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Mohsin KF, Ahsan MN, Haider MZ. Understanding variation in catastrophic health expenditure from socio-ecological aspect: a systematic review. BMC Public Health 2024; 24:1504. [PMID: 38840231 PMCID: PMC11151512 DOI: 10.1186/s12889-024-18579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payment is one of many countries' main financing options for health care. High OOP payments push them into financial catastrophe and the resultant impoverishment. The infrastructure, society, culture, economic condition, political structure, and every element of the physical and social environment influence the intensity of financial catastrophes in health expenditure. Hence, the incidence of Catastrophic Health Expenditure (CHE) must be studied more intensively, specifically from regional aspects. This systematic review aims to make a socio-ecological synthesis of the predictors of CHE. METHOD We retrieved data from Scopus and Web of Science. This review followed PRISMA guidelines. The interest outcomes of the included literature were the incidence and the determinants of CHE. This review analyzed the predictors in light of the socio-ecological model. RESULTS Out of 1436 screened documents, fifty-one met the inclusion criteria. The selected studies were quantitative. The studies analyzed the socioeconomic determinants from the demand side, primarily focused on general health care, while few were disease-specific and focused on utilized care. The included studies analyzed the interpersonal, relational, and institutional predictors more intensively. In contrast, the community and policy-level predictors are scarce. Moreover, neither of the studies analyzed the supply-side predictors. Each CHE incidence has different reasons and different outcomes. We must go with those case-specific studies. Without the supply-side response, it is difficult to find any effective solution to combat CHE. CONCLUSION Financial protection against CHE is one of the targets of sustainable development goal 3 and a tool to achieve universal health coverage. Each country has to formulate its policy and enact laws that consider its requirements to preserve health rights. That is why the community and policy-level predictors must be studied more intensively. Proper screening of the cause of CHE, especially from the perspective of the health care provider's perspective is required to identify the individual, organizational, community, and policy-level barriers in healthcare delivery.
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Affiliation(s)
| | - Md Nasif Ahsan
- Economics Discipline, Khulna University, Khulna, Bangladesh.
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Hasanah A, Kharisma B, Remi SS, Adam AM, Siregar AYM. Food diversity: its relation to children's health and consequent economic burden. BMC Public Health 2024; 24:1155. [PMID: 38658917 PMCID: PMC11044496 DOI: 10.1186/s12889-024-18530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This study investigates the impact of low food diversity on the health status of children using the Dietary Diversity Score (DDS) and Dietary Serving Score (DSS) in a sub-district with the highest percentage of poor households. The economic burden of low food diversity was observed by analysing the cost of illness in the children with low food diversity. METHODS Data from 329 children were collected. We determined the impact of DDS and DSS and other factors on the health status of children aged 2-14 years, using a probit model. The cost of illness (e.g., typhus, stomach ulcers, coughs, flu, and fever) due to low food diversity was calculated from medical registration fees, medical action costs, transportation costs, and other costs. RESULTS The results shows that a 1% point increase in DDS or DSS potentially decreases children's health complaints by 10% and 8%, respectively. Given the current 26% prevalence of health complaints among children with low DDS, the annual economic burden reaches US$75.72 per child per household. In addition, the current 41% prevalence of children with low DDS resulted in an annual cost to the government of US$153.45 per child. CONCLUSIONS The effect of inadequate dietary diversity on children's health is potentially high and contributes to the economic burden on households and the government.
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Affiliation(s)
- Alfiah Hasanah
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia.
| | - Bayu Kharisma
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Sutyastie S Remi
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Asep Muhammad Adam
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Adiatma Y M Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
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Ochieng FO. SEIRS model for malaria transmission dynamics incorporating seasonality and awareness campaign. Infect Dis Model 2024; 9:84-102. [PMID: 38125201 PMCID: PMC10733109 DOI: 10.1016/j.idm.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Malaria, a devastating disease caused by the Plasmodium parasite and transmitted through the bites of female Anopheles mosquitoes, remains a significant public health concern, claiming over 600,000 lives annually, predominantly among children. Novel tools, including the application of Wolbachia, are being developed to combat malaria-transmitting mosquitoes. This study presents a modified susceptible-exposed-infectious-recovered-susceptible (SEIRS) compartmental mathematical model to evaluate the impact of awareness-based control measures on malaria transmission dynamics, incorporating mosquito interactions and seasonality. Employing the next-generation matrix approach, we calculated a basic reproduction number (R0) of 2.4537, indicating that without robust control measures, the disease will persist in the human population. The model equations were solved numerically using fourth and fifth-order Runge-Kutta methods. The model was fitted to malaria incidence data from Kenya spanning 2000 to 2021 using least squares curve fitting. The fitting algorithm yielded a mean absolute error (MAE) of 2.6463 when comparing the actual data points to the simulated values of infectious human population (Ih). This finding indicates that the proposed mathematical model closely aligns with the recorded malaria incidence data. The optimal values of the model parameters were estimated from the fitting algorithm, and future malaria dynamics were projected for the next decade. The research findings suggest that social media-based awareness campaigns, coupled with specific optimization control measures and effective management methods, offer the most cost-effective approach to managing malaria.
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Affiliation(s)
- Francis Oketch Ochieng
- Department of Pure and Applied Mathematics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, 62000-00200, Kenya
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Njuguna C, Tola HH, Maina BN, Magambo KN, Phoebe N, Mgamb EA, Tibananuka E, Turyashemererwa FM, Rubangakene M, Richard K, Opong G, Richard S, Opesen C, Mateeba T, Muyingo E, George U, Namukose S, Woldemariam YT. Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study. BMC Public Health 2024; 24:390. [PMID: 38321413 PMCID: PMC10848454 DOI: 10.1186/s12889-024-17830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda.
| | - Habteyes Hailu Tola
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Benson Ngugi Maina
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kwikiriza Nicholas Magambo
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Nabunya Phoebe
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Elizabeth Adhiambo Mgamb
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Evelyne Tibananuka
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Florence M Turyashemererwa
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Moses Rubangakene
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kisubika Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - George Opong
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Ssekitoleko Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Chris Opesen
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Tim Mateeba
- Ministry of Health of Uganda, Kampala, Uganda
| | | | | | | | - Yonas Tegegn Woldemariam
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
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Kumar V, Shankar G, Akhter Y. Deciphering drug discovery and microbial pathogenesis research in tuberculosis during the two decades of postgenomic era using entity mining approach. Arch Microbiol 2023; 206:46. [PMID: 38153595 DOI: 10.1007/s00203-023-03776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
We examined literature on Mycobacterium tuberculosis (Mtb) subsequent to its genome release, spanning years 1999-2020. We employed scientometric mapping, entity mining, visualization techniques, and PubMed and PubTator databases. Most popular keywords, most active research groups, and growth in quantity of publications were determined. By gathering annotations from the PubTator, we determined direction of research in the areas of drug hypersensitivity, drug resistance (AMR), and drug-related side effects. Additionally, we examined the patterns in research on Mtb metabolism and various forms of tuberculosis, including skin, brain, pulmonary, extrapulmonary, and latent tuberculosis. We discovered that 2011 had the highest annual growth rate of publications, at 19.94%. The USA leads the world in publications with 18,038, followed by China with 14,441, and India with 12,158 publications. Studies on isoniazid and rifampicin resistance showed an enormous increase. Non-tuberculous mycobacteria also been the subject of more research in effort to better understand Mtb physiology and as model organisms. Researchers also looked at co-infections like leprosy, hepatitis, plasmodium, HIV, and other opportunistic infections. Host perspectives like immune response, hypoxia, and reactive oxygen species, as well as comorbidities like arthritis, cancer, diabetes, and kidney disease etc. were also looked at. Symptomatic aspects like fever, coughing, and weight loss were also investigated. Vitamin D has gained popularity as a supplement during illness recovery, however, the interest of researchers declined off late. We delineated dominant researchers, journals, institutions, and leading nations globally, which is crucial for aligning ongoing and evolving landscape of TB research efforts. Recognising the dominant patterns offers important information about the areas of focus for current research, allowing biomedical scientists, clinicians, and organizations to strategically coordinate their efforts with the changing priorities in the field of tuberculosis research.
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Affiliation(s)
- Vinit Kumar
- Department of Library and Information Science, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India.
| | - Gauri Shankar
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India
| | - Yusuf Akhter
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India.
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Semahegn A, Manyazewal T, Hanlon C, Getachew E, Fekadu B, Assefa E, Kassa M, Hopkins M, Woldehanna T, Davey G, Fekadu A. Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review. Health Res Policy Syst 2023; 21:131. [PMID: 38057873 PMCID: PMC10699029 DOI: 10.1186/s12961-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review. METHODS The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question. RESULTS A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. CONCLUSION Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | | | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
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Sarker AR, Paul S, Zohara F, Hossain Z, Zabeen I, Chowdhury SMZI, Ahmed M, Ali N, Oppong R. Economic burden of dengue in urban Bangladesh: A societal perspective. PLoS Negl Trop Dis 2023; 17:e0011820. [PMID: 38051738 PMCID: PMC10723663 DOI: 10.1371/journal.pntd.0011820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 12/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Dengue, a vector-borne disease, is a major public health problem in many tropical and subtropical countries including Bangladesh. The objective of this study is to estimate the societal cost of illness of dengue infections among the urban population in Dhaka, Bangladesh. METHODS A cost-of-illness study was conducted using a prevalence-based approach from a societal perspective. Costs attributable to dengue were estimated from a bottom-up strategy using the guideline proposed by the World Health Organization for estimating the economic burden of infectious diseases. RESULTS A total of 302 hospitalized confirmed dengue patients were enrolled in this study. The average cost to society for a person with a dengue episode was US$ 479.02. This amount was ranged between US$ 341.67 and US$ 567.12 for those patients who were treated at public and private hospitals, respectively. The households out-of-pocket cost contributed to a larger portion of the total costs of illness (66%) while the cost burden was significantly higher for the poorest households than the richest quintile. CONCLUSIONS Dengue disease imposes a substantial financial burden on households and society. Therefore, decision-makers should consider the treatment cost of dengue infections, particularly among the poor in the population while balancing the benefits of introducing potentially effective dengue preventive programs in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Health Economic Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Health Economic Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Subrata Paul
- Health Economics Unit, Health Services Division, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Fatema Zohara
- General Economics Division, Bangladesh Planning Commission, Dhaka, Bangladesh
| | - Zakir Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Irfat Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | | | - Maruf Ahmed
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Raymond Oppong
- Health Economic Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Ararsa T, Wolde D, Alemayehu H, Bizuwork K, Eguale T. Prevalence and Antimicrobial Susceptibility Profile of Salmonella and Shigella among Diarrheic Patients Attending Selected Health Facilities in Addis Ababa, Ethiopia. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:6104416. [PMID: 37867502 PMCID: PMC10590268 DOI: 10.1155/2023/6104416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
Diarrhea is one of the important public health problems in developing countries. Salmonella and Shigella species are the major bacterial causal agents of diarrhea. The increasing burden of antimicrobial resistance is posing difficulty in the treatment of these pathogens. This study aimed to assess the occurrence of Salmonella and Shigella in the feces of diarrheic patients receiving health services in Addis Ababa, Ethiopia, and to determine their antimicrobial susceptibility profile. A cross-sectional study involving 13 health centers was conducted where 428 diarrheic patients were recruited. Standard microbiology techniques were used to isolate Salmonella and Shigella from stool samples. In addition, Salmonella isolates were confirmed by polymerase chain reaction (PCR). The Kirby-Bauer disc diffusion method was employed to assess susceptibility to 11 antimicrobials for each of the Salmonella and Shigella isolates. The prevalence of Salmonella and Shigella spp. among diarrheic patients was 8.4%; n = 36 and 5.6%; n = 24, respectively. Thirty (83.3%) of Salmonella isolates were susceptible to all antimicrobials tested, whereas 4 (10.8%) of isolates were resistant to 2 or more antimicrobials and 2 (5.6%) were multidrug resistant. Resistance to ampicillin was recorded in only one (2.7%) of Salmonella isolates; however, resistance to ampicillin was recorded in 12 (50%) of the Shigella isolates. Half of the Shigella isolates (n = 12) were resistant to 2 or more antimicrobials while 5 (20.8%) of them were resistant to 3 or more antimicrobials. The overall rate of resistance to antimicrobials was more common in Shigella compared to Salmonella isolates. In conclusion, Salmonella and Shigella were isolated from the feces of diarrheic patients, with a higher rate of antimicrobial resistance in Shigella isolates, which could make the treatment of shigellosis challenging. Therefore, increasing hygienic practices during food preparation to reduce the burden of Salmonella and Shigella infection and prudent use of antimicrobials are recommended to limit the spread of antimicrobial resistant strains.
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Affiliation(s)
- Tiruneh Ararsa
- Tikur Anbesssa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Deneke Wolde
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Haile Alemayehu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ketema Bizuwork
- Tikur Anbesssa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- The Ohio State University, Global One Health LLC, Addis Ababa, Ethiopia
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Micán Rincón CA, Rubiano-Ovalle O, Delgado Hurtado C, Andrade-Eraso CA. Project portfolio risk management. Bibliometry and collaboration Scientometric domain analysis. Heliyon 2023; 9:e19136. [PMID: 37809855 PMCID: PMC10558319 DOI: 10.1016/j.heliyon.2023.e19136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose ''Project Portfolio Risk Management" is approached through a bibliometry and collaboration networks study determining its dynamics and development as a formal domain that links Project, Risk Management and Portfolio concepts. Design/methodology/approach To facilitate replicability, a scientometric study under a PRISMA structure is carried out: i) Identification or domain structuring, as well as keywording accuracy; ii) Screening: Search string refinement and outputs review; iii) Eligibility: Several criteria applied to a content analysis, and iv) Inclusion: Consolidation of domain analytics through bibliometry and collaboration networks. Originality and findings Assessing the field as a formal knowledge domain is novel, contributing to a synthesis of its trends and evolution: For first time, descriptive statistics show increasing attention based on the growing citation scores, participation, H index and productivity of its main journals. Project Portfolio Selection is established as hot topic, the main authors are identified, as well as key concepts such as optimization, mathematical programming, multi-objective optimization, stochastic programming, and robust optimization. Three main research themes are obtained: Incorporation of Risk Assessment into Project Portfolio Selection problem, Risk Management as a Project Portfolio Management process, and Risk Analysis considering social and environmental issues. An accurate match is found in the contrast of the domain's behavior with some bibliometric and linguistic laws. Practical implications Theoretical richness is achieved in the conjunction of the three terms, presenting dynamics and tendencies and thus contributing to focus related research processes on a unified field for the use of both scholars' and practitioners' perspectives.
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Sin MP, Hasan MZ, Forsberg BC. Change in economic burden of diarrhoea in children under-five in Bangladesh: 2007 vs. 2018. J Glob Health 2023; 13:04089. [PMID: 37622687 PMCID: PMC10451101 DOI: 10.7189/jogh.13.04089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background In Bangladesh, diarrhoea in children under-five is a major public health problem with cost implications. Although under-five diarrhoea mortality and morbidity have declined from 2007 to 2018, change in the economic burden is unknown. This study determined the change in the societal economic burden of under-five diarrhoea in Bangladesh comparing 2007 to 2018. Methods A prevalence-based, retrospective cost analysis was conducted from a societal perspective, including costs to households, providers, and economic loss from premature deaths. Data were obtained from the previous cost of illness studies, government reports, and international databases. Direct costs for treatment were estimated by the bottom-up costing approach. Indirect costs on the loss of productivity of caretakers and loss from premature deaths were calculated by the human capital method. Total costs were presented in both local currency (Bangladeshi Taka (BDT)) and US dollars (US$)) in 2018 price. Sensitivity analyses were conducted to assess the robustness of the input parameters. Results A 36.4% reduction was found on the economic burden of under-five diarrhoea when comparing 2007 and 2018; US$1 209 million (95% CI = 1066 million-1299 million) for 2007 and US$769 million (95% CI = 484 million-873 million) for 2018. Economic loss from premature deaths imposed the highest costs (2007 = 66%, 2018 = 66% of all) followed by indirect costs on the loss of productivity of caretakers (2007 = 21%, 2018 = 26%) and direct medical costs (2007 = 13%, 2018 = 8%). Conclusions Societal costs from diarrhoeal diseases were reduced from 2007 to 2018 in Bangladesh. However, the economic burden was equivalent to 0.29% of country's gross domestic product in 2018 and remains a challenge. The major contributor to the costs was premature mortality from diarrhoeal diseases. Premature deaths are still prevalent though they to a large extent are avoidable. To further limit the economic burden, under-five diarrhoea mortality and morbidity reduction should be accelerated.
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Affiliation(s)
- May Phyu Sin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Md Zahid Hasan
- Health Systems and Population Studies Division, ICDDR,B, Mohakhali, Dhaka, Bangladesh
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Emami M, Haghdoost AA, Yazdi-Feyzabadi V, Mehrolhassani MH. Identification of Key Components in Health System Using System Thinking Approach: A Scoping Review. Med J Islam Repub Iran 2023; 37:47. [PMID: 37426481 PMCID: PMC10329510 DOI: 10.47176/mjiri.37.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 07/11/2023] Open
Abstract
Background The dynamic and systemic planning and targeting in the health system require attention to all the system's components and investigation of their causal relationship in order to form a clear view and image of it. Therefore, the present study was designed with the aim of identifying the comprehensive dimensions of the system within a specific framework. Methods Key components in the health system were identified through the scoping review method. For this purpose, 61 studies with selected keywords were extracted from international databases, including Scopus, Web of Science, PubMed and Embase, and Persian language databases including Magiran and SID. Inclusion and exclusion criteria in this study were languages, time range, repeated studies, studies related to the health system, appropriateness of studies with the subject and purpose of the present study and the method used. The content of the selected studies and extracted themes were analyzed and categorized in the Balanced Scorecard (BSC) framework. Results In health system analysis, key components were divided into 18 main categories and 45 categories. Also, they were categorized according to the BSC framework into five dimensions of population health, service delivery, growth and development, financing, and governance & leadership. Conclusion For health system improvement, policymakers and planners should consider these factors in a dynamic system and a causal network.
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Affiliation(s)
- Mozhgan Emami
- Health Services Management Research Center, Institute for Futures Studies in
Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Social Determinants of Health Research Center, Institute for Futures Studies in
Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy, and Economics, Faculty of Management
and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Department of Health Management, Policy, and Economics, Faculty of Management
and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
- Medical Informatics Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
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Sarker AR. Economic assessment of childhood rotavirus vaccination in Bangladesh. J Infect Public Health 2023; 16:816-822. [PMID: 37003027 DOI: 10.1016/j.jiph.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/06/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Rotavirus is one of the most highly prevalent communicable diseases in Bangladesh. The objective of this study is to evaluate the benefit-cost ratio of childhood rotavirus vaccination program in Bangladesh. A spreadsheet-based model was used to estimate the benefit and cost of a nationwide universal rotavirus vaccination program against rotavirus infections among under-five children in Bangladesh. A benefit-cost analysis was performed to evaluate a universal vaccination program compared with a status quo. Data from various published vaccination-related studies and public reports were used. The introduction of a childhood rotavirus vaccination program in Bangladesh for 14.78 million under-five children is projected to prevent approximately 1.54 million rotavirus cases during the first 2 years including 0.7 million severe rotavirus infections. This study shows that among the WHO-prequalified rotavirus vaccines, the net societal benefit is the highest if the vaccination program adopts ROTAVAC® rather than Rotarix® or ROTASIIL®. For every dollar invested in the outreach-based ROTAVAC® vaccination program, society would gain $2.03 in return, while in a facility-based vaccination program, society would gain up to about $2.2. The findings of this study demonstrate that a universal childhood rotavirus vaccination program is a cost-beneficial investment of public money. Thus, the government should consider the introduction of rotavirus vaccination in their Expanded Program on Immunization since the rotavirus immunization policy in Bangladesh will be economically justifiable.
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Affiliation(s)
- Abdur Razzaque Sarker
- Health Economics and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Agargaon, Dhaka 1207, Bangladesh.
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Hussein AI, Kurtay S, Omar AA, Yusuf AA, Mohamud RYH. An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report from Somalia. Int J Womens Health 2023; 15:225-233. [PMID: 36816454 PMCID: PMC9930581 DOI: 10.2147/ijwh.s383122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
Background There has been an increase in worldwide cesarean section rates, although they remain low in most Sub-Saharan African countries, including Somalia. The present is the first hospital-based study that analyzes the rate, indications, and associated maternal mortality of cesarean deliveries reported from Somalia. Methods This retrospective study reviewed data of all deliveries from 2015 to 2021 using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications and the type of cesarean section, and the documented maternal mortality during the study period. Results During seven years, there were 12,540 total deliveries. Among these, 2703 were cesarean sections giving an overall cesarean section rate of 21.6%. The mean age of the patients was 26.7±7.3 years [14-44 years]. Multiparous mothers constituted 67.7% during the study period. According to cesarean deliveries, nulliparous mothers (55.7%) underwent the maximum number of cesarean sections. Emergency cesarean section was the predominant intervention compared to elective C-sections (59.2% vs 40.8%). Primary CS was the most common predominant, while repeat CS increased timely, 77.7% vs 22.3%, respectively. Overall, previous C-sections and fetal distress were the two most common indications for cesarean delivery (22.3% and 22.1%), respectively. C-sections were predominant in women of younger age, Primiparity, having term deliveries, and did not receive regular antenatal care. The maternal mortality rate was 1.7%, and 61% was due to direct obstetric hemorrhage, including postpartum hemorrhage, Placenta abruption, and uterine rupture. Conclusion The study findings showed a slight increase in cesarean delivery rates during the study period. This rate is higher than the 10-15% recommended by the WHO in developing countries. Policies and efforts to decrease unnecessary cesarean sections should be promoted and implemented at each health facility.
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Affiliation(s)
- Ahmed Issak Hussein
- Obstetrics and Gynecology department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia,Correspondence: Ahmed Issak Hussein, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252615597479, Email
| | - Sabri Kurtay
- Obstetrics and Gynecology department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Abdikarim Ali Omar
- Obstetrics and Gynecology department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Rahma Yusuf Haji Mohamud
- Obstetrics and Gynecology department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Alcohol consumption and its associated factors among adolescents in a rural community in central Thailand: a mixed-methods study. Sci Rep 2022; 12:19605. [PMID: 36380057 PMCID: PMC9666648 DOI: 10.1038/s41598-022-24243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Early onset of alcohol use was associated with alcohol dependence and other health problems. We aimed to identify the prevalence and factors associated with alcohol consumption among adolescents in a rural community in Thailand. A mixed-methods study was carried out in 2021 using an explanatory sequential design. The study enrolled a total of 413 adolescents. On average, young adolescents initiated alcohol consumption at age 13. The lifetime drinking prevalence among adolescents was 60.5%, while the 1-year drinking prevalence was 53.0%. The prevalence of hazardous drinking among current drinkers was 42.0%. Alcohol consumption was associated with females (adjusted prevalence ratio (APR): 1.19; 95% CI 1.01-1.41), age ≥ 16 years (APR: 1.28; 95% CI 1.09-1.50), having close friends consuming alcohol (APR: 1.75; 95% CI 1.43-2.14), night out (APR: 1.93; 95% CI 1.53-2.45), being a current smoker (APR: 1.39; 95% CI 1.15-1.69), and having relationship (with boyfriend/girlfriend) problems (APR: 1.18; 95% CI 1.01-1.38). Qualitative data demonstrated that individual and environmental factors, including friends, family, social media use, and alcohol accessibility, affect alcohol use in this population. Therefore, effective strategies should be implemented across multiple levels of the socio-ecological model simultaneously to alleviate alcohol consumption and attenuate its complications.
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Fusaro C, Chávez-Romero YA, Prada SLG, Serrano-Silva N, Bernal JE, González-Jiménez FE, Sarria-Guzmán Y. Burden and Epidemiology of Human Intestinal Giardia duodenalis Infection in Colombia: A Systematic Review. Trop Med Infect Dis 2022; 7:tropicalmed7100325. [PMID: 36288066 PMCID: PMC9608748 DOI: 10.3390/tropicalmed7100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
The genus Giardia is a unicellular protozoan able to parasitize both humans and animals. Cysts of Giardia can be found in soil samples, aquatic environments, food, and any surface that gets in contact with the feces of parasitized animals. The aim of this systematic review was to analyze the burden and epidemiology of Giardia infection in Colombia summarizing recent scientific reports and existing knowledge and to identify knowledge gaps that may be addressed in future investigations. This work follows the guidelines established by "Preferred Reporting Items for Systematic Reviews and Meta-Analyzes" (PRISMA). Published scientific literature from 1 January 2010 to 18 September 2022 was searched in six electronic scientific databases using the search terms: "Giardia" OR "Giardiasis" AND "Colombia". Twenty-three scientific articles were performed in 22 departments of Colombia at rural, urban, and a combination of rural and urban contexts. The prevalence of Giardia in the Colombian population was between 0.9 and 48.1% when the samples were analyzed with classical microscopy; the range of Giardia prevalence was even bigger (4.2-100%) when qPCR and nested PCR were used. The dominant Giardia assemblages found in Colombia were A and B, and most frequent subassemblages were AII, BIII, and BIV.
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Affiliation(s)
- Carmine Fusaro
- Facultad de Ingenierías, Universidad de San Buenaventura, Cartagena de Indias 130010, Colombia
| | - Yosef A. Chávez-Romero
- Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Santa Cruz 90640, Mexico
| | | | - Nancy Serrano-Silva
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Correspondence: (N.S.-S.); (Y.S.-G.); Tel.: +52-5556224827 (N.S.-S.); +57-5-5894093 (Y.S.-G.)
| | - Jaime E. Bernal
- Facultad de Medicina, Universidad del Sinú, Cartagena de Indias 130011, Colombia
| | | | - Yohanna Sarria-Guzmán
- Facultad de Ingeniería y Ciencias Básicas, Fundación Universitaria del Área Andina, Valledupar 200005, Colombia
- Correspondence: (N.S.-S.); (Y.S.-G.); Tel.: +52-5556224827 (N.S.-S.); +57-5-5894093 (Y.S.-G.)
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16
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Coulibaly LP, Poder TG, Tousignant M. Attributes Underlying Patient Choice for Telerehabilitation Treatment: A Mixed-Methods Systematic Review to Support a Discrete Choice Experiment Study Design. Int J Health Policy Manag 2022; 11:1991-2002. [PMID: 34861762 PMCID: PMC9808290 DOI: 10.34172/ijhpm.2021.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Across most healthcare systems, patients are the primary focus. Patient involvements enhance their adherence to treatment, which in return, influences their health. The objective of this study was to determine the characteristics (ie, attributes) and associated levels (ie, values of the characteristics) that are the most important for patients regarding telerehabilitation (TR) healthcare to support a future discrete choice experiment (DCE) study design. METHODS A mixed-methods systematic review was conducted from January 2005 to the end of July 2020 and the search strategy was applied to five different databases. The initial selection of articles that met the eligibility criteria was independently made by one researcher, two researchers verified the accuracy of the extracted data, and all researchers discussed about relevant variables to include. Reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study. A qualitative synthesis was used to summarize findings. RESULTS From a total of 928 articles, 11 (qualitative [n = 5], quantitative [n = 3] and mixed-methods [n = 3] design) were included, and 25 attributes were identified and grouped into 13 categories: Accessibility, Distance, Interaction, Technology experience, Treatment mode, Treatment location, Physician contact mode, Physician contact frequency, Cost, Confidence, Ease of use, Feeling safer, and Training session. The attributes levels varied from two to five. The DCE studies identified showed the main stages to undertake these types of studies. CONCLUSION This study could guide the development of interview grid for individual interviews and focus groups to support a DCE study design in the TR field. By understanding the characteristics that enhance patients' preferences, healthcare providers can create or improve TR programs that provide high-quality and accessible care. Future research via a DCE is needed to determine the relative importance of the attributes.
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Affiliation(s)
- Lucien P. Coulibaly
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada
| | - Thomas G. Poder
- Département de Gestion, Évaluation et Politique de Santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Michel Tousignant
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada
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Aluri KZ, Halder AK, Islam M, Benjamin‐Chung J, Alam M, Shoab AK, Rahman M, Unicomb L, Luby SP. The effect of a large-scale water, sanitation and hygiene intervention in Bangladesh on knowledge, behaviour and health: Findings from an endline programme evaluation. Trop Med Int Health 2022; 27:913-924. [PMID: 36096154 PMCID: PMC9826406 DOI: 10.1111/tmi.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) was a 5-year intervention aiming to improve water, sanitation and hygiene (WASH) practices among 20 million rural residents through community hygiene promoters. This analysis evaluates the impact of SHEWA-B on knowledge, behaviour and childhood diarrhoea outcomes. METHODS The evaluation included repeated cross-sectional surveys and health surveillance in matched cohorts in intervention and control clusters. Cross-sectional surveys and structured observations at baseline, midline, and endline assessed the availability of WASH technology, caregiver knowledge and behaviour. Fieldworkers collected monthly health data in a subset of control and intervention households to determine the prevalence of diarrhoea. RESULTS Of 5091 households surveyed, participants residing in intervention clusters showed minimal improvements in knowledge, reported behaviour, or use of WASH technology compared to the control clusters. During structured observations, intervention households increased more than control households at handwashing before preparing food and after cleaning a baby's anus when comparing endline to baseline, but these changes were not seen when comparing endline to the midline. The prevalence of childhood diarrhoea remained similar in both groups before (10.2% in intervention, 10.0% in control) and after (8.8% in intervention, 11.7% in control) midline changes were made to improve the intervention. Intervention clusters showed no improvement in diarrhoea over time compared to control clusters. CONCLUSIONS SHEWA-B's community-based WASH promotion did not yield the intended impact on knowledge, behaviour or health. Greater priority should be given to approaches that have demonstrated effectiveness. Including rigorous evaluations would broaden the evidence base to support and improve large-scale programmes.
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Affiliation(s)
- Kelly Zhang Aluri
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Amal K. Halder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Mahfuza Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Jade Benjamin‐Chung
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Monirul Alam
- United Nations Children's Fund BangladeshDhakaBangladesh
| | - Abul Kasham Shoab
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Stephen P. Luby
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA,Department of Medicine, Infectious DiseaseStanford University School of MedicineStanfordCaliforniaUSA
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Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa: a meta-analysis. Sci Rep 2022; 12:5554. [PMID: 35365718 PMCID: PMC8975863 DOI: 10.1038/s41598-022-09567-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
Caesarean delivery (C-section) has been increasing worldwide; however, many women from developing countries in Sub-Saharan Africa are deprived of these lifesaving services. This study aimed to explore the impact of certain socioeconomic factors, including respondent's education, husband's education, place of residence, and wealth index, on C-section delivery for women in Sub-Saharan Africa. We used pooled data from 36 demographic and health surveys (DHS) in Sub-Saharan Africa. Married women aged 15-49 years who have at least one child in the last five years were considered in this survey. After inclusion and excluding criteria, 234,660 participants were eligible for final analysis. Binary logistic regression was executed to determine the effects of selected socioeconomic factors. The countries were assembled into four sub-regions (Southern Africa, West Africa, East Africa, and Central Africa), and a meta-analysis was conducted. We performed random-effects model estimation for meta-analysis to assess the overall effects and consistency between covariates and utilization of C-section delivery as substantial heterogeneity was identified (I2 > 50%). Furthermore, the meta-regression was carried out to explain the additional amount of heterogeneity by country levels. We performed a sensitivity analysis to examine the effects of outliers in this study. Findings suggest that less than 15% of women in many Sub-Saharan African countries had C-section delivery. Maternal education (OR 4.12; CI 3.75, 4.51), wealth index (OR 2.05; CI 1.94, 2.17), paternal education (OR 1.71; CI 1.57, 1.86), and place of residence (OR 1.51; CI 1.44, 1.58) were significantly associated with the utilization of C-section delivery. These results were also consistent in sub-regional meta-analyses. The meta-regression suggests that the total percentage of births attended by skilled health staff (TPBASHS) has a significant inverse association with C-section utilization regarding educational attainment (respondent & husband), place of residence, and wealth index. The data structure was restricted to define the distinction between elective and emergency c-sections. It is essential to provide an appropriate lifesaving mechanism, such as C-section delivery opportunities, through proper facilities for rural, uneducated, impoverished Sub-Saharan African women to minimize both maternal and infant mortality.
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Sarker AR, Ali SMZ, Ahmed M, Chowdhury SMZI, Ali N. Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS One 2022; 17:e0262900. [PMID: 35073368 PMCID: PMC8786169 DOI: 10.1371/journal.pone.0262900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. Results We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. Conclusions Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.
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Affiliation(s)
| | - S. M. Zulfiqar Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | - Maruf Ahmed
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | | | - Nausad Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
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Lugira YS, Kimaro FD, Mkhoi ML, Mafwenga SG, Joho AA, Yahaya JJ. Prevalence, aetiology, antimicrobial susceptibility testing, and predictors of urinary tract infection among neonates with clinical sepsis: a cross-sectional study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-021-00088-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urinary tract infection (UTI) is the most common and life-threatening bacterial infection among neonates. This study aimed to determine the prevalence, aetiology, and susceptible antimicrobial agents among neonates with UTI.
Methods
This was a cross-sectional analytical hospital-based study that included 152 neonates with clinical sepsis who were admitted at Dodoma regional referral hospital from January to June 2020. Bacterial growth of 1 × 103 colony forming units/mL of a single uropathogen was used to define the presence of UTI. Statistical analysis was performed using SPSS version 23.0 and multivariate analysis was used to determine the predicting factors of UTI. P <0.05 was regarded statistically significant.
Results
The prevalence of UTI was 18.4% (28/152). Klebsiella pneumoniae 64.3% (18/28) and Enterobacter spp. 35.7% (10/28) were the bacterial agents isolated. The bacterial isolates were 90%, and 60% sensitive to ciprofloxacin and amikacin, respectively. Low Apgar score (AOR = 12.76, 95% CI = 4.17–39.06, p<0.001), prolonged labour (AOR = 5.36, 95% CI = 1.28–22.52, p = 0.022), positive urine nitrite test (AOR = 26.67, 95% CI = 7.75–91.70, p<0.001), and positive leucocyte esterase test (AOR = 6.64, 95% CI = 1.47–29.97, p = 0.014) were potential predictors of UTI.
Conclusion
The prevalence of UTI confirmed by urine culture among neonates that were included in the present study indicates that this problem is common in the population where the study was conducted. Klebsiella pneumoniae and Enterobacter spp. were the uropathogens which were isolated. Ciprofloxacin, nitrofurantoin, and amikacin were sensitive to the isolated uropathogens.
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Adeoye RI, Okaiyeto K, Oguntibeju OO. Global mapping of research outputs on nanoparticles with peroxidase mimetic activity from 2010–2019. INORG NANO-MET CHEM 2021. [DOI: 10.1080/24701556.2021.2020841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Raphael Idowu Adeoye
- Enzymology and Drug Design Unit, Department of Biochemistry, Faculty of Life Sciences, University of Ilorin, Ilorin, Nigeria
| | - Kunle Okaiyeto
- Phytomedicine and Phytochemistry Group, Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Oluwafemi Omoniyi Oguntibeju
- Phytomedicine and Phytochemistry Group, Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
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22
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Ahmed S, Dorin F, Satter SM, Sarker AR, Sultana M, Gastanaduy PA, Parashar U, Tate JE, Heffelfinger JD, Gurley ES, Khan JAM. The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh. Vaccine 2021; 39:7082-7090. [PMID: 34756769 DOI: 10.1016/j.vaccine.2021.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. METHODS We estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. RESULTS The total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116-136) and total household costs were 161 USD (95% CI: 145-177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. CONCLUSIONS A substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.
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Affiliation(s)
- Sayem Ahmed
- icddr,b, Dhaka, Bangladesh; Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.
| | | | | | - Abdur Razzaque Sarker
- icddr,b, Dhaka, Bangladesh; University of Strathclyde, Glasgow, Scotland, UK; Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Marufa Sultana
- icddr,b, Dhaka, Bangladesh; Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | | | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - James D Heffelfinger
- icddr,b, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- icddr,b, Dhaka, Bangladesh; John Hopkins University, Baltimore, MD, USA
| | - Jahangir A M Khan
- icddr,b, Dhaka, Bangladesh; Karolinska Institutet, Stockholm, Sweden; School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Sunderaraman P, Irani F, Krishnan K, Hundal JS. A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning. Clin Neuropsychol 2021:1-19. [PMID: 34818985 DOI: 10.1080/13854046.2021.1987524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H.Sergeivsky Center, and the Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,The Framingham Heart Study - Brain Aging Program, 73 Mount Wayte Avenue, Framingham, MA, USA
| | | | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jasdeep S Hundal
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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24
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Zaman K, Aziz AB, Yunus M, Qadri F, Ross AG, Clemens JD. Rotavirus vaccine trials in icddr,b and future use of the vaccine in Bangladesh. J Infect Dis 2021; 224:S801-S804. [PMID: 34528671 PMCID: PMC8687083 DOI: 10.1093/infdis/jiab442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Safe and effective rotavirus vaccines (RVs) are needed to reduce the enormous public health burden of rotavirus illness in developing countries. Vaccination is critical for effective control of rotavirus infection since it cannot be prevented with improvements in water and sanitation. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has completed several groundbreaking RV trials (Phase I–Phase IV). The safety, immunogenicity, efficacy, and effectiveness of different RVs were evaluated among both urban and rural populations. In this study, we present the results, policy implications, and lessons learned for successful implementation of these trials as well as future directions for rotavirus vaccination in Bangladesh.
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Affiliation(s)
- K Zaman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Asma B Aziz
- International Vaccine Institute (IVI), 08826 Seoul, Republic of Korea
| | - Md Yunus
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Allen G Ross
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - John D Clemens
- International Vaccine Institute (IVI), 08826 Seoul, Republic of Korea.,UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
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25
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Heenan RC, Parks T, Bärnighausen T, Kado J, Bloom DE, Steer AC. The cost-of-illness due to rheumatic heart disease: national estimates for Fiji. Trans R Soc Trop Med Hyg 2021; 114:483-491. [PMID: 32232393 DOI: 10.1093/trstmh/trz118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a chronic valvular heart disease that is responsible for a heavy burden of premature mortality in low- and middle-income countries. The total costs of RHD are important to health policy and research investment decisions. We estimate for the first time the total cost of RHD for Fiji (2008-2012) using a cost-of-illness approach and novel primary data on RHD disease burden and costs. METHODS RHD cases were identified using probabilistic record linkage across four routine data sources: (1) the Fiji RHD Control Program, (2) national hospital admissions records, (3) the Ministry of Health database of cause-specific deaths and (4) hospital ECG clinic registers. For each individual with RHD, we obtained information on RHD hospital admissions, treatment and death. We conducted a prevalence-based cost-of-illness analysis, including bottom-up assessment of indirect and direct (healthcare) costs. RESULTS The estimated cost of RHD in Fiji for 2008-2012 was year-2010 $FJ91.6 million (approximately US$47.7 million). Productivity losses from premature mortality constituted the majority of costs (71.4%). Indirect costs were 27-fold larger than the direct costs. CONCLUSIONS RHD leads to a heavy economic burden in Fiji. Improved prevention strategies for RHD will likely confer substantial economic benefits to the country.
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Affiliation(s)
- Rachel C Heenan
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia.,Department of General Medicine, Royal Children's Hospital Melbourne, Parkville 3052, Australia
| | - Tom Parks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.,Wellcome Centre for Human Genetics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, USA.,Africa Health Research Institute, KwaZulu-Natal 4013, South Africa.,Institute of Public Health, Heidelberg University, Heidelberg 69120, Germany
| | - Joseph Kado
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.,Telethon Kids Institute, Nedlands 6009, Australia
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Andrew C Steer
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia.,Department of General Medicine, Royal Children's Hospital Melbourne, Parkville 3052, Australia.,Tropical Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville 3052, Australia
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26
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Sultana R, Luby SP, Gurley ES, Rimi NA, Swarna ST, Khan JAM, Nahar N, Ghosh PK, Howlader SR, Kabir H, Khan S, Jensen PKM. Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009439. [PMID: 34115764 PMCID: PMC8221788 DOI: 10.1371/journal.pntd.0009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods. The illness cost borne by households, known as out-of-pocket expenditure was 74% of the total health expenditure in Bangladesh in 2017. Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children. Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had ≤ 2 US$ dollar income per capita per day still remained unknown. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 2015 to July 2016 to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 (2,147 BDT) and non-severe diarrhea was US$ 6.36 (499 BDT). A single diarrheal episode substantially affects financial capability of the low-income urban community: a severe episode can cost 4.35 days (17%) and a non-severe episode can cost 1 day (4%) of income of a households. Preventing diarrhea preserves health and supports financial livelihoods.
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Affiliation(s)
- Rebeca Sultana
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Stephen P. Luby
- Stanford University, Stanford, California, United States of America
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Nazmun Nahar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Sultana M, Alam NH, Ali N, Faruque ASG, Fuchs GJ, Gyr N, Chisti MJ, Ahmed T, Gold L. Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study. Arch Dis Child 2021; 106:539-546. [PMID: 33906852 PMCID: PMC8142430 DOI: 10.1136/archdischild-2020-320834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh. DESIGN An incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective. Face-to-face interviews collected data on socioeconomic, resource use and cost from caregivers. A micro-costing bottom-up approach was applied to calculate medical, non-medical and time costs. Multiple regression analysis was applied to explore the factors associated with COI. Sensitivity analysis explored the robustness of cost parameters. SETTING Four urban and rural study sites from two districts in Bangladesh. PATIENTS Children aged 2-59 months with severe pneumonia. RESULTS 1472 children with severe pneumonia were enrolled between November 2015 and March 2019. The mean age of children was 12 months (SD ±10.2) and 64% were male. The mean household cost per episode was US$147 (95% CI 141.1 to 152.7). Indirect costs were the main cost drivers (65%, US$96). Household costs for the poorest income quintile were lower in absolute terms, but formed a higher proportion of monthly income. COI was significantly higher if treatment was received from urban health facilities compared with rural health facilities (difference US$84.9, 95% CI 73.3 to 96.3). Child age, household income, healthcare facility and hospital length of stay (LoS) were significant predictors of household COI. Costs were most sensitive to hospital LoS and productivity loss. CONCLUSIONS Severe pneumonia in young children is associated with high household economic burden and cost varies significantly across socioeconomic parameters. Management strategies with improved accessibility are needed particularly for the poor to make treatment affordable in order to reduce household economic burden.
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh .,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Nur H Alam
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh,Clinical Sciences Division (CSD), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Nausad Ali
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - George J Fuchs
- Department of Paediatrics, University of Kentucky College of Medicine and Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Md Jobayer Chisti
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Hasan MZ, Mehdi GG, De Broucker G, Ahmed S, Ali MW, Martin Del Campo J, Constenla D, Patenaude B, Uddin MJ. The economic burden of diarrhea in children under 5 years in Bangladesh. Int J Infect Dis 2021; 107:37-46. [PMID: 33864914 PMCID: PMC8208894 DOI: 10.1016/j.ijid.2021.04.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diarrhea is a leading cause of morbidity and mortality among under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden on households and health systems. The aim of this study was to estimate the cost of illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh. METHOD A cross-sectional study with an ingredient-based costing approach was conducted in 48 healthcare facilities in Bangladesh. In total, 899 caregivers of under-five children with diarrhea were interviewed face-to-face between August 2017 and May 2018, followed up over phone after 7-14 days of discharge, to capture all expenses and time costs related to the entire episode of diarrhea. RESULTS The average cost per episode for caregivers was US$62, with $29 direct and $34 indirect costs. From the societal perspective, average cost per episode of diarrhea was $71. In 2018, an estimated $79 million of economic costs were incurred for treating diarrhea in Bangladesh. Using 10% of income as threshold, over 46% of interviewed households faced catastrophic expenditure from diarrheal disease. CONCLUSION The economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.
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Affiliation(s)
- Md Zahid Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
| | - Gazi Golam Mehdi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sayem Ahmed
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Md Wazed Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Jorge Martin Del Campo
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; GlaxoSmithKline Plc., Panama City, Panama
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Md Jasim Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
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29
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Niyibitegeka F, Riewpaiboon A, Youngkong S, Thavorncharoensap M. Economic burden of childhood diarrhea in Burundi. Glob Health Res Policy 2021; 6:13. [PMID: 33845920 PMCID: PMC8042854 DOI: 10.1186/s41256-021-00194-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. METHODS The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. RESULTS One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. CONCLUSION Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
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Affiliation(s)
- Fulgence Niyibitegeka
- Master of Science Program in Social, Economic, and Administrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand.
| | - Sitaporn Youngkong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
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30
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Fagbamigbe AF, Oyinlola FF, Morakinyo OM, Adebowale AS, Fagbamigbe OS, Uthman AO. Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis. BMC Public Health 2021; 21:575. [PMID: 33757471 PMCID: PMC7988905 DOI: 10.1186/s12889-021-10615-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/11/2021] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Diarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities. METHODS Data of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010-2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package. RESULTS Two-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education. CONCLUSIONS The gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.
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Affiliation(s)
- A F Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Division of Health Sciences, Populations, Evidence and Technologies Group, Warwick Medical School, University of Warwick, Coventry, UK.
- Division of Population and Behavioural Studies, School of Medicine, University of St Andrews, Fife, UK.
| | - F F Oyinlola
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O M Morakinyo
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A S Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O S Fagbamigbe
- Techmodia, London, West Sussex, UK
- Portsmouth Business School, Faculty of Business and Law, University of Portsmouth, Portsmouth, UK
| | - A O Uthman
- Division of Health Sciences, Populations, Evidence and Technologies Group, Warwick Medical School, University of Warwick, Coventry, UK
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Al-Rawashdeh I, Kharboush I, Al-Kubaisy W. Disparities in cesarean section among women in Jordan: analysis of the 2017-2018 Jordan Population and Family Health Survey (JPFHS) data. J Matern Fetal Neonatal Med 2021; 35:5168-5176. [PMID: 33645408 DOI: 10.1080/14767058.2021.1875437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Cesarean sections (C-sections) are surgical procedures that save maternal and infant lives. In some cases, C-sections are done when they are not necessary, while in other cases, some women are unable to access this life-saving intervention. Sociodemographic characteristics are associated with an increased use of C-section. Disparities in socioeconomic status and other factors exist in the rates of C-sections across diverse populations worldwide. Although C-sections are common in Jordan, there is limited evidence about the characteristics associated with C-sections. We aim to assess the factors related to the use of C-sections and to examine the sociodemographic disparities of these deliveries in Jordan. METHODS We analyzed data from the 2017-2018 Jordan Population and Family Health Survey, which is the seventh to be conducted in Jordan. The analysis included a total of 6525 women age 15-49 who delivered their most recent birth in a health facility in the 5 years before the survey. Statistical analyses used descriptive, bivariate, and logistic regression methods. RESULTS The results show that 27% of women were delivered by C-sections. C-section is significantly associated with older age groups, region, and place of delivery. No significant differences were found by wealth status, place of residence, educational level, employment, nationality, decision making on health, or health insurance. The odds ratio of C-section use for women over age 40 is 3.3 (CI 2.0-5.5), compared to women under age 20. The odds of having a C-section is 40% higher for women who delivered in a private hospital compared to women who delivered in a public hospital (CI 1.2-1.8). The odds of C-section are 60% lower for women in Aqaba compared to women in Amman (CI 0.3-0.6), and 60% higher for women in Madaba compared to the women in Amman (CI 1.2-2.1). CONCLUSIONS This study assessed factors related to C-section among Jordanian mothers. Our findings highlight the increased practice of C-section in the private sector and suggest the importance of developing national and subnational policies that include clear guidelines for performing C-sections, especially in the private sector.
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Affiliation(s)
- Israa Al-Rawashdeh
- Department of Community Medicine and Public Health, Faculty of Medicine, Mutah University, Jordan
| | - Ibrahim Kharboush
- Department of Community Medicine and Public Health, Faculty of Medicine, Mutah University, Jordan
| | - Waqar Al-Kubaisy
- Department of Community Medicine and Public Health, Faculty of Medicine, Mutah University, Jordan
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Long C, Tang S, Wang R, Ji L, Wang Y, Wu T, Li Z, Feng Z. The migrating mediators and the interaction associated with the use of essential public health services: a cross-sectional study in Chinese older migrants. BMC Geriatr 2020; 20:475. [PMID: 33198656 PMCID: PMC7670818 DOI: 10.1186/s12877-020-01878-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite the incremental implementation of the essential public health services (EPHS) during the last decade, the goal of EPHS’s equalization is impossible to cannot be achieved without appropriate policies targeting older migrants. Therefore, this study aims to examine whether the supply side meets the needs of older migrants and to explore the relationships among health status, the use of health services, and diverse factors. Methods The data were derived from a national cross-sectional dataset (N = 11,161) of the 2015 Chinese Migrant Dynamic Monitoring Survey. Mediating effects analysis and moderating effects analysis were conducted to explore the interactions between physical status and the use of EPHS in older migrants such as physical examination, health record, and follow-up services. Results The use of physical examination, health record, and follow-up services were correlated with each other. Household income, migrating for employment, and migrating for offspring were negatively associated with the use of EPHS. A positive association was observed between the use of EPHS and willingness for long-stay. The mediating effects of household income, migrating for employment, migrating for offspring, and willingness for long-stay were observed on the relationship between physical status and the use of EPHS. The moderating effects of household income and migrating for employment were discovered. Conclusion Public health policies that may be worthy of consideration include further enhancing the delivery capacity of primary health institutions, integrating professional clinical resources into the primary health system, and launching the target policies to improve the accessibility of EPHS in older migrants.
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Affiliation(s)
- Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Tailai Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhifei Li
- China National Center for Biotechnology Development, 16 West Sihuan Middle Road, Beijing, 100039, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
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Christmals CD, Aidam K. Implementation of the National Health Insurance Scheme (NHIS) in Ghana: Lessons for South Africa and Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:1879-1904. [PMID: 33061721 PMCID: PMC7537808 DOI: 10.2147/rmhp.s245615] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND South Africa is having difficulties in rolling out the National Health Insurance(NHI) policy. There are ongoing arguments on whether the NHI will provide access to quality and equitable healthcare it is intended to and whether South Africa is ready to implement the policy. Many stakeholders believe the country needs more preparation if the policy will be successful. Ghana, on the other hand, has successfully implemented the National Health Insurance Scheme(NHIS) for over 15 years. OBJECTIVE This paper sought to explore the implementation of the NHIS in Ghana and the lessons South Africa and other low- and middle-income countries can learn from such a process. METHODS A scoping review was conducted using the Joanna Brigs Institute's System for the Unified Management, Assessment and Review of Information (SUMARI) and Mendeley reference manager to manage the review process. Journal articles published on the NHIS in Ghana from January 2003 to December 2018 were searched from Science Direct, PubMed, Scopus, CINAHL, and Medline using the keywords: Ghana, Health, and Insurance. RESULTS The implementation of the NHIS has provided access to healthcare for the Ghanaian population, especially to poor and vulnerable . Despite the successful implementation of the NHIS in Ghana, the scheme is challenged with poor coverage; poor quality of care; corruption and ineffective governance; poor stakeholder participation; lack of clarity on concepts in the policy; intense political influence; and poor financing. CONCLUSION The marked inequity in the South African health system makes the implementation of the NHI inevitable. The challenges experienced in the implementation of the NHIS in Ghana are not new to the South African healthcare system. South Africa must learn from the experiences of Ghana,a context that shares common socio-cultural and economic factors and disease burden,in order to successfully implement the NHI.
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Affiliation(s)
- Christmal Dela Christmals
- Research on the Health Workforce for Equity and Quality, Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Kizito Aidam
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Biswas D, Hossin R, Rahman M, Bardosh KL, Watt MH, Zion MI, Sujon H, Rashid MM, Salimuzzaman M, Flora MS, Qadri F, Khan AI, Nelson EJ. An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions. Soc Sci Med 2020; 260:113185. [PMID: 32712557 PMCID: PMC7502197 DOI: 10.1016/j.socscimed.2020.113185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care. METHODS The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management. RESULTS Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards. CONCLUSION This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections.
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Affiliation(s)
- Debashish Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raduan Hossin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kevin Louis Bardosh
- Center for One Health Research, School of Public Health, University of Washington, USA; Department of Anthropology, University of Florida, USA
| | | | - Mazharul Islam Zion
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Hasnat Sujon
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Md Mahbubur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Salimuzzaman
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, USA.
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Baral R, Nonvignon J, Debellut F, Agyemang SA, Clark A, Pecenka C. Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates. BMC Public Health 2020; 20:619. [PMID: 32370763 PMCID: PMC7201538 DOI: 10.1186/s12889-020-08595-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. Methods The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME’s service delivery unit costs to explore input sensitivity on modelled cost estimates. Results We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 – $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 – $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 – $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 –$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson’s correlation coefficient = .75). Conclusion Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.
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Affiliation(s)
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.,Health Economics, Systems and Policy Research Group, University of Ghana, Legon, Accra, Ghana
| | | | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, London, UK
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Aik J, Ong J, Ng LC. The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore - A time-series analysis. Int J Hyg Environ Health 2020; 227:113517. [PMID: 32272437 DOI: 10.1016/j.ijheh.2020.113517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diarrhoeal disease is common and imposes substantial health and economic burdens across the globe, especially in the African and Southeast Asian regions. Besides causing high mortality and morbidity, diarrhoeal disease has also been associated with growth and cognitive shortfalls in children in low-resource settings. Extreme weather events brought about by climate change may increase diarrhoeal disease and impact vulnerable populations in countries regardless of levels of development. We examined the seasonal and climatic influences of acute diarrhoeal disease reports in Singapore, a city-state located in Southeast Asia. METHODS We used a time-series analysis, adjusting for time-varying potential confounders in a negative binomial regression model and fitting fractional polynomials to investigate the relationship between climatic factors (temperature, relative humidity and rainfall) and reported diarrhoeal disease. RESULTS We included 1,798,198 reports of diarrhoeal disease from 2005 to 2018. We observed annual trimodal peaks in the number of reports. Every 10% increase in relative humidity in the present week was positively associated with an increase in reports one week later [Incidence Rate Ratio (IRR): 1.030, 95% CI 1.004-1.057] and negatively associated with a decrease in reports six weeks later (IRR: 0.979, 95% CI 0.961-0.997). We observed effect modification of relative humidity on the risk of diarrhoeal disease in the first calendar quarter (January to March). There was weak evidence of a delayed effect of ambient air temperature on reports of diarrhoeal disease one week later (IRR: 1.013, 95% CI 0.998-1.027). No threshold effects of climatic factors were observed. Each week of school holidays was associated with a 14.4% reduction in diarrhoeal disease reports (IRR: 0.856, 95% CI: 0.840 to 0.871). Public holidays were associated with a reduction in reports in the same week and an increase a week later. CONCLUSIONS Diarrhoeal disease is highly seasonal and is associated with climate variability. Food safety and primary healthcare resource mitigation could be timed in anticipation of seasonal and climate driven increases in disease reports.
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Affiliation(s)
- Joel Aik
- Environmental Health Institute, National Environment Agency, 40 Scotts Road, Environment Building, #13-00, 228231, Singapore; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, New South Wales, Australia.
| | - Janet Ong
- Environmental Health Institute, National Environment Agency, 40 Scotts Road, Environment Building, #13-00, 228231, Singapore.
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, 40 Scotts Road, Environment Building, #13-00, 228231, Singapore.
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Bray AE, Ahmed S, Das SK, Khan SH, Chisti MJ, Ahmed T, Faruque ASG, Fuchs GJ. Viral Pathogen-Specific Clinical and Demographic Characteristics of Children with Moderate-to-Severe Diarrhea in Rural Bangladesh. Am J Trop Med Hyg 2020; 101:304-309. [PMID: 31264563 DOI: 10.4269/ajtmh.19-0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Diarrheal disease is a leading cause of childhood morbidity and mortality worldwide, but particularly in low-income countries in sub-Saharan Africa and South Asia. The Global Enteric Multicenter Study (GEMS) examined the infectious etiologies as well as associated demographics, socioeconomic markers, health-care-seeking behaviors, and handwashing practices of the households of children with diarrhea and their age- and gender-matched controls in seven countries over a 3-year period (December 2007-December 2010). Stool studies to determine diarrheal etiologies and anthropometry were performed at baseline and at 60-day follow-up visits, along with surveys to record demographics and living conditions of the children. We performed secondary analyses of the GEMS data derived from the Bangladesh portion of the study in children with diarrhea associated with viral enteropathogens and explored pathogen-specific features of disease burden. Rotavirus and norovirus were the most prevalent pathogens (39.3% and 35%, respectively). Disease due to rotavirus and adenovirus was more common in infants than in older children (P < 0.001 and P = 0.001, respectively). Height for age decreased from baseline to follow-up in children with diarrhea associated with rotavirus, norovirus, and adenovirus (P < 0.001). Based on these analyses, preventive measures targeted at rotavirus, norovirus, and adenovirus will be expected to have meaningful clinical impact. Cost of treatment was highest for rotavirus as well, making it an obvious target for intervention. Association of specific viruses with stunting is particularly notable, as stunting is an attributable risk factor for poor cognitive development and future productivity and economic potential.
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Affiliation(s)
- Abigail E Bray
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abu S G Faruque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - George J Fuchs
- Department of Preventive Medicine and Environmental Health, College of Public Health, Lexington, Kentucky.,Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
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Rahman MM, Zhang C, Swe KT, Rahman MS, Islam MR, Kamrujjaman M, Sultana P, Hassan MZ, Alam MS, Rahman MM. Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis. PLoS One 2020; 15:e0227565. [PMID: 31935266 PMCID: PMC6959568 DOI: 10.1371/journal.pone.0227565] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/21/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Because of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage. OBJECTIVES We first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses. METHOD A cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively. RESULTS Overall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%). CONCLUSION The study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.
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Affiliation(s)
| | - Cherri Zhang
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Khin Thet Swe
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Md. Shafiur Rahman
- Global Public Health Research Foundation, Dhaka, Bangladesh
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Md. Rashedul Islam
- Global Public Health Research Foundation, Dhaka, Bangladesh
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Md. Kamrujjaman
- Department of Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Zakiul Hassan
- icddr,b, (Formerly, International Centre for Diarrheal Disease Research Bangladesh) Dhaka, Bangladesh
| | | | - Md. Mizanur Rahman
- Global Public Health Research Foundation, Dhaka, Bangladesh
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
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Bhandari D, Bi P, Sherchand JB, Dhimal M, Hanson-Easey S. Assessing the effect of climate factors on childhood diarrhoea burden in Kathmandu, Nepal. Int J Hyg Environ Health 2019; 223:199-206. [PMID: 31537454 DOI: 10.1016/j.ijheh.2019.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study was undertaken to assess the effect of climate variability on diarrhoeal disease burden among children under 5 years of age living in Kathmandu, Nepal. The researchers sought to predict future risk of childhood diarrhoea under different climate change scenarios to advance the evidence base available to public health decision-makers, and the Nepalese infection control division, in planning for climate impacts. METHODS A time series study was conducted using the monthly case count of diarrhoeal disease (2003-2013) among children under 5 years of age living in Kathmandu, Nepal. A quasi Poisson generalised linear equation with distributed lag linear model was fitted to estimate the lagged effect of monthly maximum temperature and rainfall on childhood diarrhoea. The environmental framework of comparative risk assessment was used to assess the environmental burden of diarrhoea within this population. RESULTS A total of 219,774 cases of diarrhoeal disease were recorded during the study period with a median value of 1286 cases per month. The results of a regression model revealed that the monthly count of diarrhoea cases increased by 8.1% (RR: 1.081; 95% CI: 1.02-1.14) per 1 °C increase in maximum temperature above the monthly average recorded within that month. Similarly, rainfall was found to have significant effect on the monthly diarrhoea count, with a 0.9% (RR; 1.009; 95% CI: 1.004-1.015) increase in cases for every 10 mm increase in rainfall above the monthly cumulative value recorded within that month. It was estimated that 7.5% (95% CI: 2.2%-12.5%) of the current burden of diarrhoea among children under 5 years of age could be attributed to climatic factors (maximum temperature), and projected that 1357 (UI: 410-2274) additional cases of childhood diarrhoea could be climate attributable by the year 2050 under low-risk scenario (0.9 °C increase in maximum temperature). CONCLUSION It is estimated that there exists a significant association (p < 0.05) between childhood diarrhoea and an increase in maximum temperature and rainfall in Kathmandu, Nepal. The findings of this study may inform the conceptualization and design of early warning systems for the prediction and control of childhood diarrhoea, based upon the observed pattern of climate change in Kathmandu.
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Affiliation(s)
- Dinesh Bhandari
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.
| | - Peng Bi
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.
| | - Jeevan Bahadur Sherchand
- Public Health Research Laboratory, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - Scott Hanson-Easey
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.
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Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladesh. Trop Med Infect Dis 2018; 4:tropicalmed4010005. [PMID: 30587776 PMCID: PMC6473641 DOI: 10.3390/tropicalmed4010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. METHODS This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. RESULTS The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). CONCLUSIONS The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.
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Sarker AR, Sultana M, Mahumud RA, Van Der Meer R, Morton A. Cost-effectiveness analysis of introducing universal childhood rotavirus vaccination in Bangladesh. Hum Vaccin Immunother 2018; 14:189-198. [PMID: 29099653 PMCID: PMC5791570 DOI: 10.1080/21645515.2017.1356962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/21/2017] [Accepted: 07/14/2017] [Indexed: 10/18/2022] Open
Abstract
Diarrhea is one of the world's leading killers of children, and globally, rotavirus is the most common cause of severe diarrhea among under 5 children. In Bangladesh, rotavirus kills nearly 6,000 under 5 children in each year. To reduce the burden of childhood rotavirus diseases, universal rotavirus vaccination is recommended by World Health Organization. The objective of this study is to assess the cost-effectiveness of introducing universal childhood rotavirus vaccination with the newly developed ROTAVAC vaccine in national Expanded Programme of Immunization in Bangladesh. We developed a decision model to examine the potential impact of vaccination in Bangladesh and to examine the effect if the vaccination is applied in the nationwide immunization program schedule. Introduction of childhood universal rotavirus vaccination in Bangladesh scenario appears as highly cost-effective and would offer substantial future benefits for the young population if vaccinated today. The cost per DALY averted of introducing the rotavirus vaccine compared with status quo is approximately US$ 740.27 and US$ 728.67 per DALY averted from the health system and societal perspective respectively which is "very cost-effective" using GDP threshold level according to World Health Organization definition. The results of this analysis seek to contribute to an evidence-based recommendation about the introduction of universal rotavirus vaccination in national Expanded Programme of Immunization (EPI) in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
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