1
|
Turner HC, Kura K, Roth B, Kuesel AC, Kinrade S, Basáñez MG. An Updated Economic Assessment of Moxidectin Treatment Strategies for Onchocerciasis Elimination. Clin Infect Dis 2024; 78:S138-S145. [PMID: 38662693 PMCID: PMC11045023 DOI: 10.1093/cid/ciae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control and elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas have increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies. METHODS We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) with minimal or enhanced coverage (65% or 80% of total population taking the drug, respectively) in intervention-naive areas with 30%, 50%, or 70% microfilarial baseline prevalence (representative of hypo-, meso-, and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of program delivery when EoT90 was not reached earlier. The delivery costs do not include drug costs. RESULTS aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with 1 exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI. CONCLUSIONS Moxidectin-based strategies could accelerate progress toward EoT and reduce programmatic delivery costs compared with ivermectin-based strategies. The costs of moxidectin to national programs are needed to quantify whether delivery cost reductions will translate into overall program cost reduction.
Collapse
Affiliation(s)
- Hugo C Turner
- UK Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Klodeta Kura
- UK Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Barbara Roth
- Medicines Development for Global Health, Melbourne, Victoria, Australia
| | - Annette C Kuesel
- UNICEF/United Nations Development Progamme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (retired)
| | - Sally Kinrade
- Medicines Development for Global Health, Melbourne, Victoria, Australia
| | - Maria-Gloria Basáñez
- UK Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Abstract
This study examines insurer coverage of ivermectin prescriptions for COVID-19 in the US.
Collapse
Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, Massachusetts
| | - Nora V. Becker
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
3
|
Mow M, Thean LJ, Parnaby M, Mani J, Rafai E, Sahukhan A, Kama M, Tuicakau M, Kado J, Romani L, Engelman D, Whitfeld M, Kaldor J, Steer A, Carvalho N. Costs of mass drug administration for scabies in Fiji. PLoS Negl Trop Dis 2022; 16:e0010147. [PMID: 35113888 PMCID: PMC8846527 DOI: 10.1371/journal.pntd.0010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/15/2022] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
In 2019, the Murdoch Children’s Research Institute in partnership with the Fiji Ministry of Health and Medical Services carried out an integrated mass drug administration (MDA) for the treatment of scabies and lymphatic filariasis in the Northern Division of Fiji (population estimate 131,914). We conducted a retrospective micro-costing exercise focused on the cost of scabies control in order to inform budgeting and policy decision making in an endemic setting. We collected detailed information on financial and economic costs incurred by both parties during the course of the MDA campaign (April 2018 to July 2019). We also conducted interviews with personnel involved in the financial administration of the MDA campaign. The economic cost of delivering two doses of ivermectin was US$4.88 per person. The cost of donated drugs accounted for 36.3% of total MDA costs. In this first large-scale MDA for the public health control of scabies, the estimated cost of delivering MDA per person for scabies was considerably more expensive than the costs reported for other neglected tropical diseases. The important cost drivers included the remuneration of health care workers who were extensively involved in the campaign, coverage of hard-to-reach, mainly rural populations and the two-dose regimen of ivermectin. These results highlight the importance of these cost determinants and can be used to plan current and future MDA programs. Scabies poses a significant burden on both health and economic systems. The Global Burden of Disease estimated that this skin disease affects more than 200 million people globally. However, the economic burden of scabies has not been studied widely and there are limited data on the cost of treating scabies in highly endemic areas. We conducted a costing study of a mass drug administration (MDA) program in the Northern Division of Fiji (population of 131,914). We collected financial and economic costs of administering ivermectin and permethrin to the whole of the Northern Division population in order to estimate the per capita cost of delivering MDA. The costs of MDA for scabies in Fiji were higher than those estimated in previous studies of MDA for other neglected tropical diseases. The study highlights significant cost components of implementing a large-scale MDA and provides key insights for the design and implementation of future MDA programs for scabies. It also adds to the general knowledge in understanding cost inputs and estimating the overall cost-effectiveness of this public health intervention.
Collapse
Affiliation(s)
- Maria Mow
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- * E-mail:
| | - Li Jun Thean
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Parnaby
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Jyotishna Mani
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Joseph Kado
- Ministry of Health and Medical Services, Suva, Fiji
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Engelman
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Margot Whitfeld
- Department of Dermatology, St. Vincent’s Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Natalie Carvalho
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Banerjee K, Nandy M, Dalai CK, Ahmed SN. The Battle against COVID 19 Pandemic: What we Need to Know Before we "Test Fire" Ivermectin. Drug Res (Stuttg) 2020; 70:337-340. [PMID: 32559771 PMCID: PMC7417290 DOI: 10.1055/a-1185-8913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
The world is faced with the dire challenge of finding an effective treatment against the rampaging COVID 19 pandemic. Amidst the crisis, reports of in vitro inhibitory activity of ivermectin, an approved anthelmintic, against the causative SARSCoV2 virus, have generated lot of optimism. In this article, we have fished and compiled the needed information on the drug, that will help readers and prospective investigators in having a quick overview. Though the primordial biological action of the drug is allosteric modulation of helminthic ion channel receptor, its in vitro activity against both RNA and DNA viruses is known for almost a decade. In the past two years, efficacy study in animal models of pseudorabies and zika virus was found to be favourable and unfavourable respectively. Only one clinical study evaluated the drug in dengue virus infection without any clinical efficacy. However, the proposed mechanism of drug action, by inhibiting the importin family of nucleus-cytoplasmic transporters along with favourable pharmacokinetics, warrants exploration of its role in COVID 19 through safely conducted clinical trials. Being an available and affordable drug, enlisted in WHO List of Essential Medicine, and a long track record of clinical safety, the drug is already in clinical trials the world over. As the pandemic continues to ravage human civilisation with unabated intensity, the world eagerly waits for a ray of hope emanating from the outcome of the ongoing trials with ivermectin as well as other drugs.
Collapse
Affiliation(s)
- Kushal Banerjee
- Post graduate trainee, Department of Pharmacology, Medical College and
Hospital Kolkata, Kolkata, West Bengal, India
| | - Manab Nandy
- Professor, Department of Pharmacology, Medical College and Hospital
Kolkata, Kolkata, West Bengal, India
| | - Chanchal Kumar Dalai
- Associate Professor, Department of Pharmacology, The West Bengal
University of Health Sciences, College of Medicine and JNM Hospital, Kalyani,
West Bengal, India
| | - Shah Newaz Ahmed
- Demonstrator, Department of Pharmacology, The West Bengal University of
Health Sciences, College of Medicine and JNM Hospital, Kalyani, West Bengal,
India
| |
Collapse
|
5
|
Fritsch P, Kolber MR, Korownyk C. Topical treatments for rosacea. Can Fam Physician 2019; 65:803. [PMID: 31722913 PMCID: PMC6853348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Paul Fritsch
- Family medicine resident at the University of Calgary in Alberta
| | - Michael R Kolber
- Professor the PEER (Patients, Experience, Evidence, Research) Group in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Christina Korownyk
- Associate Professor, the PEER (Patients, Experience, Evidence, Research) Group in the Department of Family Medicine at the University of Alberta in Edmonton
| |
Collapse
|
6
|
van der Linden N, van Gool K, Gardner K, Dickinson H, Agostino J, Regan DG, Dowden M, Viney R. A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions. PLoS Negl Trop Dis 2019; 13:e0007182. [PMID: 30849124 PMCID: PMC6426261 DOI: 10.1371/journal.pntd.0007182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/20/2019] [Accepted: 01/23/2019] [Indexed: 01/12/2023] Open
Abstract
Background Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies. Scabies is a neglected tropical disease affecting more than 130 million people, with major costs on health care systems worldwide. While effective treatments exist, it is unknown which treatment strategies result in the best outcomes against the lowest costs, and to what extent this differs between communities. Health economic modelling can help answer these questions, but has rarely been used in this disease area. This review discusses all available scabies transmission models (n = 4), and uses them to create a new, comprehensive modelling framework. This framework can be used as aid for creating a scabies transmission model, the details of which will be determined by the context (population) and the question being addressed. The current paper also reviews the data that is needed to inform scabies modelling: on scabies biology, quality of life and resource use. Unfortunately, available data is limited and particularly data on crusted scabies (associated with high morbidity and mortality rates) is rare. With this review, we hope to assist researchers and policy makers to predict and/or evaluate the cost-effectiveness of interventions against scabies in their population(s) of interest. To tackle scabies, it is key to use effective treatment strategies in a cost-effective and sustainable way. The models and data described in this review, may help researchers, clinicians and funding bodies to facilitate this.
Collapse
Affiliation(s)
- Naomi van der Linden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Karen Gardner
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Jason Agostino
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | | | | | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
7
|
|
8
|
Brodine SK, Thomas A, Huang R, Harbertson J, Mehta S, Leake J, Nutman T, Moser K, Wolf J, Ramanathan R, Burbelo P, Nou J, Wilkins P, Reed SL. Community based parasitic screening and treatment of Sudanese refugees: application and assessment of Centers for Disease Control guidelines. Am J Trop Med Hyg 2009; 80:425-430. [PMID: 19270293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Centers for Disease Control guidelines for schistosomiasis and strongyloidiasis in Sudanese and Somali refugees are not widely implemented. Given limited prevalence data, we conducted a seroprevalence study of schistosomiasis, strongyloidiasis, and loiasis in Sudanese refugees across diverse ages. Sudanese refugees, ages 4-78, were recruited via community organizations. Half of the patients (86/172), were seropositive for schistosomiasis (46/171; 26.9%), strongyloidiasis (56/172; 33%), or both (16/171; 9.4%). No Loa loa infections were detected. Infection rates were similar in adults and children except that no schistosomiasis was detected in children < 4 years of age at the time of immigration to the United States. The high prevalence of schistosomiasis and strongyloidiasis in a community-based sample of Sudanese confirms the urgency for compliance with CDC refugee health guidelines. We detected no co-infection with Loa loa using the most sensitive serologic techniques, allowing use of ivermectin, the most effective treatment of strongyloidiasis.
Collapse
Affiliation(s)
- Stephanie K Brodine
- San Diego State University Graduate School of Public Health, San Diego, California 92182, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Campagna AM, Patnaik MM, Walker PF. Neglected tropical disease: challenges, progress, and hope. Minn Med 2008; 91:42-44. [PMID: 18714931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ann M Campagna
- Department of Internal Medicine, University of Minnesota, USA
| | | | | |
Collapse
|
10
|
|
11
|
Muennig P, Pallin D, Challah C, Khan K. The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States. Epidemiol Infect 2005; 132:1055-63. [PMID: 15635962 PMCID: PMC2870196 DOI: 10.1017/s0950268804003000] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of 1700 dollars per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions.
Collapse
Affiliation(s)
- P Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA.
| | | | | | | |
Collapse
|
12
|
Abstract
Since its introduction more than 20 years ago, ivermectin has proved to be one of the most successful therapeutic drugs in veterinary medicine, as well as the basis of one of the most successful public-health programmes of the past century. The drug arose from a unique international collaboration between the public and private sectors. The development process also incorporated the world's first and largest drug-donation programme and involved a unique association between governments, non-governmental organizations and industry. The drug is now being used, free of charge, in two global disease-elimination programmes that are benefiting millions of the world's poorest people.
Collapse
Affiliation(s)
- Satoshi Omura
- Kitasato Institute, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8642, Japan.
| | | |
Collapse
|
13
|
Mathieu E, Deming M, Lammie PJ, McLaughlin SI, Beach MJ, Deodat DJ, Addiss DG. Comparison of methods for estimating drug coverage for filariasis elimination, Leogane Commune, Haiti. Trans R Soc Trop Med Hyg 2004; 97:501-5. [PMID: 15307410 DOI: 10.1016/s0035-9203(03)80006-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In the global effort to eliminate lymphatic filariasis, annual mass treatments are conducted with diethylcarbamazine (DEC) or ivermectin, combined with albendazole. The success of this strategy depends on achieving high levels of drug coverage, which reduces the number of persons with circulating microfilariae so that transmission of the parasite is interrupted. Because resources are often limited, a simple, inexpensive, and reliable method to estimate drug coverage is needed. During the period December 2000 to February 2001, three methods were used to assess drug coverage in Leogane Commune, Haiti: a probability survey using a cluster sample design (n = 1421 persons); a distribution-point survey based on a convenience sample of houses near the distribution points (n = 4341 persons); and a survey based on a convenience sample of primary schools (n = 5036 children). The coverage estimations were 71.3% (95% CI 66.7-75.9), 73.6% (95% CI 70.1-77.0), and 77.8% (95% CI 73.5-82.1), respectively. Survey costs for the probability, distribution point, and school surveys were US$2217, US$979, and US$312, respectively. The 2 convenience sampling methods provided point estimates of drug coverage that were similar to those of the probability survey. These methods may have a role for monitoring drug treatment coverage between less frequent, but more costly, probability sample surveys.
Collapse
Affiliation(s)
- Els Mathieu
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
| | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
A unique public/private partnership situated around a pharmaceutical, Merck's Mectizan donation program stands out as an example of corporate philanthropy in the history of the pharmaceutical industry and provides insight into future public/private partnerships in public health. This paper considers the issues Merck faced in the decision to donate Mectizan (ivermectin) and in the subsequent development of the Mectizan donation program, delineating the moral and financial debates that arose within the company. Coming after almost 15 years of donation, this assessment of the program's strengths and shortcomings suggests how the pharmaceutical industry can better serve as a viable partner in improving international health.
Collapse
|
15
|
Abstract
In the US, 6% sulfur in petrolatum has been the most frequently administered treatment for infantile scabies. It appears to be safe but there is no literature containing a large series of patients on which to base that determination. In the UK, benzyl benzoate is the approved product. Benzyl benzoate is rarely used in the US at the present time. 5% Permethrin is an excellent substitute and has many advantages. It appears to be quite safe in infants, although it is more expensive than other products. It remains present on the skin for several days, therefore protecting against reinfestation. Ivermectin is a systemic drug which is assumed to be safe in infants, although it requires repeated doses and does not protect against reinfestation. In the opinion of the author, 5% permethrin is the best treatment for scabies in infants and young children.
Collapse
Affiliation(s)
- Mervyn L Elgart
- The George Washington University Medical Center, University Dermatology Associates, Suite 250, 1120 19 street NW, Washington, DC 20036, USA.
| |
Collapse
|
16
|
Krishnamoorthy K, Rajendran R, Sunish IP, Reuben R. Cost-effectiveness of the use of vector control and mass drug administration, separately or in combination, against lymphatic filariasis. Ann Trop Med Parasitol 2002; 96 Suppl 2:S77-90. [PMID: 12625921 DOI: 10.1179/000349802125002428] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The costs and effects of two intervention strategies for the control of bancroftian filariasis-annual mass drug administrations (MDA) with a combination of diethylcarbamazine and ivermectin, with or without integrated vector control (VC)-were estimated in rural villages in South India. The aim was to compare the cost-effectiveness of MDA alone with that of MDA plus VC. Control of the local vector, Culex quinquefasciatus, was based on the application of polystyrene beads to cesspits, the treatment of drains with larvicidal Bacillus sphaericus and the stocking of wells with larvivorous fish. An itemized cost menu was used to cost MDA and MDA + VC, retrospectively. The annual transmission potential was used to assess the direct outcome of the disease-control methods, whereas the prevalence and intensity of microfilaraemia were used as indicators of the impact of each method. The per-capita costs were 1.49 U.S. dollars for two rounds of MDA, 1.70 U.S. dollars for 2 years of VC and, therefore, 3.19 U.S. dollars for 2 years of MDA + VC. Integration of VC with MDA did not appear to be cost-effective: it cost an estimated 1.80 U.S. dollars to stop an infective mosquito biting a villager using MDA alone but 3.32 U.S. dollars to achieve the same result using MDA + VC. Similarly, the cost to reduce the prevalence of microfilaraemia in a three-village group by 1% was only 96.62 U.S. dollars for MDA alone but 201.16 U.S. dollars when vector control was integrated. The implications of these results for the control and elimination of filariasis in Indian village communities, and the options for sharing and minimizing costs, are discussed.
Collapse
Affiliation(s)
- K Krishnamoorthy
- Vector Control Research Centre (ICMR), Medical Complex, Indira Nagar, Pondicherry - 605 006, India.
| | | | | | | |
Collapse
|
17
|
Onwujekwe O, Chima R, Shu E, Okonkwo P. Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences. Health Policy 2002; 62:31-51. [PMID: 12151133 DOI: 10.1016/s0168-8510(01)00226-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme. METHODS Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. RESULT The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. CONCLUSION Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.
Collapse
Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Unit, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, P.M.B. 01129, Enugu, Nigeria.
| | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE To compare single dose oral ivermectin with topical benzyl benzoate for the treatment of paediatric scabies. METHODS An observer-blinded randomized controlled trial was undertaken at Vila Central Hospital, Vanuatu. One hundred and ten children aged from 6 months to 14 years were randomized to receive either ivermectin 200 micro g/kg orally or 10% benzyl benzoate topically. Follow up was at 3 weeks post-treatment. Primary outcome measures were the number of scabies lesions, the itch visual analogue score and nocturnal itch. Secondary outcome measures were the skin's reaction to treatment, the passage of worms in stool and other side effects. RESULTS Eighty patients completed the study protocol. There was no significant difference between the two treatments; both produced a significant decrease in the number of scabies lesions seen at follow up. Ivermectin cured 24 out of 43 patients (56%), and benzyl benzoate 19 out of 37 patients (51%) at 3 weeks post-treatment. No serious side effects were noted with either treatment, but benzyl benzoate was more likely to produce local skin reactions (P = 0.004, OR 6.4, 95% CI 1.6-25.0) CONCLUSIONS Ivermectin is cheap and effective in the treatment of paediatric scabies. Ivermectin has minimal observed toxicity and has the additional beneficial effects of antiparasitic action in onchocerciasis, filariasis and strongyloidiasis. Ivermectin is better than benzyl benzoate for the treatment of paediatric scabies in developing countries.
Collapse
Affiliation(s)
- P A Brooks
- Outpatients Department, Vila Central Hospital, Port Vila, Vanuatu.
| | | |
Collapse
|
19
|
Onwujekwe O, Shu E, Onwuameze O, Ndum C, Okonkwo P. Onchocerciasis control in Nigeria: will households be able to afford community-directed treatment with ivermectin? Acta Trop 2001; 80:277-81. [PMID: 11700186 DOI: 10.1016/s0001-706x(01)00162-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the level of affordability of community-directed treatment with ivermectin (CDTI) to households living in two onchocerciasis endemic Nigerian communities namely Toro in the north and Nike in the south. METHODS The proportion of the cost of treating people with ivermectin will deplete in average monthly/projected annual household expenditure on food and health care, and on average monthly and projected annual household income were respectively calculated and used to determine the level of affordability of CDTI. Questionnaires administered to heads of households or their representatives were used to collect information on the household expenditures and income. The suggested unit CDTI cost of $0.20 was used. However, as a test of sensitivity, we also used the unit cost of $0.056 which some community based distributors are charging per treatment. RESULT Using $0.20 as the unit treatment cost, this will consume less than 0.05% of average annual household income in both communities. It will equally deplete 0.05% of combined annual household expenditures on food and health care in both communities. However, using $0.056 as the unit treatment cost, then 0.02% of average annual household expenditure on health care, 0.01% average annual expenditure on combined health care and food, and 0.01% of average annual household income will be depleted. CONCLUSION The households living in both communities may be able to afford CDTI schemes. However, the final decision on levels of affordability lies with the households. They will decide whether they can afford to trade-off some household income for ivermectin distribution.
Collapse
Affiliation(s)
- O Onwujekwe
- Department of Pharmacology and Therapeutics, Health Policy Research Unit, College of Medicine, University of Nigeria, P.M.B. 01129, Enugu, Nigeria.
| | | | | | | | | |
Collapse
|
20
|
Guichon PT, Jim GK, Booker CW, Schunicht OC, Wildman BK, Brown JR. Relative cost-effectiveness of treatment of feedlot calves with ivermectin versus treatment with a combination of fenbendazole, permethrin, and fenthion. J Am Vet Med Assoc 2000; 216:1965-9. [PMID: 10863598 DOI: 10.2460/javma.2000.216.1965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare growth performance, animal health characteristics, and carcass characteristics of feedlot calves treated with ivermectin topically with that of feedlot calves treated with a combination of fenbendazole orally and permethrin and fenthion topically. DESIGN Clinical trial. ANIMALS 14,184 British crossbred steer calves (mean weight, 286 kg [630 lb]) in 30 pens at a commercial feedlot in Nebraska. PROCEDURE On arrival at the feedlot, calves were randomly assigned to be treated with ivermectin topically or with a combination of fenbendazole orally and permethrin and fenthion topically (control). At the time of assignment to treatment groups, fecal samples were collected from 5% of the calves. Growth performance, carcass characteristics, and health information were recorded. RESULTS Geometric mean fecal egg counts at the time of arrival at the feedlot were not significantly different between groups. Final weight, weight gain, average daily gain, and the dry matter intake-to-gain ratio were significantly improved for calves in the ivermectin group. The percentage of carcasses classified as quality grade choice was higher for the ivermectin group than the control group; however, the percentage of carcasses classified as yield grade 1 and the dressing percentage were higher for the control group than for the ivermectin group. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that topical administration of ivermectin to feedlot calves is relatively more cost-effective than administration of a combination of fenbendazole orally and permethrin and fenthion topically.
Collapse
Affiliation(s)
- P T Guichon
- Feedlot Health Management Services, Okotoks, AB, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.
Collapse
Affiliation(s)
- O E Onwujekwe
- Department of Pharmacology and Therapeutics College of Medicine, University of Nigeria, Enugu, Nigeria.
| | | | | |
Collapse
|
22
|
Schunicht OC, Guichon PT, Booker CW, Jim GK, Wildman BK, Ward TI, Bauck SW, Gross SJ. Comparative cost-effectiveness of ivermectin versus topical organophosphate in feedlot yearlings. Can Vet J 2000; 41:220-4. [PMID: 10738601 PMCID: PMC1476312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A replicated-pen field trial was performed under commercial feedlot conditions in western Canada to determine the cost-effectiveness of administering ivermectin to yearling beef cattle upon entry to the feedlot after the grazing season, and to establish the level of trichostrongylid gastrointestinal parasite infection in this population, as estimated by fecal egg counts. Six thousand eight hundred and eighty-three, mixed breed, yearling steers were randomly allocated upon arrival at the feedlot to one of 2 experimental groups as follows: Ivermectin, which received topical ivermectin (0.5%) at the rate of 1.0 mL/10 kg body weight; or Fenthion, which received topical fenthion (20%) at the rate of 12 mL/295 kg body weight. There were 15 pens in each experimental group. Final weight, weight gain, average daily gain, and dry matter intake to gain ratio were significantly (P < 0.05) improved in the Ivermectin group as compared with the Fenthion group. There were no significant (P > or = 0.05) differences in initial weight, days on feed, or daily dry matter intake between the experimental groups. The geometric mean fecal egg counts at the time of allocation were 14.7 eggs/5 g and 16.6 eggs/5 g for the Ivermectin and Fenthion groups, respectively (P > or = 0.05). There were no significant (P > or = 0.05) differences in morbidity or mortality between the experimental groups. In the economic analysis, the significant improvements in feedlot performance in the Ivermectin group resulted in a net economic advantage of $4.20 CDN per animal.
Collapse
Affiliation(s)
- O C Schunicht
- Feedlot Health Management Services, Okotoks, Alberta
| | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Katabarwa M, Mutabazi D, Richards F. The community-directed, ivermectin-treatment programme for onchocerciasis control in Uganda--an evaluative study (1993-1997). Ann Trop Med Parasitol 1999; 93:727-35. [PMID: 10715701 DOI: 10.1080/00034989957989] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The first 5 years of a community-directed, ivermectin-treatment programme, to control onchocerciasis in 1805 endemic communities in 10 districts in Uganda, are evaluated. Each year, the desired treatment coverage of the population eligible to take invermectin (90%) was achieved in 42.6%-51% of the 1713 communities for which complete data were available; 67%-74.8% achieved 80% coverage. The annual cost per person treated with ivermectin (ACPTI) was much higher in the districts with small populations to be treated (< 15,000) than in those with large populations (> 40,000) (U.S.$0.40 v. U.S.$0.10 or less). The community members' acceptance of the programme was related to their attendance at health-education sessions (P = 0.009), and their participation in the mobilisation of other community members increased greatly when they were allowed to take part in the selection of the community-based distributors (CBD) and the choice of treatment sites. The overall target ratio of one CBD/71 families was attained by 1997. However, the failure of some trained CBD to participate in the treatment exercise prevented some communities achieving 90% treatment coverage. Providing CBD with cash incentives or externally derived incentives 'in kind' proved counter-productive whereas locally generated incentives 'in kind' were simply regarded as the normal obligations of the community. District health staff successfully integrated the programme with their other health commitments, but the involvement of CBD in other programmes proved detrimental to their performance. Other constraints identified were rebel insurgency in some areas, and abnormally heavy rains in hilly areas with poor roads.
Collapse
Affiliation(s)
- M Katabarwa
- Global 2000 River Blindness Program, Kampala, Uganda.
| | | | | |
Collapse
|
25
|
Onwujekwe OE, Shu EN, Okonkwo PO. Willingness to pay for the maintenance of equity in a local ivermectin distribution scheme in Toro, Northern Nigeria. Public Health 1999; 113:193-4. [PMID: 10483083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The willingness to pay (WTP) for the maintenance of equity in a local ivermectin distribution scheme in the context of a community financing framework was determined in Toro, Northern Nigeria, using 214 randomly selected heads of households, or their representatives. Though WTP of the respondents for their own households was elicited, the focus of this paper is on WTP to maintain equity in a community financing scheme. Contingent valuation was used for the exercise, and WTP was elicited using an open-ended question. 97.2% of the respondents were in favour of allowing those that lack the ability to pay, to benefit from the scheme and the maximum WTP amounts they were willing to contribute annually so that those who lack the ability to pay could benefit from the scheme ranged from 5 Naira ($0. 06) to 100 Naira ($1.25). The mean WTP to maintain equity was 29.00 Naira ($0.36) while the median was 20.00 Naira ($0.25). This study shows that a community financing scheme for local ivermectin distribution will not be inequitable, since enough funds will be realised from well-to-do community members to cover the costs for those who are unable to pay.
Collapse
Affiliation(s)
- O E Onwujekwe
- Health Policy Research Unit, Department of Pharmacology and Therapeutics, University of Nigeria, College of Medicine, PMB 01129, Enugu, Nigeria
| | | | | |
Collapse
|
26
|
Abstract
BACKGROUND Community-based distribution of ivermectin and other drugs requires people in the endemic communities who are capable of distributing the drug. It is essential also to collect information on local people's views concerning different financing mechanisms and approaches to distributing ivermectin. However, studies at household level are resource-intensive. Eliciting the preferences of the community by interviewing a smaller number of community leaders offers an alternative strategy. METHODS A comparison of information from community leaders and household heads on the financing and distribution of ivermectin through communities was conducted in three communities in Nigeria to determine whether rapidly collected information from key community leaders could represent broad community preferences. RESULTS The preferences of community leaders and household heads were comparable in relation to the method of collecting payments, managing payments and making payments, who should set the level of payments and the drug distribution mechanisms. However, there were differences between community leaders' views and those of heads of households concerning how the scheme should be supervised. CONCLUSIONS This study has shown that community leaders' views can only be used as a partial substitute for more laborious methods of data collection insofar as they have the attraction of being quicker and less costly to use. However, they should not be assumed to be identical with the views of the community as a whole.
Collapse
Affiliation(s)
- O Onwujekwe
- Onchocerciasis Unit, University of Nigeria, Enugu, Nigeria
| | | | | |
Collapse
|
27
|
|
28
|
Abstract
The Central African Republic (CAR) has a serious onchocerciasis problem. The disease is endemic in three quarters of the country and there is considerable onchocercal blindness in the north-west. The low population density and extreme poverty (the CAR being one of the 20 poorest countries in the world) combine to make mass treatment with Mectizan (ivermectin, MSD) a challenge. Although planned, primary health care (PHC) is not widely developed in the country. Mectizan distribution was carried out in 1993-1994 by mobile teams in order to address the most urgent need, particularly in the north-west. Since then, the strategy has been one of community involvement, using village health workers, chosen by their own communities, to do the treatment. The system has been a stimulus to the development of PHC in some areas, as the co-ordinators of the Mectizan programme are often the only health personnel to visit every village. The long distances between health centres, with a mean of 45 km, are likely to be an obstacle to the population collecting their own Mectizan, within the self-treatment system otherwise in place. Operational research is planned to examine ways in which the population can contribute to cost recovery without there being a reduction in treatment coverage.
Collapse
Affiliation(s)
- A D Hopkins
- Programme National de Lutte contre l'Onchocercose et la Cécité, Bangui, Central African Republic
| |
Collapse
|
29
|
Amazigo U, Noma M, Boatin BA, Etya'alé DE, Sékétéli A, Dadzie KY. Delivery systems and cost recovery in Mectizan treatment for onchocerciasis. Ann Trop Med Parasitol 1998; 92 Suppl 1:S23-31. [PMID: 9861264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treatment for onchocerciasis are reviewed. The search is on for an effective system of Mectizan delivery, involving drug procurement, delivery from port to districts and distribution to eligible persons, which can be sustained by the endemic countries for many years. The mechanisms for procuring and clearing the drug at the ports, and the drug's integration into the existing delivery systems of each national health service, need to be improved. Although large-scale treatments by mobile teams or community-based methods evidently achieve high and satisfactory rates of coverage, they also incur high recurrent costs which have to be covered by external partners and are not sustainable by national health services. Cost-sharing is considered an important factor in a sustainable delivery system and community-directed treatment, in which the community shares the cost and ownership of local distribution and is empowered to design and implement it, is likely to be more cost-effective and sustainable.
Collapse
Affiliation(s)
- U Amazigo
- World Health Organization/African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso.
| | | | | | | | | | | |
Collapse
|
30
|
Jiya JJ. Problems and perspective in programme management: the case of the National Onchocerciasis Control Programme in Nigeria. Ann Trop Med Parasitol 1998; 92 Suppl 1:S167-8. [PMID: 9861288 DOI: 10.1080/00034983.1998.11813386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J J Jiya
- National Onchocerciasis Control Programme, Federal Secretariat Phase II, Ikoyi, Lagos, Nigeria
| |
Collapse
|
31
|
Benton B. Economic impact of onchocerciasis control through the African Programme for Onchocerciasis Control: an overview. Ann Trop Med Parasitol 1998; 92 Suppl 1:S33-9. [PMID: 9861265 DOI: 10.1080/00034989859537] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This note overviews several studies that have been conducted on the economic impact of onchocerciasis (river blindness) control through the African Programme for Onchocerciasis Control (APOC). A cost-benefit analysis of the APOC concludes that the programme is highly cost-effective. The economic rate of return (ERR) is 17% if benefits are considered in accordance with the stated objective of the programme (i.e. the achievement of long-term, sustainable, ivermectin-delivery systems). However, the cost-benefit analysis significantly under-estimates the net benefits from the APOC, since it considers, for ease of quantification, only the reduction in blindness as the principal benefit accruing from control activities. Recent studies, summarized here, have shown that there may be substantial benefits (in terms of enhanced productivity, increased household-level welfare, and reduced health-related expenditure, for instance) resulting from the reduction of the skin-related symptoms associated with the disease.
Collapse
Affiliation(s)
- B Benton
- Onchocerciasis Co-ordination Unit, World Bank, Washington, DC 20433, USA.
| |
Collapse
|
32
|
Dadzie Y. [The African onchocerciasis control program: essential characteristics]. Sante 1998; 8:42. [PMID: 9592877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
Namangué K. [Onchocerciasis control program in Chad: the Mectizan donation]. Sante 1998; 8:51-2. [PMID: 9592880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K Namangué
- Programme national de lutte contre l'onchocercose, N'Djamena, Tchad
| |
Collapse
|
34
|
|
35
|
Abstract
Data from two 12 month prospective monitoring programs that followed management, economics and animal health from randomly-sampled equine operations in Michigan were used to determine patterns of health maintenance. Health maintenance measures were grouped, and average uses per year were computed for the most-common measures reported: respiratory, Potomac Horse Fever, neurological and multiple-system vaccinations, deworming, and general farrier work. Factors examined for potential association with health maintenance measure use were numbers of equids and horse-days on the operation, average age of equids, disease prevention management procedures, and operation and individual equine activities. The most-common vaccinations reported were respiratory vaccines (administered an average of 0.9 times per equid per year, of which 61% were for rhinopneumonitis). Multiple-system, Potomac Horse Fever and neurological vaccines were given on average 0.9, 0.9 and 0.7 times per equid per year, respectively. Deworming treatments were administered approximately 2.7 times per equid per year, of which 64% were ivermectin. Overall farrier work was reported 3.3 times per equid per year, trimming was done 2.9 times and shoeing was done 1.5 times per equid per year. In general, operations with active equids engaged in training, breeding or showing showed increased use of health maintenance measures. Overall use of health maintenance measures in the Michigan equine operations monitored did not appear to reach recommended levels, because many operations reported no use of these measures. However, on operations where health maintenance measures were reported, operators were using these measures at or near recommended levels.
Collapse
Affiliation(s)
- J B Kaneene
- Population Medicine Center, Michigan State University, East Lansing 48824-1314, USA
| | | | | | | |
Collapse
|
36
|
Chippaux JP, Boussinesq M, Prod'hon J. [The use of ivermectin in the control of onchocerciasis]. Sante 1995; 5:149-58. [PMID: 7640897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Onchocerciasis is an infection with the nematode Onchocerca volvulus. The main clinical symptoms are caused by the microfilariae. They include ocular lesions leading to blindness. Onchocerciasis is widely distributed in Africa from the Sahara to the southern tip, and is also found in some areas of South and Central America. Ivermectin was shown to be an effective treatment in the early 1980's, and is safe and better tolerated than diethylcarbamazine. We report the results of ivermectin treatment of onchocerciasis, and various features of the control obtained by large-scale ivermectin treatment programs. In large-scale programs, ivermectin (150 micrograms/kg) is administered once a year. This dose paralyses the microfilariae, such that they are carried away by the lymph to the lymph nodes where they are destroyed. This dose thereby reduces the load of microfilaria by 90%. The effects of a dose of ivermectin last about two or three years, and the lesions in the anterior segment of the eye can be cured or substantially reduced. Regular treatment prevents severe lesions of the posterior segment of the eye. The effects of repeated treatment on lesions of the retina are currently under investigation. Frequent doses of ivermectin prevent the development of embryo parasites in the females, and reduces the number of adults by attrition. Large-scale treatment programs reduce the transmission of the parasite by its vectors. There are several problems impeding large-scale treatment programs. Choosing patients for priority treatment requires expensive and sometimes aggressive methods of diagnosis. Thus new techniques for the identification of communities in which onchocerciasis is a serious public health problem are required. The choice of strategies for distribution, to optimize the cost, benefit ratio and feasibility, remain controversial. Wide distribution by mobile teams is effective, but expensive. Active distribution by trained community distributors is a cheaper potential alternative. Clinic-based or passive distribution requires the population to present to be able to obtain ivermectin. Thus, although cheap, this approach is generally poorly effective. A further complication is the clearly defined criteria on which these methods should be evaluated.
Collapse
|
37
|
Abstract
The productivity of Merino ewes treated with ivermectin and a controlled-release capsule containing albendazole was compared with untreated ewes grazing the same pastures on each of 3 farms. Treated breeding ewes had significantly increased greasy fleece weights (GFW, 6.5% and 7.1%) compared with untreated breeding ewes, on 2 of 3 farms but treatment caused no significant increase in the GFW of non-breeding ewes. Other benefits of treatment on all farms were a significant increase in body weight gain (from 1.7 to 3.7 kg) and a significant decrease in the weight of dag removed at crutching (from 42 to 622 g). These benefits occurred despite the presence on each farm of worms resistant to benzimidazoles. One disadvantage of treatment was an increase in mean fibre diameter of wool from treated ewes of from 0.12 to 0.41 microns. This increase reduces the value of the wool. Partial budgets indicated a net loss of from 8 to 62 cents per ewe for treatment. However, potential benefits such as increased growth rate and wool production from lambs of treated ewes were not included in the analysis. On one farm ewes were classified as 'susceptible' to severe dag if they had a dag score > or = 4 at the time of capsule treatment. Ewes classified as 'susceptible' were about 7 times more likely to develop severe dag than were other ewes. There was no significant difference between the GFW of untreated 'susceptible' ewes and untreated ewes not classified as 'susceptible'.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J W Larsen
- Faculty of Veterinary Science, University of Melbourne, Werribee, Victoria
| | | | | |
Collapse
|
38
|
Van Damme W. Supply of ivermectin in developing countries. Lancet 1993; 341:634-5. [PMID: 8094862 DOI: 10.1016/0140-6736(93)90397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|