Browsing by Author "Horton, S."

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The Costs and cost-cffectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds
(Public Library of Science, 2009) Hall, A.; Horton, S.; de Silva, N.
BACKGROUND: It is estimated that almost a half of all of people living in developing countries today are infected with roundworms, hookworms, or whip worms or combinations of these types of intestinal nematode worms. They can all be treated using safe, effective, and inexpensive single-dose generic drugs costing as little as USD 0.03 per person treated when bought in bulk. The disease caused by intestinal nematodes is strongly related to the number of worms in the gut, and it is typical to find that worms tend to be aggregated or clumped in their distribution so that <20% of people may harbour >80% of all worms. This clumping of worms is greatest when the prevalence is low. When the prevalence rises above 50%, the mean worm burden increases exponentially, worms are less clumped, and more people are likely to have moderate to heavy infections and may be diseased. Children are most at risk. For these reasons, the World Health Organization (WHO) currently recommends mass treatment of children > or =1 year old without prior diagnosis when the prevalence is > or =20% and treatment twice a year when the prevalence is > or =50%. METHODS AND FINDINGS: The risk of moderate to heavy infections with intestinal nematodes was estimated by applying the negative binomial probability distribution, then the drug cost of treating diseased individuals was calculated based on different threshold numbers of worms. Based on this cost analysis, a new three-tier treatment regime is proposed: if the combined prevalence is >40%, treat all children once a year; >60% treat twice a year; and >80% treat three times a year. Using average data on drug and delivery costs of USD 0.15 to treat a school-age child and USD 0.25 to treat a pre-school child (with provisos) the cost of treating children aged 2-14 years was calculated for 105 low- and low-middle-income countries and for constituent regions of India and China based on estimates of the combined prevalence of intestinal nematode worms therein. The annual cost of the three-tier threshold was estimated to be USD 224 million compared with USD 276 million when the current WHO recommendations for mass treatment were applied. CONCLUSION: The three-tier treatment thresholds were less expensive and more effective as they allocated a greater proportion of expenditures to treating infected individuals when compared with the WHO thresholds (73% compared with 61%) and treated a larger proportion of individuals with moderate to heavy worm burdens, arbitrarily defined as more than 10 worms per person (31% compared with 21%).
Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition
(Elsevier, 2018) Bundy, D.A.P.; de Silva, N.; Horton, S.; Patton, G.C.; Schultz, L.; Jamison, D.T.; Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group
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.
Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition
(Elsevier, 2018) Jamison, D.T; Alwan, A.; Mock, C.N.; Nugent, R.; Watkins, D.; Adeyi, O.; Anand, S.; Atun, R.; Bertozzi, S.; Bhutta, Z.; Binagwaho, A.; Black, R.; Blecher, M.; Bloom, B.R.; Brouwer, E.; Bundy, D.A.P.; Chisholm, D.; Cieza, A.; Cullen, M.; Danforth, K.; de Silva, N.; Debas, H.T.; Donkor, P.; Dua, T.; Fleming, K.A.; Gallivan, M.; Garcia, P.J.; Gawande, A.; Gaziano, T.; Gelband, H.; Glass, R.; Glassman, A.; Gray, G.; Habte, D.; Holmess, K.K.; Horton, S.; Hutton, G.; Jha, P.; Knaul, F.M.; Kobusingye, O.; Krakauer, E.L.; Kruk, M.E.; Lechmann, P.; Laxminarayan, R.; Levin, C.; Looi, L.M.; Madhav, N.; Mahmoud, A.; Mbanya, J.C.; Measham, A.; Medina-Mora, M.E.; Medin, C.; Mills, A.; Mills, J.A.; Montoya, J.; Norheim, O.; Olson, Z.; Omokhodion, F.; Oppenheim, B.; Ord, T.; Patel, V.; Patton, G.C.; Peabody, J.; Prabhakaran, D.; Qi, J.; Reynolds, T.; Ruacan, S.; Sankaranarayan, R.; Sepulveda, J.; Skolnik, R.; Smith, K.R.; Temmerman, M.; Tollman, S.; Verguet, S.; Walker, D.G.; Walker, N.; Wu, Y.; Zhao, K.
The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.