Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. (+info)
A mobile unit: an effective service for cervical cancer screening among rural Thai women.
BACKGROUND: We carried out a systematic screening programme using a mobile unit with the purpose of increasing use of Papanicolaou (Pap) smear screening among rural Thai women. The mobile unit campaign was carried out initially between January and February 1993 and then in 1996 in all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand. METHODS: To evaluate the effect of the programme on changes in knowledge and use of screening, we compared the results of three interview surveys of women, 18-65 years old, in villages selected by systematic sampling for each survey; first in 1991 (before the operation of the programme), secondly in 1994 (one year after the first screening campaign), and last in 1997 (one year after the second campaign). This report also compares data on Pap smears taken by the mobile unit with other existing screening services in the study area. RESULTS: A total of 1603, 1369, and 1576 women respectively, participated in each survey. The proportion of women reported knowing of the Pap smear test increased from 20.8% in 1991 to 57.3% in 1994 and to 75.5% in 1997. The proportion of women who had ever had a Pap smear increased from 19.9% in 1991 to 58.1% in 1994 and to 70.1% by 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers identified among the Pap smears taken by screening services in the area between 1992 and 1996. The rate of CIN III was 3.5/1000 smears in this screening programme, which was 5.2 and 2.0 times higher than the rates in the maternal and child health/family planning clinic and the annual one-week mass screening campaign respectively. CONCLUSIONS: The use of a mobile unit may be an effective screening programme in rural areas where existing screening activities cannot effectively reach the female population at risk. (+info)
Evaluation of visual outcome of cataract surgery in an Indian eye camp.
AIM: To evaluate the results of cataract surgery performed in a rural Indian eye camp. METHOD: The pre- and postoperative visual acuities and surgical complications were recorded prospectively in 6383 eyes undergoing cataract extraction for age related cataract in rural eye camps held in northern India in 1993-4. The best visual acuity and cause of poor outcome were recorded on 3908 eyes seen at 6 weeks' follow up. RESULTS: Of 6383 operated eyes 94.8% had a visual acuity of less than 3/60 preoperatively, and 41% of the procedures were performed on patients who were bilaterally blind (less than 3/60 better eye). At discharge with standard aphakic spherical spectacles, 11.3% of eyes had an acuity of less than 6/60 (poor outcome), and 25.9% had an acuity of 6/18 or better. At 6 weeks' follow up 3908 eyes were examined (61.2%), of which, with best correction, 4.3% had poor outcome (acuity of less than 6/60) and 79.9% obtained 6/18 or better. Pre-existing eye pathology was responsible for poor outcome in 3.0% of eyes and surgical complications in 1.3% of eyes, of which corneal decompensation was the major cause (0.5%). In 237 eyes which received an intraocular lens implantation (IOL) in the camp, the visual acuity at discharge was 6/18 or better in 44.5% of eyes improving to 87.9% in the 157 eyes which were seen at 6 weeks' follow up. Poor outcome (less than 6/60) was seen in 5.7% of the eyes with an IOL at discharge improving to 1.9% at follow up. CONCLUSION: This evaluation suggests that it is possible to obtain acceptable results from cataract extraction with experienced ophthalmologists in well conducted Indian eye camps. Better correction of aphakia at discharge from the camp would improve the immediate visual results, which is important as a significant number of patients do not return for follow up. The use of posterior chamber IOLs in the eye camp by experienced ophthalmologists, appeared to give satisfactory results, although further evaluation with a larger series of cases and more surgeons is required before it can be recommended. (+info)
Yavatmal District Blindness Control Society: a case study.
PURPOSE: To retrospectively study the records and reports available at the District Blindness Control Society (DBCS), Yavatmal in terms of target fixation, performance and utilisation of manpower and equipment. METHODS: All the available records, reports, correspondence, and proceedings of meetings from 1981-98 were scrutinized and analyzed. RESULTS: The performance records and reports showed that over the last 10 years the target achievement of DBCS is close to 100%. However, the fixed facility (District hospital/Tertiary hospital where cataract surgeries are being performed under strict aseptic conditions) performance does not match the targets. The district mobile unit camp performance achieved 35-40% of the target in the last quarter of the financial year. CONCLUSION: The target fixation is irrational and needs improvement, and it is necessary for the program managers in the district to undertake analysis of the available data to ensure performance improvement. (+info)
Sleeping sickness resurgence in the DRC: the past decade.
An overview of the evolution of sleeping sickness and control activities in the DRC during the period 1989-1998 is presented. A resurgence was already developing in the mid-1980s and, after a breakdown of active case-finding between 1990 and 1993, annual detection rates attained levels similar to those of the late 1920s. Although a staggering number of 150 591 new cases have been detected during the past decade, the problem is ignored by most of the international community. The major cause for the resurgence appears to be the interruption of active case-finding for a prolonged period of time. Control activities have improved considerably in recent years, but a lot remains to be done and supplementary resources are needed. (+info)
Bringing the mountain to Mohammed: a mobile dental team serves a community-based program for people with HIV/AIDS.
In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed. (+info)
Medical relief operation in rural northern Ethiopia: addressing an ongoing disaster.
BACKGROUND: Following the recent drought in Ethiopia, the Jewish Agency, aided by the Israel Ministry of Foreign Affairs, launched a medical relief mission to a rural district in Ethiopia in May-August 2000. OBJECTIVES: To present the current medical needs and deficiencies in this representative region of Central Africa, to describe the mission's mode of operation, and to propose alternative operative modes. METHODS: We critically evaluate the current local needs and existing medical system, retrospectively analyze the mission's work and the patients' characteristics, and summarize a panel discussion of all participants and organizers regarding potential alternative operative modes. RESULTS: An ongoing medical disaster exists in Ethiopia, resulting from the burden of morbidity, an inadequate health budget, and insufficient medical personnel, facilities and supplies. The mission operated a mobile outreach clinic for 3 months, providing primary care to 2,500 patients at an estimated cost of $48 per patient. Frequent clinical diagnoses included gastrointestinal and respiratory tract infections, skin and ocular diseases (particularly trachoma), sexually transmitted diseases, AIDS, tuberculosis, intestinal parasitosis, malnutrition and malaria. CONCLUSIONS: This type of operation is feasible but its overall impact is marginal and temporary. Potential alternative models of providing medical support under such circumstances are outlined. (+info)
Risk-taking behaviors among injecting drug users who obtain syringes from pharmacies, fixed sites, and mobile van needle exchanges.
Needle-exchange programs (NEPs) have been shown to be effective in reducing harm related to injection drug use and to act as an important link between the injection drug using community and preventive/treatment services. Different needle-exchange distribution methods may reach different subpopulations of injecting drug users (IDUs). We undertook this study to characterize risk behaviors by primary source of clean needles accessed by IDUs in a city with pharmacy access and fixed and mobile exchange programs. We hypothesized there would be a gradient of risk across the three types of distribution. Data were collected from within the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort study. Participants who primarily obtained clean needles from pharmacies, fixed sites, or mobile exchange vans were compared using the Cochran-Armitage trend test to test for trends in increasing risk behaviors across the three types of distribution. Ordinal multivariate regression was used to adjust the associations for potential confounders. Results illustrate clear trends for increasing risk profiles from pharmacy to fixed site to mobile exchange vans. Van users were generally at higher risk than fixed-site and pharmacy users. Independent predictors of van use were fewer years injecting, difficulty finding needles, Aboriginal ethnicity, incarceration in the previous 6 months, and injecting cocaine daily. An important component of needle-exchange programs is outreach to access those who are at highest risk. Use of distribution beyond fixed sites will improve such outreach, thereby increasing program effectiveness and further preventing the transmission of blood-borne infections. (+info)