45 research outputs found
Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage
No full textBackground: A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity.
Methods: We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages.
Results: Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA—pursuing LF eradication as soon as possible—was most likely to be cost-effective above a willingness to pay threshold of US483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US14.4 billion.
Conclusions: In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes
What is needed to eradicate lymphatic filariasis? : A model-based assessment on the impact of scaling up mass drug administration programs
No full textLymphatic filariasis (LF) is a neglected tropical disease for which more than a billion people in 73 countries are thought to be at-risk. At a global level, the efforts against LF are designed as an elimination program. However, current efforts appear to aim for elimination in some but not all endemic areas. With the 2020 goal of elimination looming, we set out to develop plausible scale-up scenarios to reach global elimination and eradication. We predict the duration of mass drug administration (MDA) necessary to reach local elimination for a variety of transmission archetypes using an existing model of LF transmission, estimate the number of treatments required for each scenario, and consider implications of rapid scale-up.; We have defined four scenarios that differ in their geographic coverage and rate of scale-up. For each scenario, country-specific simulations and calculations were performed that took into account the pre-intervention transmission intensity, the different vector genera, drug regimen, achieved level of population coverage, previous progress toward elimination, and potential programmatic delays due to mapping, operations, and administration.; Our results indicate that eliminating LF by 2020 is unlikely. If MDA programs are drastically scaled up and expanded, the final round of MDA for LF eradication could be delivered in 2028 after 4,159 million treatments. However, if the current rate of scale-up is maintained, the final round of MDA to eradicate LF may not occur until 2050.; Rapid scale-up of MDA will decrease the amount of time and treatments required to reach LF eradication. It may also propel the program towards success, as the risk of failure is likely to increase with extended program duration
Lessons learned from developing an eradication investment case for lymphatic filariasis
No full textIn the last few years, the concepts of disease elimination and eradication have again gained consideration from the global health community, with Guinea worm disease (dracunculiasis) on track to become the first parasitic disease to be eradicated. Given the many complex and interlinking issues involved in committing to a disease eradication initiative, such commitments must be based on a solid assessment of a broad range of factors. In this chapter, we discuss the value and implications of undertaking a systematic and fact-based analysis of the overall situation prior to embarking on an elimination or eradication programme. As an example, we draw upon insights gained from a series of lymphatic filariasis (LF) studies from our research group that adopted an eradication investment case (EIC) framework. The justification for EICs, and related epidemiological, geospatial and other mathematical/operational research modelling, stems from the necessity for proper planning prior to committing to disease eradication. Across all considerations for LF eradication, including: time, treatments, level of investments necessary, health impact, cost-effectiveness, and broader economic benefits, scaling-up mass drug administration coverage to all endemic communities immediately provided the most favourable results. The coherent and consistent pursuit of eradication goals, operationally tailored to a given socioecological system and based on integrated measures of available tools will lead relatively rapidly to elimination in many parts of endemic areas and provide the cornerstone towards eradication
Macon, Celie, Patricia and Me
No full textThis article offers a reflective analysis on how the author came to a deeper understanding of transformative learning while collaborating on a research project with Patricia Cranton from 2012-2014, resulting in A Novel Idea: Researching Transformative Learning in Fiction, published by Sense Publishers in 2015. They read six contemporary novels and then analyzed the transformative experiences of the main characters. They created imagined dialogues between the characters to explore emergent themes from the research. They further explored the themes through dialogues between the two of them. Through her work and relationship with Patricia Cranton, Randee had the opportunity to explore new and exciting ways to understand transformative learning and to contribute to the development of theory. This writing is her tribute to Patricia.</p
Eradicating lymphatic filariasis
No full textThe neglected tropical disease, lymphatic filariasis (LF), is endemic in 73 countries, primarily among impoverished populations. Infection with LF can damage the lymphatic system, causing permanent disability including hydrocele, lymphedema, and elephantiasis. In 1997, LF was named by the World Health Assembly as a potentially eradicable disease, in part because it is preventable through once yearly treatment administered through mass drug administration (MDA) using albendazole with ivermectin or diethylcarbamazine citrate (DEC). This PhD thesis presents evidence-based guidance on the rationale for investing in LF eradication by providing estimates on the duration of MDA necessary and number of treatments needed to reach local elimination for a variety of transmission archetypes, as well as the potential economic and financial investment needed, the potential health impact and cost-effectiveness of eradicating LF, and the potential health systems savings and gains in worker productivity as a result of averted LF-related morbidity. The results show that across all considerations, including: time, treatments, level of investments necessary, health impact, cost-effectiveness, and broader economic benefits, scaling-up MDA coverage to all endemic communities immediately provides the most favorable results. Ultimately, though, the success of eradicating LF will depend on the political engagement and enthusiasm at all levels.
How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis.
No full textLymphatic filariasis (LF), a neglected tropical disease (NTD) preventable through mass drug administration (MDA), is one of six diseases deemed possibly eradicable. Previously we developed one LF elimination scenario, which assumes MDA scale-up to continue in all countries that have previously undertaken MDA. In contrast, our three previously developed eradication scenarios assume all LF endemic countries will undertake MDA at an average (eradication I), fast (eradication II), or instantaneous (eradication III) rate of scale-up. In this analysis we use a micro-costing model to project the financial and economic costs of each of these scenarios in order to provide evidence to decision makers about the investment required to eliminate and eradicate LF.Costing was undertaken from a health system perspective, with all results expressed in 2012 US dollars (USD). A discount rate of 3% was applied to calculate the net present value of future costs. Prospective NTD budgets from LF endemic countries were reviewed to preliminarily determine activities and resources necessary to undertake a program to eliminate LF at a country level. In consultation with LF program experts, activities and resources were further reviewed and a refined list of activities and necessary resources, along with their associated quantities and costs, were determined and grouped into the following activities: advocacy and communication, capacity strengthening, coordination and strengthening partnerships, data management, ongoing surveillance, monitoring and supervision, drug delivery, and administration. The costs of mapping and undertaking transmission assessment surveys and the value of donated drugs and volunteer time were also accounted for. Using previously developed scenarios and deterministic estimates of MDA duration, the financial and economic costs of interrupting LF transmission under varying rates of MDA scale-up were then modelled using a micro-costing approach. The elimination scenario, which includes countries that previously undertook MDA, is estimated to cost 929 million USD (95% Credible Interval: 884m-972m). Proceeding to eradication is anticipated to require a higher financial investment, estimated at 1.24 billion USD (1.17bn-1.30bn) in the eradication III scenario (immediate scale-up), with eradication II (intensified scale-up) projected at 1.27 billion USD (1.21bn-1.33bn), and eradication I (slow scale-up) estimated at 1.29 billion USD (1.23bn-1.34bn). The economic costs of the eradication III scenario are estimated at approximately 7.57 billion USD (7.12bn-7.94bn), while the elimination scenario is projected to have an economic cost of 5.21 billion USD (4.91bn-5.45bn). Countries in the AFRO region will require the greatest investment to reach elimination or eradication, but also stand to gain the most in cost savings. Across all scenarios, capacity strengthening and advocacy and communication represent the greatest financial costs, whereas mapping, post-MDA surveillance, and administration comprise the least.Though challenging to implement, our results indicate that financial and economic savings are greatest under the eradication III scenario. Thus, if eradication for LF is the objective, accelerated scale-up is projected to be the best investment
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Ten Spurs: the best of the best
No full textAnnual publication of The Mayborn Literary Nonfiction Conference held by the Frank W. Mayborn Graduate Institute of Journalism. This volume includes the ten literary non-fiction pieces selected from the conference submissions as well as illustrations, author biographies, and additional commentary about the inspiration behind each of the stories
How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis
No full textIntroduction
Lymphatic filariasis (LF), a neglected tropical disease (NTD) preventable through mass drug administration (MDA), is one of six diseases deemed possibly eradicable. Previously we developed one LF elimination scenario, which assumes MDA scale-up to continue in all countries that have previously undertaken MDA. In contrast, our three previously developed eradication scenarios assume all LF endemic countries will undertake MDA at an average (eradication I), fast (eradication II), or instantaneous (eradication III) rate of scale-up. In this analysis we use a micro-costing model to project the financial and economic costs of each of these scenarios in order to provide evidence to decision makers about the investment required to eliminate and eradicate LF.
Methodology/Key findings
Costing was undertaken from a health system perspective, with all results expressed in 2012 US dollars (USD). A discount rate of 3% was applied to calculate the net present value of future costs. Prospective NTD budgets from LF endemic countries were reviewed to preliminarily determine activities and resources necessary to undertake a program to eliminate LF at a country level. In consultation with LF program experts, activities and resources were further reviewed and a refined list of activities and necessary resources, along with their associated quantities and costs, were determined and grouped into the following activities: advocacy and communication, capacity strengthening, coordination and strengthening partnerships, data management, ongoing surveillance, monitoring and supervision, drug delivery, and administration. The costs of mapping and undertaking transmission assessment surveys and the value of donated drugs and volunteer time were also accounted for. Using previously developed scenarios and deterministic estimates of MDA duration, the financial and economic costs of interrupting LF transmission under varying rates of MDA scale-up were then modelled using a micro-costing approach. The elimination scenario, which includes countries that previously undertook MDA, is estimated to cost 929 million USD (95% Credible Interval: 884m-972m). Proceeding to eradication is anticipated to require a higher financial investment, estimated at 1.24 billion USD (1.17bn-1.30bn) in the eradication III scenario (immediate scale-up), with eradication II (intensified scale-up) projected at 1.27 billion USD (1.21bn-1.33bn), and eradication I (slow scale-up) estimated at 1.29 billion USD (1.23bn-1.34bn). The economic costs of the eradication III scenario are estimated at approximately 7.57 billion USD (7.12bn-7.94bn), while the elimination scenario is projected to have an economic cost of 5.21 billion USD (4.91bn-5.45bn). Countries in the AFRO region will require the greatest investment to reach elimination or eradication, but also stand to gain the most in cost savings. Across all scenarios, capacity strengthening and advocacy and communication represent the greatest financial costs, whereas mapping, post-MDA surveillance, and administration comprise the least.
Conclusions/Significance
Though challenging to implement, our results indicate that financial and economic savings are greatest under the eradication III scenario. Thus, if eradication for LF is the objective, accelerated scale-up is projected to be the best investment
Sociocultural concepts of pandemic influenza and determinants of community vaccine acceptance in Pune, India
No full textVaccines are considered one of public health’s greatest achievements. Yet, public concerns and hesitancy towards acceptance of vaccines has been noted around the world for various vaccines. Limited vaccine uptake against influenza A (H1N1) was a problem during the 2009-2010 pandemic. Ensuring the ability to rapidly produce large quantities of an efficacious vaccine has been a focus of pandemic preparedness at the global and national levels. Notwithstanding the importance of these preparedness measures, its availability and clinical efficacy alone may not be sufficient for the vaccine to be effective at a community level.
Culture has a powerful influence on the understanding of sickness and illness-related behaviour. The framework of cultural epidemiology used in this thesis integrates the local validity of anthropology and the explanatory power of epidemiology to clarify the cultural basis of vaccine hesitancy and acceptance.
Despite cross-cultural differences and an acknowledged need for country-specific studies, relatively little research has focussed on pandemic influenza vaccine hesitancy in lower income settings. A mixed-methods research study was conducted in urban and rural Pune, a hotspot of the influenza pandemic in India. The aim was to study local sociocultural features of illness and determinants of pandemic influenza vaccine acceptance from a community perspective.
This work is a contribution to global advances in the study of vaccine hesitancy and it underscores the value of sociocultural study and community preferences in planning effective vaccine action
MULTIPLE DEGREE OF FREEDOM PROSTHETIC ELBOW JOINT: DESIGN OF A PROSTHETIC ELBOW JOINT WITH FLUID JOINT MEMBRANE SAC TO ENABLE MORE FLUID ROTATIONAL MOVEMENT
No full textabstract: Current prosthetic designs have limitations with properly representing the full range of motion that a human elbow provides. The structure of the biological elbow was analyzed to assess how it produces the flexion/extension and pronation/supination movement. The humerus and ulna have a hinge joint relationship, the humerus acts as a concave cylinder and the ulna acts as a convex cylinder, and the radius and ulna have a pivot joint relationship, the radius rotates around the ulna on a single axis. The joint cavity is responsible for flexion/extension and pronation/supination and also provides lubrication and strength of the elbow joint. A new design of a prosthetic elbow joint was created to mimic human elbow movements. The design uses a ball-and-socket socket joint that allows for flexion/extension and pronation/supination movement while incorporating a hydrogel lining to provide lubrication and restriction of pronation/supination to not go beyond human capacity. This joint was designed to be assembled from the back to the front; the socket has a cap on the outside that would allow for the ball to be inserted inside the socket and the cap be placed onto the socket. Once the final design and assembly process was completed, analysis of the design was performed to determine whether the design would be functional and reliable. The analysis concluded that the design and the material chosen for the design would not result in fracture and would also result in a large factor of safety, thus indicating that the prosthetic joint would not be easily damaged. Further research and development of this prosthetic elbow joint could be performed to allow it to be interchangeable with hinge joints that are currently used. Future work will include further research on the hydrogel lubricant, further analysis of the design and possible design modifications to allow for use in current practices and to account for the weak points in the current design. In summary, a successful redesign of the elbow joint prosthetic that provides low friction flexion/extension as well as pronation/supination movement will better serve the needs of individuals with amputation
