The dataset (Additional file 1) was then exported to StataÂŽ software for statistical analysis. (... more The dataset (Additional file 1) was then exported to StataÂŽ software for statistical analysis. (XLSX 199 kb)
In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosom... more In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosoma mekongi was conducted along the Mekong River between December 1994 and April 1995. The results of household surveys of highly affected villages of the East and the West bank of the river and of school surveys in 20 primary schools are presented. In household surveys 1396 people were examined. An overall prevalence of infection of 49.3% was detected by a single stool examination with the Kato-Katz technique. The overall intensity of infection was 118.2 eggs per gram of stool (epg). There was no difference between the population of the east and west shore of the Mekong for prevalence (P ϭ 0.3) or intensity (P ϭ 0.9) of infection. Severe morbidity was very frequent. Hepatomegaly of the left lobe was detected in 48.7% of the population. Splenomegaly was seen in 26.8% of the study participants. Visible diverted circulation was found in 7.2% of the population, and ascites in 0.1%. Significantly more hepatomegaly (P ϭ 0.001), splenomegaly (P ϭ 0.001) and patients with diverted circulation (P ϭ 0.001) were present on the west bank of the Mekong. The age group of 10-14 years was most affected. The prevalence of infection in this group was 71.8% and 71.9% in the population of the West and East of the Mekong, respectively. The intensity of infection was 172.4 and 194.2 epg on the West and the East bank, respectively. In the peak age group hepatomegaly reached a prevalence of 88.1% on the west and 82.8% on the east bank. In the 20 schools 2391 children aged 6-16 years were examined. The overall prevalence of infection was 40.0%, ranging from 7.7% to 72.9% per school. The overalls mean intensity of infection was 110.1 epg (range by school: 26.7-187.5 epg). Both prevalence (P ϭ 0.001) and intensity of infection (P ϭ 0.001) were significantly higher in schools on the east side of the Mekong. Hepatomegaly (55.2%), splenomegaly (23.6%), diverted circulation (4.1%), ascites (0.5%), reported blood (26.7%) and mucus (24.3%) were very frequent. Hepatomegaly (P ϭ 0.001), splenomegaly (P ϭ 0.001), diverted circulation (P ϭ 0.001) and blood in stool (P ϭ 0.001) were significantly more frequent in schools of the east side of the Mekong. Boys suffered more frequently from splenomegaly (P ϭ 0.05), ascites (P ϭ 0.05) and bloody stools (P ϭ 0.004) than girls. No difference in sex was found for the prevalence and intensity of infection and prevalence of hepatomegaly. On the school level prevalence and intensity of infection were highly associated (r ϭ 0.93, P ϭ 0.0001). The intensity of infection was significantly associated only with the prevalence of hepatomegaly (r ϭ 0.44, P ϭ 0.05) and blood in stool (r ϭ 0.40, P ϭ 0.02). This comprehensive epidemiological study documents for the first time the public health importance of schistosomiasis mekongi in the Province of Kracheh, Northern Cambodia and points at key epidemiological features of this schistosome species, in particular the high level of morbidity associated with infection.
The International Journal of Tuberculosis and Lung Disease, 2011
To report on the trends in new and recurrent tuberculosis (TB) case notifi cations in a rural dis... more To report on the trends in new and recurrent tuberculosis (TB) case notifi cations in a rural district of Malawi that has embarked on large-scale rollout of antiretroviral treatment (ART). M E T H O D S : Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009. R E S U LT S : There were a total of 10 070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifi cations in the fi rst years after starting ART (2002-2005) was followed by a highly signifi cant and sustained decline from 259 to 173 TB cases per 100 000 population (χ 2 for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a signifi cant drop, from 20 to 15 cases/100 000 (χ 2 for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases.
Health in the service of state-building in fragile and merit critical review: quality of humanita... more Health in the service of state-building in fragile and merit critical review: quality of humanitarian health interventions, tangible contributions to population level health benefits, perception of health and humanitarian workers. To keep health needs as yardstick to determine effective
The effects of conflict continue to have an impact on mortality • Throughout the country the mort... more The effects of conflict continue to have an impact on mortality • Throughout the country the mortality rates are worrying. The crude morality rates for the three population groups surveyed (using the flat fee, cost sharing at 50% and cost recovery) are 1.2, 1.9 and 1.6 deaths per 10.000 persons per day. These rates are higher than the threshold of 1 death per 10.000 persons per day, and indicate an emergency situation. • Children are particularly affected. The mortality rates for the under-fives are 102 91 76 13
Background: To report on the trend in all-cause mortality in a rural district of Malawi that has ... more Background: To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/ AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. Methods and Findings: Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X 2 for linear trend: 338.4 P,0.0001, 989 P,0.0001 and 197, P,0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/ year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period. Conclusions: Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART.
Blumer IR. Severe injection site reaction to insulin detemir. Diabetes Care 2006; 29: 946. 3 Resh... more Blumer IR. Severe injection site reaction to insulin detemir. Diabetes Care 2006; 29: 946. 3 Resh MD. Fatty acylation of proteins: new insights into membrane targeting of myristoylated and palmitoylated proteins.
Over recent years, antiretroviral treatment (ART) coverage has increased signifi cantly thanks to... more Over recent years, antiretroviral treatment (ART) coverage has increased signifi cantly thanks to the support of global health initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the US President's Emergency Plan For AIDS Relief (PEPFAR). For those fortunate enough to receive ART, HIV/AIDS has become a chronic lifelong disease, one that requires strict adherence to treatment. Wellfunctioning health systems are needed to ensure the appropriate treatment of chronic diseases and achieve long-term retention in care, including regular follow-up appointments, patient education, adherence counselling, defaulter tracing and data monitoring. However, in health systems of many countries in the sub-Saharan Africa, such services are weak, as these health systems were primarily designed to deal with mother and child health issues and acute infections. Consequently, the current health systems typically lack the skills and capacity to manage chronic lifelong illness [1]. One of the major challenges in high HIV prevalence countries with weak health systems is the retention of the increasing numbers of patients on lifelong ART. Health systems in these countries need a fundamental overhaul
Financial access to HIV care and treatment can be difficult for many people in China, where the g... more Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient&amp;amp;amp;amp;amp;amp;#39;s clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident&amp;amp;amp;amp;amp;amp;#39;s annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Civilians in Burundi have lived through years of conflict and are currently in a state of chronic... more Civilians in Burundi have lived through years of conflict and are currently in a state of chronic crisis. Although a ceasefire was agreed at the end of 2003, in certain areas of Burundi peace still remains a hope rather than a reality and the effects of war are still very much present.1 The country's civil war has compounded the economic crisis, and severely damaged the health sector. The government's capacity to invest in the health sector is limited. Medical staff are lacking, infrastructure has been destroyed, and ongoing insecurity in certain regions has increased the inaccessibility of health care for many.2 At the same time, infectious and parasitic diseases, especially malaria, remain huge health problems. Despite the beginnings of political stability in Burundi, the mortality rates are alarming and well above those associated with even an emergency situation.3 The violence has led to a scarcity of goods and services, supply and transport problems, an increase in viol...
The dataset (Additional file 1) was then exported to StataÂŽ software for statistical analysis. (... more The dataset (Additional file 1) was then exported to StataÂŽ software for statistical analysis. (XLSX 199 kb)
In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosom... more In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosoma mekongi was conducted along the Mekong River between December 1994 and April 1995. The results of household surveys of highly affected villages of the East and the West bank of the river and of school surveys in 20 primary schools are presented. In household surveys 1396 people were examined. An overall prevalence of infection of 49.3% was detected by a single stool examination with the Kato-Katz technique. The overall intensity of infection was 118.2 eggs per gram of stool (epg). There was no difference between the population of the east and west shore of the Mekong for prevalence (P ϭ 0.3) or intensity (P ϭ 0.9) of infection. Severe morbidity was very frequent. Hepatomegaly of the left lobe was detected in 48.7% of the population. Splenomegaly was seen in 26.8% of the study participants. Visible diverted circulation was found in 7.2% of the population, and ascites in 0.1%. Significantly more hepatomegaly (P ϭ 0.001), splenomegaly (P ϭ 0.001) and patients with diverted circulation (P ϭ 0.001) were present on the west bank of the Mekong. The age group of 10-14 years was most affected. The prevalence of infection in this group was 71.8% and 71.9% in the population of the West and East of the Mekong, respectively. The intensity of infection was 172.4 and 194.2 epg on the West and the East bank, respectively. In the peak age group hepatomegaly reached a prevalence of 88.1% on the west and 82.8% on the east bank. In the 20 schools 2391 children aged 6-16 years were examined. The overall prevalence of infection was 40.0%, ranging from 7.7% to 72.9% per school. The overalls mean intensity of infection was 110.1 epg (range by school: 26.7-187.5 epg). Both prevalence (P ϭ 0.001) and intensity of infection (P ϭ 0.001) were significantly higher in schools on the east side of the Mekong. Hepatomegaly (55.2%), splenomegaly (23.6%), diverted circulation (4.1%), ascites (0.5%), reported blood (26.7%) and mucus (24.3%) were very frequent. Hepatomegaly (P ϭ 0.001), splenomegaly (P ϭ 0.001), diverted circulation (P ϭ 0.001) and blood in stool (P ϭ 0.001) were significantly more frequent in schools of the east side of the Mekong. Boys suffered more frequently from splenomegaly (P ϭ 0.05), ascites (P ϭ 0.05) and bloody stools (P ϭ 0.004) than girls. No difference in sex was found for the prevalence and intensity of infection and prevalence of hepatomegaly. On the school level prevalence and intensity of infection were highly associated (r ϭ 0.93, P ϭ 0.0001). The intensity of infection was significantly associated only with the prevalence of hepatomegaly (r ϭ 0.44, P ϭ 0.05) and blood in stool (r ϭ 0.40, P ϭ 0.02). This comprehensive epidemiological study documents for the first time the public health importance of schistosomiasis mekongi in the Province of Kracheh, Northern Cambodia and points at key epidemiological features of this schistosome species, in particular the high level of morbidity associated with infection.
The International Journal of Tuberculosis and Lung Disease, 2011
To report on the trends in new and recurrent tuberculosis (TB) case notifi cations in a rural dis... more To report on the trends in new and recurrent tuberculosis (TB) case notifi cations in a rural district of Malawi that has embarked on large-scale rollout of antiretroviral treatment (ART). M E T H O D S : Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009. R E S U LT S : There were a total of 10 070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifi cations in the fi rst years after starting ART (2002-2005) was followed by a highly signifi cant and sustained decline from 259 to 173 TB cases per 100 000 population (χ 2 for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a signifi cant drop, from 20 to 15 cases/100 000 (χ 2 for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases.
Health in the service of state-building in fragile and merit critical review: quality of humanita... more Health in the service of state-building in fragile and merit critical review: quality of humanitarian health interventions, tangible contributions to population level health benefits, perception of health and humanitarian workers. To keep health needs as yardstick to determine effective
The effects of conflict continue to have an impact on mortality • Throughout the country the mort... more The effects of conflict continue to have an impact on mortality • Throughout the country the mortality rates are worrying. The crude morality rates for the three population groups surveyed (using the flat fee, cost sharing at 50% and cost recovery) are 1.2, 1.9 and 1.6 deaths per 10.000 persons per day. These rates are higher than the threshold of 1 death per 10.000 persons per day, and indicate an emergency situation. • Children are particularly affected. The mortality rates for the under-fives are 102 91 76 13
Background: To report on the trend in all-cause mortality in a rural district of Malawi that has ... more Background: To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/ AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. Methods and Findings: Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X 2 for linear trend: 338.4 P,0.0001, 989 P,0.0001 and 197, P,0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/ year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period. Conclusions: Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART.
Blumer IR. Severe injection site reaction to insulin detemir. Diabetes Care 2006; 29: 946. 3 Resh... more Blumer IR. Severe injection site reaction to insulin detemir. Diabetes Care 2006; 29: 946. 3 Resh MD. Fatty acylation of proteins: new insights into membrane targeting of myristoylated and palmitoylated proteins.
Over recent years, antiretroviral treatment (ART) coverage has increased signifi cantly thanks to... more Over recent years, antiretroviral treatment (ART) coverage has increased signifi cantly thanks to the support of global health initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the US President's Emergency Plan For AIDS Relief (PEPFAR). For those fortunate enough to receive ART, HIV/AIDS has become a chronic lifelong disease, one that requires strict adherence to treatment. Wellfunctioning health systems are needed to ensure the appropriate treatment of chronic diseases and achieve long-term retention in care, including regular follow-up appointments, patient education, adherence counselling, defaulter tracing and data monitoring. However, in health systems of many countries in the sub-Saharan Africa, such services are weak, as these health systems were primarily designed to deal with mother and child health issues and acute infections. Consequently, the current health systems typically lack the skills and capacity to manage chronic lifelong illness [1]. One of the major challenges in high HIV prevalence countries with weak health systems is the retention of the increasing numbers of patients on lifelong ART. Health systems in these countries need a fundamental overhaul
Financial access to HIV care and treatment can be difficult for many people in China, where the g... more Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient&amp;amp;amp;amp;amp;amp;#39;s clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident&amp;amp;amp;amp;amp;amp;#39;s annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Civilians in Burundi have lived through years of conflict and are currently in a state of chronic... more Civilians in Burundi have lived through years of conflict and are currently in a state of chronic crisis. Although a ceasefire was agreed at the end of 2003, in certain areas of Burundi peace still remains a hope rather than a reality and the effects of war are still very much present.1 The country's civil war has compounded the economic crisis, and severely damaged the health sector. The government's capacity to invest in the health sector is limited. Medical staff are lacking, infrastructure has been destroyed, and ongoing insecurity in certain regions has increased the inaccessibility of health care for many.2 At the same time, infectious and parasitic diseases, especially malaria, remain huge health problems. Despite the beginnings of political stability in Burundi, the mortality rates are alarming and well above those associated with even an emergency situation.3 The violence has led to a scarcity of goods and services, supply and transport problems, an increase in viol...
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