MosquirixTM malaria vaccine: an evaluation of patients' willingness to pay in Cameroon

OBJECTIVES

The purpose of this study was to determine the average price that a patient living in Cameroon would be willing to pay for the MosquirixTM vaccine and the factors influencing the proposed price.

STUDY DESIGN

Cross-sectional study Methods: Data were collected using a semi-open questionnaire in 5 hospitals in Cameroon. This study included all persons over 18 years who came for consultation in one of the 5 selected hospitals during the study period (from 02th to 14th April 2018 and from 02th to 22th July 2018). The factors associated with the price of the vaccine proposed by the patient were determined by linear multiple regression analysis. The average price was determined based on the patient's income and the percentage of that income proposed for the purchase of the vaccine.

RESULTS

We collected data from 1,187 participants aged 18 to 80 years. The average price that Cameroonian patients were willing to pay for the MosquirixTM vaccine was 1,514±475 XAF (2.3±0.73 Euro). The minimum and maximum purchase price of the vaccine were 1,178 XAF (1.8 Euro) and 1,850 XAF (2.8 Euro) respectively. We also noted that patients were willing to spend an average of 1.34% of their income on the vaccine. This percentage of income was significantly (lt;0.001) associated with the respondents' income, the fact that they had been consulted at least once for malaria in the 12 months preceding the survey (lt;0.001) and the fact that the respondent had at least one under- five year child (lt;0.001).

CONCLUSION

Factors associated with the average price are elements that should be strongly considered by policy makers to introduce this vaccine in Cameroon. This pilot study can serve as a framework for a potential national population-based study.

Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security and the new suggested FRAX criteria

To assess the number of anti-osteoporosis treatments that would be reimbursed by the Belgian social security if either FRAX or the current criteria were used to determine access to reimbursement. This is a retrospective study based on data from 1,000 women randomly selected from an outpatient hospital specialized in bone metabolism in Belgium. Proportions of potentially refunded treatments between FRAX and current criteria were compared. Out of the 1,000 women files, 890 have sufficient information to assess FRAX. In Belgium, current criteria include a bone mineral density (BMD) T score below -2.5 at the lumbar spine, the femoral neck or the total hip and/or at least a prevalent vertebral fracture. Using these criteria, 167 women (18.8 %) would have access to reimbursement. Using the criteria based on the validated Belgian FRAX tool, only 116 women (13.0 %) would have access to reimbursement, meaning that access to reimbursement based on FRAX criteria would reduce by 30 % the anti-osteoporosis drug expenses covered by the national social security. Interestingly, only 65 women out of the 116 (56.0 %) selected with the FRAX criteria were also selected with the current criteria of the national social security. A substantial proportion of individuals that would potentially receive a reimbursement for their treatment using the FRAX criteria do not have access to any refund for their treatment with the current criteria. Since patients identified with the FRAX tool are those with the highest risk profile for future fractures, reappraisals of treatment reimbursement guidelines are expected in Belgium.

Eradication of endemicBrachyspira pilosicoliinfection from a farrowing herd: a case report

Brachyspira pilosicoliandB. innocenswere isolated repeatedly from a herd of 60 sows which mostly produced feeder pigs but also raised some fattening pigs. Postweaning diarrhea had been a severe problem in this herd for years. TheB. pilosicolieradication plan was based on the general guidelines for elimination ofB. hyodysenteriae, with some modifica-tions. The eradication measures were run in August 1997. In-feed medication with 200p.p.m. tiamulin lasted for 18–30 days, depending on the age group. The piggery unit was emptied, cleaned, disinfected and dried, and all worn surfaces were repaired. The animals were removed to temporary sheds situated 0–100m from the piggery unit. Only the sows and the boar returned to the piggery unit. All other pigs were sold from the sheds within 3 months after the eradication. Immediately after the eradication, the clinical postweaning diarrhea disappeared. The success of the program was monitored four times bacteriologically, and the last control sampling was in December 1999, 7 months after the total withdrawal of antimicrobial feed additives. The primary cultures from the last three samplings were also analysed withB. pilosicoli-specific PCR. All the samples were negative forB. pilosicoli. However,B. innocenscould be isolated from each batch of samples. The analysis ofB. inno-censisolates by pulsed-field gel electrophoresis indicated that at least one genotype persisted in the herd. The clinical and laboratory findings suggest that the eradication ofB. pilosicolihad succeeded in this herd

Quality-control ranges for antimicrobial susceptibility testing by broth dilution of the Brachyspira hyodysenteriae type strain (ATCC 27164T)

There are no approved standards for antimicrobial susceptibility testing of the fastidious spirochete Brachyspira hyodysenteriae. An interlaboratory study was performed to establish MIC quality control ranges for six antimicrobial agents for the type strain of B. hyodysenteriae using broth dilution. The results showed that B. hyodysenteriae B78T ATCC 27164T is a suitable quality control strain. This is a first step toward standardization of methods regarding this anaerobe.

The effect of antimicrobial growth promoter withdrawal on the health of weaned pigs in Finland

The use of the antimicrobial growth promoters (AGPs) carbadox and olaquindox has been banned in the European Union (EU) since September 1999. We studied the effects of the withdrawal on the health of weaned piglets on two types of piglet-producing farms (farrowing herds and farrow-to-finish herds) from the different regions of Finland. Farms with no major problems with post-weaning diarrhoea were selected for the study to better evaluate the effect of AGPs alone. Data on production, medication and incidence of diarrhoea were collected from 73 farms during 1 year after the withdrawal. On 29 of these farms, the data collection began 4 months before the withdrawal. The health management of the pigs is considered good in Finland, and special attention has been paid to improve the husbandry practices and management of the farms. Eighty-two percent of the farms in the study were free of both Mycoplasma hyopneumoniae and Sarcoptes scabiei infection. Brachyspira hyodysenteriae infection was not detected in any of the farms. The median number of sows in the herds was 56.0 (IQR=43.0; 72.5) in 2000. The level of antimicrobial use in each herd was classified as low, moderate and high when the percentage of weaned pigs treated for diarrhoea during a 4-month period was 0-5%, 6-19% and > or =20%, respectively. Only on four herds (14%), there was an increase in the level of antibiotic use after the AGP withdrawal, when seasonally corresponding 4-month periods were compared. Fourty-one percent of these 29 farms were categorized as low users of antimicrobials, 38% as moderate users and 21% as high users. The level of antimicrobial use for treatment of diarrhoea after weaning (and the incidence of diarrhoea in weaned piglets) did not increase significantly after the withdrawal of AGPs from weaner feeds according to farmers' evaluations. In this study, the Escherichia coli infection was the most-common cause of diarrhoea in weaned pigs. The age at weaning did not change after the withdrawal of AGPs.

Eradication of endemic Brachyspira pilosicoli infection from a farrowing herd: a case report

Brachyspira pilosicoli and B. innocens were isolated repeatedly from a herd of 60 sows which mostly produced feeder pigs but also raised some fattening pigs. Postweaning diarrhea had been a severe problem in this herd for years. The B. pilosicoli eradication plan was based on the general guidelines for elimination of B. hyodysenteriae, with some modifications. The eradication measures were run in August 1997. In-feed medication with 200 p.p.m. tiamulin lasted for 18-30 days, depending on the age group. The piggery unit was emptied, cleaned, disinfected and dried, and all worn surfaces were repaired. The animals were removed to temporary sheds situated 0-100 m from the piggery unit. Only the sows and the boar returned to the piggery unit. All other pigs were sold from the sheds within 3 months after the eradication. Immediately after the eradication, the clinical postweaning diarrhea disappeared. The success of the program was monitored four times bacteriologically, and the last control sampling was in December 1999, 7 months after the total withdrawal of antimicrobial feed additives. The primary cultures from the last three samplings were also analysed with B. pilosicoli-specific PCR. All the samples were negative for B. pilosicoli. However, B. innocens could be isolated from each batch of samples. The analysis of B. innocens isolates by pulsed-field gel electrophoresis indicated that at least one genotype persisted in the herd. The clinical and laboratory findings suggest that the eradication of B. pilosicoli had succeeded in this herd.

Detectability and prevalence of Brachyspira species in herds rearing health class feeder pigs in Finland

Faeces samples were taken three times at two-week intervals, from the farrowing units of four herds of known Brachyspira (formerly Serpulina) status and one of unknown Brachyspira status. Brachyspira hyodysenteriae, Brachyspira pilosicoli, Brachyspira intermedia and Brachyspira group III were isolated from the faecal samples from the weaners in the herds using either a maximum of 50 ppm of olaquindox or no feed additives. The detection rates were relatively consistent. However, B hyodysenteriae was not detected at one sampling in a known positive herd. The prevalence of Brachyspira species was also studied in feeder pigs originating from LSO 2000 health class farrowing units, comparable with specific pathogen-free herds. These farms were free from swine dysentery, sarcoptic mange, swine enzootic pneumonia and progressive atrophic rhinitis. Fifty of 428 herds were sampled once. B hyodysenteriae was not isolated from any of them, but B intermedia, B pilosicoli and Brachyspira group III were isolated from five, 14 and 37 of the herds, respectively. The detection of Brachyspira species did not relate to the prevalence of diarrhoea in the herds, as judged by the farmers. The herds using carbadox (40 to 50 ppm) had a lower prevalence of Brachyspira species than those using olaquindox (40 to 50 ppm).

[Requirements of nutrients which participate in erythropoiesis]

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.

Daily physiological iron requirements in children

Median daily iron absorption was determined in iron-replete males and females between 2 and 19 years of age from the upper and lower socioeconomic strata of the Venezuelan population. A comparison was made with iron absorption of well-nourished children, on the basis of hematological and anthropometric reference values from the U.S. The median absorption level, which was calculated from the increase in total body iron due to growth and the daily losses through exfoliation and menstruation, was also used to estimate the requirements of 95% of the population. When the requirements were expressed in terms of body weight, no significant difference in iron absorption was observed between the three Venezuelan and one U.S. groups, ranging from about 30 to 38 micrograms/kg/day in both sexes between 4 and 16 years of age. However, when the requirements were expressed without division by the weight factor, the requirements of the better nourished groups were somewhat higher than those of the Venezuelan lower socioeconomic population with, in addition, a threefold variation over the 5 to 16 year age range. These findings suggest that the total iron requirements of children at a certain age may be most adequately expressed in terms of the optimal body weight for that age.

[Hematologic profile and absorption of iron from diets consumed by a population of low socioeconomic level of 2 Venezuelan states]

Hematologic studies carried out in inhabitants of the State of Carabobo revealed that 19% of the subjects studied presented iron deficiency, this being more prominent in women and in children. Iron deficiency anemia was absent in men, while in the other groups its frequency, as registered, was from 5 to 13%. Tests for iron absorption from foods which form the average diet of the population in the Carabobo State, and the diet consumed by adults from the low socioeconomic strata in the States of Carabobo and Yaracuy, demonstrated that in normal subjects, bioavailability is lower than physiological requirements of men, women and children. In the iron-deficient subjects, its bioavailability can cover physiological needs. It is estimated that an important proportion of the population strata consuming such diets, suffer from iron nutritional deficiency, especially women during the reproductive age, and children.