...of this population-based approach, the disability weights for visual impairment, blindness, and troublesome itch have changed considerably and should better reflect our ideas and beliefs as a ...society of what constitutes health. According to our updated estimates, skin disease is now the most important contributor to the burden of onchocerciasis, rather than eye disease. ...the true disease burden of onchocercal skin disease (and the burden averted by APOC) is still larger than we estimate here, as our updated estimates do not include disfiguring skin disease, or other sequelae potentially associated with onchocerciasis, such as epilepsy 14 and head-nodding syndrome 15.
While there is some evidence to suggest an added benefit to combined deworming and vitamin A supplementation, a number of studies in similar settings have either been unable to reproduce this ...positive outcome or have not specifically tested the combined intervention 19, 20. ...while the WHO and the United Nations Children's Fund (UNICEF) recommend that benzimidazole anthelminthics can be safely coadministered with vitamin A 21, the potential synergies of deworming with vitamin A supplementation are neither well documented nor consistent. ...an approach is currently adopted as part of clinical case management and is appropriate to the setting of antenatal care or the management of severe anemia. ...in populations in which hookworm is a significant hazard and MDA for deworming is offered, it would be useful to ensure that those responsible for case management in the community were aware of the particular synergies with iron supplementation, especially for pregnant women.
Objective
To provide a systematic review of economic evaluations that has been conducted for onchocerciasis interventions, to summarise current key knowledge and to identify research gaps.
Method
A ...systematic review of the literature was conducted on the 8th of August 2018 using the PubMed (MEDLINE) and ISI Web of Science electronic databases. No date or language stipulations were applied to the searches.
Results
We identified 14 primary studies reporting the results of economic evaluations of onchocerciasis interventions, seven of which were cost‐effectiveness analyses. The studies identified used a variety of different approaches to estimate the costs of the investigated interventions/programmes. Originally, the studies only quantified the benefits associated with preventing blindness. Gradually, methods improved and also captured onchocerciasis‐associated skin disease. Studies found that eliminating onchocerciasis would generate billions in economic benefits. The majority of the cost‐effectiveness analyses evaluated annual mass drug administration (MDA). The estimated cost per disability‐adjusted life year (DALY) averted of annual MDA varies between US$3 and US$30 (cost year variable).
Conclusions
The cost benefit and cost effectiveness of onchocerciasis interventions have consistently been found to be very favourable. This finding provides strong evidential support for the ongoing efforts to eliminate onchocerciasis from endemic areas. Although these results are very promising, there are several important research gaps that need to be addressed as we move towards the 2020 milestones and beyond.
Objectif
Fournir une analyse systématique des évaluations économiques réalisées pour les interventions contre l'onchocercose, résumer les principales connaissances actuelles et identifier les lacunes de la recherche.
Méthode
Une revue systématique de la littérature a été menée le 8 août 2018 en utilisant les bases de données électroniques PubMed (Medline) et ISI Web of Science. Aucune indication de date ou de langue n'a été appliquée aux recherches.
Résultats
Nous avons identifié 14 études principales rapportant sur les résultats d’évaluations économiques d'interventions contre l'onchocercose, dont 7 étaient des analyses coût‐efficacité. Les études identifiées ont utilisé diverses approches pour estimer les coûts des interventions/programmes étudiés. A l'origine, les études ne mesuraient que les avantages associés à la prévention de la cécité. Progressivement, les méthodes se sont améliorées et ont également capturé les maladies de la peau associées à l'onchocercose. Les études ont montré que l’élimination de l'onchocercose générerait des milliards de bénéfices économiques. La majorité des analyses coût‐efficacité ont évalué l'administration annuelle en masse de médicaments (AMD). Le coût estimé par année de vie ajustée par rapport à l'incapacité (DALY) corrigé pour l’AMD annuelle varie entre 3 et 30 USD (variable de l'année de coût).
ConclusionsLe rapport coût‐efficacité et la rentabilité des interventions contre l'onchocercose se sont toujours avérés très favorables. Cette constatation fournit un solide appui probant aux efforts en cours pour éliminer l'onchocercose des zones d'endémie. Bien que ces résultats soient très prometteurs, plusieurs lacunes importantes en matière de recherche doivent être comblées à mesure que nous nous approchons des étapes clés pour 2020 et au‐delà.
This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of ...British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expense of attention to the social determinants of disease. Burton Singer argues that this represents another example of the inappropriate "overmedicalization" of contemporary tropical disease control. Peter Hotez and colleagues, in contrast, argue that the best return on investment will continue to be mass drug administration for NTDs.
Background: Reliable and updated maps of helminth (worm) infection distributions are essential to target control strategies to those populations in greatest need. Although many surveys have been ...conducted in endemic countries, the data are rarely available in a form that is accessible to policy makers and the managers of public health programmes. This is especially true in sub-Saharan Africa, where empirical data are seldom in the public domain. In an attempt to address the paucity of geographical information on helminth risk, this article describes the development of an updated global atlas of human helminth infection, showing the example of East Africa. Methods: Empirical, cross-sectional estimates of infection prevalence conducted since 1980 were identified using electronic and manual search strategies of published and unpublished sources. A number of inclusion criteria were imposed for identified information, which was extracted into a standardized database. Details of survey population, diagnostic methods, sample size and numbers infected with schistosomes and soil-transmitted helminths were recorded. A unique identifier linked each record to an electronic copy of the source document, in portable document format. An attempt was made to identify the geographical location of each record using standardized geolocation procedures and the assembled data were incorporated into a geographical information system. Results: At the time of writing, over 2,748 prevalence surveys were identified through multiple search strategies. Of these, 2,612 were able to be geolocated and mapped. More than half (58%) of included surveys were from grey literature or unpublished sources, underlining the importance of reviewing in-country sources. 66% of all surveys were conducted since 2000. Comprehensive, countrywide data are available for Burundi, Rwanda and Uganda. In contrast, information for Kenya and Tanzania is typically clustered in specific regions of the country, with few records from areas with very low population density and/or environmental conditions which are unfavourable for helminth transmission. Information is presented on the prevalence and geographical distribution for the major helminth species. Conclusion: For all five countries, the information assembled in the current atlas provides the most reliable, up-to-date and comprehensive source of data on the distribution of common helminth infections to guide the rational implementation of control efforts.
40 Years of the APOC Partnership Roungou, Jean-Baptist; Yameogo, Laurent; Mwikisa, Chris ...
PLoS neglected tropical diseases,
05/2015, Letnik:
9, Številka:
5
Journal Article
Recenzirano
Odprti dostop
In 1987, in light of demonstrated ivermectin efficacy and safety in humans, Merck & Co. Inc. committed to providing the medicine free of charge to endemic countries for as long as necessary to ...eliminate river blindness as a public health problem. On their side, the health workers who are trained by experts from APOC and in-country consultants ensure training of CDDs and their supervision; they help with management of ivermectin supply and take charge of responding to severe adverse effects of ivermectin treatment.
The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but ...insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5–9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10–14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15–19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.
Surprisingly little is known about the geographical overlap between malaria and other tropical diseases, including helminth infections. This is despite the potential public health importance of ...co-infection and synergistic opportunities for control.
Statistical models are presented that predict the large-scale distribution of hookworm in sub-Saharan Africa (SSA), based on the relationship between prevalence of infection among schoolchildren and remotely sensed environmental variables. Using a climate-based spatial model of the transmission potential for Plasmodium falciparum malaria, adjusted for urbanization, the spatial congruence of populations at coincident risk of infection is determined.
The model of hookworm indicates that the infection is widespread throughout Africa and that, of the 179.3 million school-aged children who live on the continent, 50.0 (95% CI: 48.9-51.1) million (27.9% of total population) are infected with hookworm and 45.1 (95% CI: 43.9-46) million are estimated to be at risk of coincident infection.
Malaria and hookworm infection are widespread throughout SSA and over a quarter of school-aged children in sub-Saharan Africa appear to be at risk of coincident infection and thus at enhanced risk of clinical disease. The results suggest that the control of parasitic helminths and of malaria in school children could be viewed as essential co-contributors to promoting the health of schoolchildren.
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