scholarly journals Is Option B+ the best choice?

2013 ◽  
Vol 14 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Coutsoudis A ◽  
A Goga ◽  
C Desmond ◽  
P Barron ◽  
V Black ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Infant Health ◽  
Hiv Transmission ◽  
Clinical Trial Data ◽  
Population Level ◽  
Cost Effective ◽  
Economic Benefits ◽  
Middle Income ◽  
Targeted Interventions ◽  
Local Evidence

This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8] The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+. Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence. S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898

scholarly journals Evaluating costs and health consequences of sick leave strategies against pandemic and seasonal influenza in Norway using a dynamic model

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027832 ◽  
Author(s):  
Christina Hansen Edwards ◽  
Gianpaolo Scalia Tomba ◽  
Ivar Sonbo Kristiansen ◽  
Richard White ◽  
Birgitte Freiesleben de Blasio
Keyword(s):  
Sick Leave ◽  
Health Benefit ◽  
Population Data ◽  
Population Level ◽  
Cost Effective ◽  
Economic Benefits ◽  
Illness Severity ◽  
Sensitivity Analyses ◽  
Economic Losses ◽  
High Morbidity

ObjectivesTo quantify population-level health and economic consequences of sick leave among workers with influenza symptoms.InterventionsCompared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2.MethodsA dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective.ResultsCompared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%–99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses.ConclusionsPrompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.

scholarly journals The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 354 ◽  
Author(s):  
Penjani Mkambula ◽  
Mduduzi N. N. Mbuya ◽  
Laura A. Rowe ◽  
Mawuli Sablah ◽  
Valerie M. Friesen ◽  
...  
Keyword(s):  
Data Exchange ◽  
Large Scale ◽  
Population Level ◽  
Cost Effective ◽  
Food Fortification ◽  
Maize Flour ◽  
Fortified Foods ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Coverage

Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (<50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.

scholarly journals Cost and cost-effectiveness of a parenting programme to prevent violence against adolescents in South Africa

2019 ◽  
Vol 4 (3) ◽  
pp. e001147 ◽  
Author(s):  
Alice Redfern ◽  
Lucie D Cluver ◽  
Marisa Casale ◽  
Janina I Steinert
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Low Income ◽  
Emotional Abuse ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Economic Benefits ◽  
Parenting Programme ◽  
Middle Income

IntroductionThis paper presents the costs and cost-effectiveness of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a non-commercialised parenting programme aimed at preventing violence against adolescents in low-income and middle-income countries.MethodsThe effectiveness of Sinovuyo Teen was evaluated with a cluster randomised controlled trial in 40 villages and peri-urban townships in the Eastern Cape of South Africa from 2015 to 2016. The costs of implementation were calculated retrospectively and models of costs at scale estimated, from the perspective of the programme provider. Cost-effectiveness analysis considers both the cost per incident of abuse averted, and cost per disability-adjusted life year averted. Potential economic benefits from the societal perspective were estimated by developing a framework of possible savings.ResultsThe total implementation cost for Sinovuyo Teen over the duration of the trial was US$135 954, or US$504 per family enrolled. Among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% CI 29 to 118 incidents averted). During the trial, the total cost per incident of physical or emotional abuse averted was US$1837, which is likely to decrease to approximately US$972 if implemented at scale. By comparison, the economic benefits of averting abuse in South Africa are large with an estimated lifetime saving of US$2724 minimum per case.ConclusionParenting programmes are a cost-effective intervention to prevent the abuse of adolescents by their caregivers in South Africa, when compared with existing violence prevention programmes and cost-effectiveness thresholds based on GDP per capita.

scholarly journals Syringe sharing among people who inject drugs in Tijuana: before and after the Global Fund

Salud Mental ◽  
2019 ◽  
Vol 42 (4) ◽  
pp. 149-156 ◽  
Author(s):  
Annick Bórquez ◽  
Daniela Abramovitz ◽  
Javier Cepeda ◽  
Gudelia Rangel ◽  
Patricia González-Zúñiga ◽  
...  
Keyword(s):  
Risk Behaviors ◽  
Global Fund ◽  
People Who Inject Drugs ◽  
Hiv Transmission ◽  
Population Level ◽  
Syringe Sharing ◽  
Middle Income ◽  
Segmented Regression Analysis ◽  
Before And After ◽  
Needle And Syringe Programs

Introduction. Needle and syringe programs (NSP) reduce syringe sharing and HIV transmission among people who inject drugs (PWID). However, their effectiveness relies on sufficient individual and population level coverage. In Tijuana, Mexico, the Global Fund (GF) supported NSP during 10/2011-12/2013, but withdrew funds at the end of 2013 following Mexico’s re-classification as an upper-middle income country. Objective. We tested the hypothesis of higher NSP access and lower receptive syringe sharing among PWID in Tijuana during the GF support period compared to pre-GF initiation and post-GF withdrawal. Method. We used data from an ongoing cohort study of PWID in Tijuana (03/2011-10/2015) to implement a segmented regression analysis investigating changes in the self-reported probability of NSP access, reported difficulty in finding sterile syringes and receptive syringe sharing before GF initiation and after GF discontinuation. Results. We found a large significant increase in the probability of NSP access (+.07) and decrease in receptive syringe sharing (-.23) right after GF initiation, which continued over the GF period. Subsequently, we found a significant decline in NSP access (-.05) and an increase in receptive syringe sharing (+.02) right after post-GF withdrawal, which continued thereafter. Discussion and conclusion. We demonstrated significant temporal changes in NSP access and receptive syringe sharing among PWID in Tijuana after GF initiation and withdrawal consistent with our hypothesis. Coordinated efforts with local authorities are needed to sustain major coverage NSP in settings receiving GF or external aid to guarantee continuity of harm reduction services and prevent reinside in risk behaviors associated with HIV transmission.

Heterogeneity in Cost-Effectiveness Analysis

2019 ◽  
Author(s):  
Ciaran N. Kohli-Lynch ◽  
Andrew H. Briggs
Keyword(s):  
Cost Effectiveness ◽  
Decision Rules ◽  
Population Level ◽  
Cost Effective ◽  
Economic Benefits ◽  
Cost Effectiveness Analysis ◽  
Decision Makers ◽  
Effectiveness Analysis ◽  
Healthcare Interventions ◽  
Effectiveness Studies

Cost-effectiveness analysis is conducted with the aim of maximizing population-level health outcomes given an exogenously determined budget constraint. Considerable health economic benefits can be achieved by reflecting heterogeneity in cost-effectiveness studies and implementing interventions based on this analysis. The following article describes forms of subgroup and heterogeneity in patient populations. It further discusses traditional decision rules employed in cost-effectiveness analysis and shows how these can be adapted to account for heterogeneity. This article discusses the theoretical basis for reflecting heterogeneity in cost-effectiveness analysis and methodology that can be employed to conduct such analysis. Reflecting heterogeneity in cost-effectiveness analysis allows decision-makers to define limited use criteria for treatments with a fixed price. This ensures that only those patients who are cost-effective to treat receive an intervention. Moreover, when price is not fixed, reflecting heterogeneity in cost-effectiveness analysis allows decision-makers to signal demand for healthcare interventions and ensure that payers achieve welfare gains when investing in health.

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

2020 ◽  
Vol 81 (2) ◽  
pp. 97-104
Author(s):  
Kathleen Chan ◽  
Kyly C. Whitfield
Keyword(s):  
Infant Feeding ◽  
Infant Health ◽  
Population Level ◽  
Economic Benefits ◽  
Postnatal Period ◽  
Sociocultural Factors ◽  
Breastfeeding Promotion ◽  
Individual Level ◽  
Breastfeeding Knowledge ◽  
Knowledge And Attitudes

Exclusive breastfeeding to 6 months with continued breastfeeding up to 2 years and beyond are well-established infant feeding recommendations based on evidence that breastfeeding has unparalleled maternal and infant health benefits as well as environmental and economic benefits. As with many high-income countries, breastfeeding rates remain suboptimal with only a quarter of Canadian and European infants receiving breast milk exclusively for the first 6 months. Breastfeeding promotion efforts have largely targeted caregivers in the prenatal and postnatal period; however, breastfeeding outcomes have been shown to be associated with broader sociocultural factors. Noncaregivers play an influential role in infant feeding at both an individual level (e.g., cues and input from health care practitioners and caregivers’ social networks; as future parents) as well as a broader population level (sociocultural norms and policy decisions). This paper outlines recent research on breastfeeding knowledge and attitudes of noncaregivers by population subgroup. Positive correlations have been identified between breastfeeding attitudes, infant feeding knowledge, breastfeeding exposure, and breastfeeding intention among different subgroups; however, key knowledge gaps, lack of exposure to breastfeeding, and negative public perceptions of breastfeeding persist. Dietitians can advocate for breastfeeding promotion strategies that consider the role of noncaregivers to address sociocultural norms around breastfeeding.

scholarly journals Should All Pregnant Women be Screened for Syphilis?

2007 ◽  
Vol 3 (5) ◽  
pp. 547-555 ◽  
Author(s):  
Anne Buvé
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Congenital Syphilis ◽  
Cost Effective ◽  
Industrialized Countries ◽  
Serological Tests ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adverse Pregnancy ◽  
Low And Middle Income

In industrialized countries, the incidence of syphilis has decreased dramatically since the discovery of penicillin in the 1940s. However, syphilis and congenital syphilis are far from eradicated, especially in low- and middle-income countries. Syphilis in pregnant women is a cause of adverse pregnancy outcomes that can be prevented by screening for syphilis and early treatment in pregnancy. Several studies have found screening of pregnant women for syphilis to be a highly cost-effective intervention, even if the prevalence of syphilis is low. Obstacles to universal screening of pregnant women include low awareness of syphilis and low quality of antenatal care and healthcare in general in many low- and middle-income countries. For these settings, we need simpler and more reliable serological tests for syphilis, but we also need to strengthen health services in general to ensure sustainable antenatal care services to ensure sustainability of syphilis screening programmes.

scholarly journals Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1118
Author(s):  
Rebecca Olson ◽  
Breda Gavin-Smith ◽  
Chiara Ferraboschi ◽  
Klaus Kraemer
Keyword(s):  
Large Scale ◽  
Cost Effective ◽  
Economic Benefits ◽  
Cognitive Capacity ◽  
Nutritional Deficiencies ◽  
Food Fortification ◽  
Public And Private ◽  
Middle Income ◽  
Point Of Use ◽  
Public And Private Sector

Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.

ASSESSMENT OF THE PLATELET COUNT IN THE PREGNANT WOMEN IN IGIMS, PATNA, BIHAR

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Tanwi Singh ◽  
Anshuman Sinha
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Screening Test ◽  
Low Cost ◽  
Medical Science ◽  
Cost Effective ◽  
Platelet Indices ◽  
Increased Risk ◽  
Low Platelet Count ◽  
Severity Of The Disease

The major risk associated with low platelet count in pregnancy is the increased risk of bleeding during the childbirth or post that. There is an increased blood supply to the uterus during pregnancy and the surgical procedure requires cutting of major blood vessels. Women with thrombocytopenia are at increased risk of losing excessive blood. The risk is more in case of caesarean delivery as compared to vaginal delivery. Hence based on above findings the present study was planned for Assessment of the Platelet Count in the Pregnant Women in IGIMS, Patna, Bihar. The present study was planned in Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India. The present study was planned from duration of January 2019 to June 2019. In the present study 200 pregnant females samples received for the platelet estimation were enrolled in the present study. Clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease. Platelet count is a simple, low cost, and rapid routine screening test. Hence the data generated from the present study concludes that platelet count can be used as a simple and cost effective tool to monitor the progression of preeclampsia, thereby preventing complications to develop during the gestational period. Keywords: Platelet Count, Pregnant Women, IGIMS, Patna, Bihar, etc.

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