scholarly journals The impact and cost‐effectiveness of community‐basedHIVself‐testing in sub‐Saharan Africa: a health economic and modelling analysis

2019 ◽  
Vol 22 (S1) ◽  
pp. e25243 ◽  
Author(s):  
Valentina Cambiano ◽  
Cheryl C Johnson ◽  
Karin Hatzold ◽  
Fern Terris‐Prestholt ◽  
Hendy Maheswaran ◽  
...  
2019 ◽  
Author(s):  
Elizabeth C. Lee ◽  
Andrew S. Azman ◽  
Joshua Kaminsky ◽  
Sean M. Moore ◽  
Heather S. McKay ◽  
...  

AbstractBackgroundIn May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize chances of success.Methods and FindingsWe compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, disability-adjusted life-years, and cost-effectiveness with models that account for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI: 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI: 33.2-34.8). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI: 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI: 270,319-277,002) and 109,817 (95% CI: 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs $1,843 (95% CI: 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach did not project annual changes in baseline cholera risk or incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors.ConclusionsOur study suggests that geographic targeting is critical to the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near-term, without rapid progress in developing water and sanitation services, our results suggest that vaccine use alone are unlikely to allow us to achieve the 2030 goals.


2018 ◽  
Author(s):  
Andrew Farmer ◽  
Kirsten Bobrow ◽  
Natalie Leon ◽  
Nicola Williams ◽  
Enita Phiri ◽  
...  

UNSTRUCTURED Background: Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicines regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making best use of medicine in low and middle-income settings are scarce. Mobile phones are widely available in these settings including among people with diabetes, and linked technologies such as SMS-text messaging have shown promise in delivering low-cost interventions efficiently. However, evidence that these interventions will work when carried out at a larger scale, and of the extent to which they will improve health outcomes when added to usual care is limited. Methods: We will carry out a randomised clinical trial in two contrasting settings in sub-Saharan Africa, Cape Town in South Africa and Lilongwe in Malawi, to provide information about the impact of sending brief automated messages via SMS text-messaging. The messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We will allocate patients using a randomly-generated assignment plan to receive either intervention messages, or an active control. We will follow up people for twelve months measuring important risk factors for poor health outcomes and complications in diabetes so we can estimate potential health benefits, including HbA1c as a marker for long-term blood glucose control and blood pressure control, We will record the costs of doing this, and estimate cost-effectiveness. We will also capture collection of medication and assess the reception of the intervention by participants and health care workers. Discussion: The knowledge gained will have wide application and advance the evidence base for effectiveness of mobile-phone based brief text-messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness that will further inform policy development and decision-making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration: ISRCTN70768808 (Registered on 3 August 2015)


2020 ◽  
Vol 2020 (10-3) ◽  
pp. 238-246
Author(s):  
Olga Dzhenchakova

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.


2021 ◽  
Vol 13 (4) ◽  
pp. 1780
Author(s):  
Chima M. Menyelim ◽  
Abiola A. Babajide ◽  
Alexander E. Omankhanlen ◽  
Benjamin I. Ehikioya

This study evaluates the relevance of inclusive financial access in moderating the effect of income inequality on economic growth in 48 countries in Sub-Saharan Africa (SSA) for the period 1995 to 2017. The findings using the Generalised Method of Moments (sys-GMM) technique show that inclusive financial access contributes to reducing inequality in the short run, contrary to the Kuznets curve. The result reveals a negative effect of financial access on the relationship between income inequality and economic growth. There is a positive net effect of inclusive financial access in moderating the impact of income inequality on economic growth. Given the need to achieve the Sustainable Development Targets in the sub-region, policymakers and other stakeholders of the economy must design policies and programmes that would enhance access to financial services as an essential mechanism to reduce income disparity and enhance sustainable economic growth.


2021 ◽  
Vol 13 (3) ◽  
pp. 525
Author(s):  
Yann Forget ◽  
Michal Shimoni ◽  
Marius Gilbert ◽  
Catherine Linard

By 2050, half of the net increase in the world’s population is expected to reside in sub-Saharan Africa (SSA), driving high urbanization rates and drastic land cover changes. However, the data-scarce environment of SSA limits our understanding of the urban dynamics in the region. In this context, Earth Observation (EO) is an opportunity to gather accurate and up-to-date spatial information on urban extents. During the last decade, the adoption of open-access policies by major EO programs (CBERS, Landsat, Sentinel) has allowed the production of several global high resolution (10–30 m) maps of human settlements. However, mapping accuracies in SSA are usually lower, limited by the lack of reference datasets to support the training and the validation of the classification models. Here we propose a mapping approach based on multi-sensor satellite imagery (Landsat, Sentinel-1, Envisat, ERS) and volunteered geographic information (OpenStreetMap) to solve the challenges of urban remote sensing in SSA. The proposed mapping approach is assessed in 17 case studies for an average F1-score of 0.93, and applied in 45 urban areas of SSA to produce a dataset of urban expansion from 1995 to 2015. Across the case studies, built-up areas averaged a compound annual growth rate of 5.5% between 1995 and 2015. The comparison with local population dynamics reveals the heterogeneity of urban dynamics in SSA. Overall, population densities in built-up areas are decreasing. However, the impact of population growth on urban expansion differs depending on the size of the urban area and its income class.


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