitis, malaria and tropical diseases. Reviews of this literature from the perspective of specific conditions such as Hepatitis B are already available, and recently the entire literature has been evaluated against the technical criteria for economic evaluations published in standard textbooks. Accordingly, this paper focuses on issues which would make economic appraisal more useful to policy-makers than it currently is. Given that few countries have the resources to undertake all the necessary analysis in their own settings, it is important that studies in one setting are undertaken in a way that allow generalisability to similar settings. Some of the most important challenges this poses for cost-effectiveness analysis (CEA) are identified. Firstly, incremental analysis is appropriate to local decision making when policy-makers are constrained to keep the current interventions and can consider only marginal improvements. However, it does not allow re-evaluation of existing interventions and is not transferable across settings. A version of Generalised CEA is proposed as an alternative. Secondly, data on costs and effectiveness are often not presented appropriately. The challenge for effectiveness is to adjust the evidence from efficacy studies to allow for different patient or population groups, and local variations in adherence, coverage, and infrastructure. For costs, it is important for studies to report the physical resources used in an intervention as well as unit prices. Thirdly, some long-term effects are still not well incorporated into CEA, especially those affecting child development and drug resistance. These questions are technically challenging and require more concerted efforts over the next few years. Finally, it is important for analysts to provide decision-makers with estimates of the resources that would be required to implement interventions claimed to be cost-effective. These improvements would better enable the evidence from economic analyses to enter the policy debate and be weighed against the other goals and objectives of the health system when allocating scarce resources.
Collapse
Affiliation(s)
- R C Hutubessy
- The Global Programme on Evidence for Health Policy, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | | | | |
Collapse
|
23
|
Boelaert M, Criel B, Leeuwenburg J, Van Damme W, Le Ray D, Van der Stuyft P. Visceral leishmaniasis control: a public health perspective. Trans R Soc Trop Med Hyg 2000; 94:465-71. [PMID: 11132368 DOI: 10.1016/s0035-9203(00)90055-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Visceral leishmaniasis (VL), also known as kala-azar, is a vector-borne disease caused by a protozoan of the Leishmania donovani complex. A phlebotomine sandfly transmits the parasite from person to person or via an animal reservoir. VL is a severe, debilitating disease, characterized by prolonged fever, splenomegaly, hypergammaglobulinaemia and pancytopenia. Patients become gradually ill over a period of a few months, and nearly always die if untreated. Case-fatality ratios are high even in treated patients. Worldwide an estimated 500,000 VL cases occur each year. This study reviews clinical, epidemiological and public health aspects of the disease and shows how critical adequate case detection is for the success of VL control. Examination of the issue of VL diagnosis with respect to the global challenges in VL control leads to the observation that a sound diagnostic-therapeutic algorithm for the health services in endemic areas is badly needed. Serological tests could be an alternative to parasitological diagnosis and the direct agglutination test (DAT) was found to fulfil many criteria for a 'field test', including cost effectiveness. Although research needs on vaccine and better drugs continue to be high on the agenda, a VL test-treatment strategy based on currently available highly sensitive serological tests, such as the DAT, should be introduced in the health services in endemic areas.
Collapse
Affiliation(s)
- M Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | | | | |
Collapse
|