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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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de Broucker G, Sim SY, Brenzel L, Gross M, Patenaude B, Constenla DO. Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2020; 38:1071-1094. [PMID: 32748334 PMCID: PMC7578143 DOI: 10.1007/s40273-020-00940-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. OBJECTIVE The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. DATA SOURCES Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies must (1) be peer reviewed, (2) be published in 2000-2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. LIMITATIONS We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1-75% of the household's monthly income or 10-83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a 'real-world' estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, 415 North Washington Street, Suite #530, Baltimore, MD, 21231, USA.
| | - So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna O Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- GlaxoSmithKline Plc, Panama City, Panama
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Nguefack F, Mah E, Kinkela MN, Tagne T, Chelo D, Dongmo R, Ndombo PK. [Mortality pattern in children aged 3-59 months hospitalized in the Intensive Care Unit at a Paediatric Center in Yaounde-Cameroon]. Pan Afr Med J 2020; 36:246. [PMID: 33014242 PMCID: PMC7519789 DOI: 10.11604/pamj.2020.36.246.11292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/08/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction le risque de décès serait élevé dans les unités des soins intensifs (USI) des pays en développement. Nous décrivons les décès survenus à l’Unité des Soins Intensifs du Centre Mère et Enfant de Yaoundé au Cameroun. Méthodes étude rétrospective portant sur les caractéristiques cliniques, sociodémographiques, l’itinéraire thérapeutique ainsi que certains facteurs associés aux décès survenus entre 2010 et 2014 chez 200 patients âgés de 3-59 mois. Résultats sur 2675 patients admis, 1807 étaient âgés de 3 à 59 mois et 303 sont décédés. Les taux de mortalité global et spécifique à cette tranche d’âge étaient de 11,3% et de 16,7% respectivement. La plupart (152/200 soit 76,0%) décédait à moins de 24 mois et le délai médian de leur admission était de 7 jours. Plus de la moitié (57,0%) avait recouru à un centre de santé et seuls 66 (33,0%) avaient bénéficié d’une référence. Le paludisme grave (41,5%), la pneumonie (22,7%) et la gastroentérite (27,8%) étaient les pathologies les plus incriminées. La malnutrition et le VIH/Sida constituaient les causes sous-jacentes de décès chez 23,0% et 20,5% de sujets respectivement. La présence de la gastroentérite multipliait le risque de décès d’environ 6 fois (OR = 5,76; P = 0,000) lorsque la malnutrition et l’infection à VIH étaient présentes. Les décès survenaient majoritairement (90,0%) dans les 72 heures d’admission. Conclusion certaines pathologies auraient pu être traitées avec des moyens simples afin d’éviter les complications nécessitant une réanimation dans un contexte à ressources limitées. Il est crucial d’intensifier la lutte contre le paludisme, l’infection à VIH et la malnutrition.
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Affiliation(s)
- Félicitée Nguefack
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.,Hôpital Gynéco-obstétrique et Pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - Evelyn Mah
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.,Hôpital Gynéco-obstétrique et Pédiatrique de Yaoundé, Yaoundé, Cameroun
| | - Mina Ntoto Kinkela
- Centre Mère et Enfant de la Fondation Chantal Biya de Yaoundé, Yaoundé, Cameroun
| | - Thierry Tagne
- Institut Supérieur de Technologie Médicale, Yaoundé, Cameroun
| | - David Chelo
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.,Centre Mère et Enfant de la Fondation Chantal Biya de Yaoundé, Yaoundé, Cameroun
| | - Roger Dongmo
- Hôpital de District d'Efoulan, Yaoundé, Cameroun
| | - Paul Koki Ndombo
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.,Centre Mère et Enfant de la Fondation Chantal Biya de Yaoundé, Yaoundé, Cameroun
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Masekela R, Vosloo S, Venter SN, de Beer WZ, Green RJ. The lung microbiome in children with HIV-bronchiectasis: a cross-sectional pilot study. BMC Pulm Med 2018; 18:87. [PMID: 29788934 PMCID: PMC5964725 DOI: 10.1186/s12890-018-0632-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Data on the lung microbiome in HIV-infected children is limited. The current study sought to determine the lung microbiome in HIV-associated bronchiectasis and to assess its association with pulmonary exacerbations. METHODS A cross-sectional pilot study of 22 children (68% male; mean age 10.8 years) with HIV-associated bronchiectasis and a control group of 5 children with cystic fibrosis (CF). Thirty-one samples were collected, with 11 during exacerbations. Sputum samples were processed with 16S rRNA pyrosequencing. RESULTS The average number of operational taxonomy units (OTUs) was 298 ± 67 vs. 434 ± 90, for HIV-bronchiectasis and CF, respectively. The relative abundance of Proteobacteria was higher in HIV-bronchiectasis (72.3%), with only 22.2% Firmicutes. There was no correlation between lung functions (FEV1% and FEF25/75%) and bacterial community (r = 0.154; p = 0.470 and r = 0.178; p = 0.403), respectively. Bacterial assemblage of exacerbation and non-exacerbation samples in HIV-bronchiectasis was not significantly different (ANOSIM, RHIV-bronchiectasis = 0.08; p = 0.14 and RCF = 0.08, p = 0.50). Higher within-community heterogeneity and lower evenness was associated with CF (Shannon-Weiner (H') = 5.39 ± 0.38 and Pielou's evenness (J) 0.79 ± 0.10 vs. HIV-bronchiectasis (Shannon-Weiner (H') = 4.45 ± 0.49 and Pielou's (J) 0.89 ± 0.03. CONCLUSION The microbiome in children with HIV-associated bronchiectasis seems to be less rich, diverse and heterogeneous with predominance of Proteobacteria when compared to cystic fibrosis.
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Affiliation(s)
- Refiloe Masekela
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Maternal and Child Health, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, 719 Umbilo Road, Congella, Durban, 4013 South Africa
| | - Solize Vosloo
- Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa
| | - Stephanus N. Venter
- Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa
| | - Wilhelm Z. de Beer
- Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa
| | - Robin J. Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, Sinha A, Madhi SA, Khandaker G, Yin JK, Booy R, Huda TM, Rahman QS, El Arifeen S, Gentile A, Giglio N, Bhuiyan MU, Sturm-Ramirez K, Gessner BD, Nadjib M, Carosone-Link PJ, Simões EA, Child JA, Ahmed I, Bhutta ZA, Soofi SB, Khan RJ, Campbell H, Nair H. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2018; 6:010408. [PMID: 27231544 PMCID: PMC4871066 DOI: 10.7189/jogh.06.010408] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health. METHODS We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate. RESULTS We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children. CONCLUSION This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.
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Affiliation(s)
- Shanshan Zhang
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China
| | - Peter M Sammon
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Isobel King
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; NHS Grampian, UK
| | | | | | - Sheila N Araujo
- Department of Community Health, Federal University of Goias, Brazil; State University of Maranhăo, Brazil
| | - Anushua Sinha
- New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Gulam Khandaker
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Jiehui Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Tanvir M Huda
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Qazi S Rahman
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Angela Gentile
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | - Norberto Giglio
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | | | - Katharine Sturm-Ramirez
- Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh; Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mardiati Nadjib
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Phyllis J Carosone-Link
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Eric Af Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Child
- Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rumana J Khan
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India
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The cost of hospital care for management of invasive group A streptococcal infections in England. Epidemiol Infect 2014; 143:1719-30. [PMID: 25262779 DOI: 10.1017/s0950268814002489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to estimate the direct financial costs of hospital care for management of invasive group A streptococcal (GAS) infections using hospital records for cases diagnosed in England. We linked laboratory-confirmed cases (n = 3696) identified through national surveillance to hospital episode statistics and reimbursement codes. From these codes we estimated the direct hospital costs of admissions. Almost all notified invasive GAS cases (92% of 3696) were successfully matched to a primary hospital admission. Of these, secondary admissions (within 30 days of primary admission) were further identified for 593 (17%). After exclusion of nosocomial cases (12%), the median costs of primary and secondary hospital admissions were estimated by subgroup analysis as £1984-£2212 per case, totalling £4·43-£6·34 million per year in England. With adjustment for unmatched cases this equated to £4·84-£6·93 million per year. Adults aged 16-64 years accounted for 48% of costs but only 40% of cases, largely due to an increased number of surgical procedures. The direct costs of hospital admissions for invasive GAS infection are substantial. These estimated costs will contribute to a full assessment of the total economic burden of invasive GAS infection as a means to assess potential savings through prevention measures.
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Le P, Griffiths UK, Anh DD, Franzini L, Chan W, Pham H, Swint JM. The economic burden of pneumonia and meningitis among children less than five years old in Hanoi, Vietnam. Trop Med Int Health 2014; 19:1321-7. [DOI: 10.1111/tmi.12370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Phuc Le
- University of Texas School of Public Health at Houston; Houston TX USA
| | | | - Dang D. Anh
- Vietnam National Institute of Hygiene and Epidemiology; Hanoi Vietnam
| | - Luisa Franzini
- University of Texas School of Public Health at Houston; Houston TX USA
| | - Wenyaw Chan
- University of Texas School of Public Health at Houston; Houston TX USA
| | - Ha Pham
- Vietnam National Hospital of Pediatrics; Hanoi Vietnam
| | - John M. Swint
- University of Texas School of Public Health at Houston; Houston TX USA
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