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A decline in the incidence of invasive non-typhoidal Salmonella infection in The Gambia temporally associated with a decline in malaria infection
No full textBACKGROUND: Malaria is a risk factor for invasive non-typhoidal Salmonella (NTS) infection in children. In the last 10 years, indices of malaria infection in The Gambia have fallen substantially. METHODS: We compared temporal trends of childhood malaria and NTS infection in two Gambian locations. In Fajara, on the coast, the incidence of NTS infection at three time points between 1979 and 2005 was compared to the percentage of malaria positive outpatient thick blood films and the percentage of admissions associated with malaria over time. In Basse, in the eastern part of the country, the incidence of NTS infection at three time points between 1989 and 2008 was compared to the prevalence of malaria parasitaemia at four time points between 1992 and 2008. RESULTS: The estimated incidence of NTS infection in Fajara fell from 60 (1979-1984) to 10 (2003-05) cases per 100,000 person years. The proportion of outpatients in Fajara with suspected malaria who were parasitaemic fell from 33% (1999) to 6% (2007) while the proportion of admissions associated with malaria fell from 14.5% (1999) to 5% (2007). In Basse, the estimated incidence of NTS infection fell from 105 (1989-1991) to 29 (2008) cases per 100,000 person years while the prevalence of malaria parasitaemia fell from 45% (1992) to 10% (2008). The incidence of pneumococcal bacteraemia in Fajara and Basse did not fall over the study period. CONCLUSIONS: These data support an association between malaria and NTS infection. Reductions in malaria infection may be associated with reduced rates of invasive childhood NTS infectio
Patient costs of accessing collaborative tuberculosis and human immunodeficiency virus interventions in Ethiopia
No full textOBJECTIVE: To measure the patient costs of tuberculosis and human immunodeficiency virus (TB-HIV) services from hospital-based pilot sites for collaborative TB-HIV interventions in Ethiopia. METHODS: Costs of pre-treatment and treatment for a range of TB-HIV services provided as part of a collaborative TB-HIV programme in Ethiopia were estimated. RESULTS: Patient costs were found to be substantial compared to income levels. Pre-treatment costs were 35% of annual household income for TB patients (with no HIV), 33% for those with TB and HIV and 40% for those with HIV (with no TB). Pre-treatment direct costs were particularly significant. Patient costs during treatment for TB range between 49% and 71% of annual household income. Patient costs in the first year of anti-retroviral treatment were 21% of annual household income. Costs fell as treatment progressed. CONCLUSION: Our results highlight the need to mitigate the economic impact on patients of treatment for TB and HIV/AIDS (acquired immune-deficiency syndrome) in low-income countries. Collaborative TB-HIV services may provide an opportunity to reduce pre-treatment costs by providing an additional channel for the early diagnosis of HIV. Costs may be further reduced by ensuring that diagnostics are provided free of charge, providing social support at the start of treatment and bringing services closer to the patien
Translating knowledge into policy and action to promote health equity: the Health Equity Fund policy process in Cambodia 2000-2008
No full textOBJECTIVES: To understand how knowledge is used to inform policy on Health Equity Funds (HEFs) in Cambodia; and to draw lessons for translating knowledge into health policies that promote equity. METHODS: We used a knowledge translation framework to analyse the HEF policy process between 2000 and 2008. The analysis was based on data from document analysis, key informant interviews and authors' observations. RESULTS: The HEF policy-making process in Cambodia was both innovative and incremental. Insights from pilot projects were gradually translated into national health policy. The uptake of HEF in health policy was determined by three important factors: a policy context conducive to the creation, dissemination and adoption of lessons gained in HEF pilots; the credibility and timeliness of HEF knowledge generated from pilot projects; and strong commitment, relationships and networks among actors. CONCLUSIONS: Knowledge locally generated through pilot projects is crucial for innovative health policy. It can help adapt blueprints and best practices to a local context and creates ownership. While international organisations and donors can take a leading role in innovative interventions in low-income countries, the involvement of government policy makers is necessary for their scaling-u
Infection with versus exposure to Taenia solium: what do serological test results tell us?
No full textTaenia solium cysticercosis is an endemic zoonosis in many developing countries. Serological tests are the most appropriate diagnostic tools to understand the transmission dynamics of the parasite, but the performances of these methods in such a setting are not known. A south Ecuadorian human population living in an endemic area was tested using three common serological tests. Because none of them is a gold standard, a Bayesian Latent Class analysis was used to estimate the test characteristics. Two definitions of a case were considered to differentiate between prevalence of current infection and prior exposure to the parasite. Differences between the performances of the same test in function of the definition of a case were observed. This study shows that test results and prior information should be interpreted carefully in a Bayesian analysis framework, particularly when the latter is based on clinical studie
