RESUMEN

OBJECTIVE: To investigate key risk factors associated with undernutrition in the first few years of life. DESIGN: A cross-sectional household survey was conducted in January 2018 collecting anthropometric data and other information on household, caregiver and child characteristics. Crude and adjusted odds ratios were calculated to assess the association of these characteristics with stunting and underweight outcomes. SETTING: Kitui and Machakos counties in south-east Kenya. PARTICIPANTS: Caregivers and their children aged 0-23 months in 967 beneficiary households of the Government of Kenya's cash for orphans and vulnerable children (CT-OVC) social protection scheme. RESULTS: Twenty-three per cent of the 1004 children with anthropometric data were stunted, 10 % were underweight and 6 % experienced wasting. The strongest predictors of stunting and underweight were being in the second year of life and being born with a low birth weight. Residing in a poor household and having more than one child under 2 years of age in the household were also significant risk factors for being underweight. Although 43 % of children did not receive the minimal acceptable diet, this was not a significant factor associated with undernutrition. When age was removed as a covariate in children aged 12-23 months, being male resulted in a significantly higher risk of being stunted. CONCLUSIONS: While only 9 % of children were born with a low birth weight, these were four to five times more likely to be stunted and underweight, suggesting that preventive measures during pregnancy could have significant nutrition and health benefits for young children in this study area.

Asunto(s)

Desnutrición , Delgadez , Humanos , Masculino , Niño , Lactante , Preescolar , Femenino , Delgadez/epidemiología , Prevalencia , Kenia/epidemiología , Estudios Transversales , Desnutrición/epidemiología , Desnutrición/etiología , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/complicaciones

RESUMEN

OBJECTIVE: To assess the association between the prevalence of tongue cyst-positive and antigen-positive pigs across different settings in Africa, to evaluate whether examining pigs for cysts could be used as a rapid surveillance tool for identifying geographical areas with a higher probability of high transmission of cysticercosis. METHODS: Published data were collated from 26 study sites across Africa that reported the prevalence of porcine cysticercosis by both lingual and serological examinations. The study sites were located in 10 countries across Africa. RESULTS: Seroprevalence rates ranged from 4% to 41%. Despite the varied study sites, the relationship between the two variables was highly consistent and suggests identification of tongue cysts may be useful for cysticercosis surveillance. We found that all areas with more than 10% of pigs having cysts in their tongues had at least 30% seroprevalence (PPV of 100%), although this cut-off is less reliable at predicting that an area is of low transmission (NPV of 84%). CONCLUSION: Assessing the prevalence of tongue cyst-positive pigs is a potential rapid epidemiological tool for identifying areas at high risk of cysticercosis, although further refinement and validation is required using standardised data sets.

Asunto(s)

Cisticercosis/diagnóstico , Cisticercosis/epidemiología , Enfermedades de los Porcinos/diagnóstico , Enfermedades de los Porcinos/epidemiología , Lengua/parasitología , África/epidemiología , Animales , Palpación , Estudios Seroepidemiológicos , Porcinos

RESUMEN

OBJECTIVE: Diarrhea is a leading cause of mortality worldwide; however, its long-term morbidity is poorly understood. Recently, early childhood diarrhea (ECD) has been associated with impaired physical fitness, growth and cognitive function 6 to 9 years later. We studied the effects of ECD on school functioning in a shantytown in northeastern Brazil. DESIGN: We administered 77 educational surveys. Complete diarrhea surveillance (ie, >90%) in the first 2 years of life and demographic and anthropometric information were available for 73 children. Age at starting school was calculated for 62 children, whereas age appropriateness for the current grade (AFG) was calculated for all 73 children who were >6 years old. Stepwise regression was used to examine the independent effect of ECD on school functioning after controlling for socioeconomic factors, maternal education, breast feeding, growth and cognitive functioning. RESULTS: ECD correlated with age at starting school (r = 0.55, P = 0.0005) and remained a significant predictor even after controlling for family demographics, days of breast feeding, early growth and TONI-3 test of nonverbal intelligence. This was true despite significant correlations of ECD with growth shortfalls and impaired cognitive functioning. ECD also correlated with AFG (r = 0.38, P = 0.001). Only TONI-3 test scores explained this association, suggesting that ECD may hinder school performance, but only in part school readiness, by impairing cognitive function as measured by performance on the TONI-3 nonverbal intelligence test. CONCLUSIONS: These findings document effects of early childhood diarrhea on later school readiness and performance and hence potential long-term human and economic costs of ECD, which warrant further attention and far greater investment for the control of ECD and its consequences.

Asunto(s)

Diarrea/complicaciones , Discapacidades para el Aprendizaje/epidemiología , Discapacidades para el Aprendizaje/etiología , Factores de Edad , Brasil , Niño , Preescolar , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Estudios Transversales , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/etiología , Diarrea/diagnóstico , Diarrea Infantil/complicaciones , Diarrea Infantil/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Modelos Lineales , Masculino , Pobreza , Valor Predictivo de las Pruebas , Medición de Riesgo , Población Rural , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Análisis y Desempeño de Tareas

RESUMEN

Malaria during pregnancy can result in low birth weight (LBW), an important risk factor for infant mortality. This article reviews the pathological effects of malaria during pregnancy and the implications for the newborn's development and survival. Empirical data from throughout Africa on associations between placental malaria and birth weight outcome, birth weight outcome and infant mortality, and the rates of LBW in areas with various levels of malaria transmission are evaluated to assess the increased risks of LBW and infant mortality associated with malaria. It is estimated that in areas where malaria is endemic, around 19% of infant LBWs are due to malaria and 6% of infant deaths are due to LBW caused by malaria. These estimates imply that around 100,000 infant deaths each year could be due to LBW caused by malaria during pregnancy in areas of malaria endemicity in Africa.

Asunto(s)

Recién Nacido de Bajo Peso , Malaria/prevención & control , Enfermedades Placentarias/mortalidad , Complicaciones Infecciosas del Embarazo/prevención & control , África del Sur del Sahara/epidemiología , Femenino , Humanos , Recién Nacido , Malaria/complicaciones , Malaria/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología

RESUMEN

This study investigates the source, timing and types of treatment for fevers across all ages in a low malaria-transmission area of Kenya. The period prevalence for fever, and subsequent treatment seeking behaviour, was similar across all ages. The use of the informal retail sector was common (47% of first actions), though most visits to shops and chemists (77%) resulted in treatment with an antipyretic not an antimalarial. The major source of the first line recommended drug, sulfadoxine-pyrimethamine (SP), was at the formal health sector, and 32% of fevers made at least one visit to a health care facility. Although only 7% of fevers received SP within 24 hours of fever onset, 27% ultimately received treatment with this antimalaria. It is estimated that of the total amount of SP consumed in this population, only 20% is administered to children less than 5 years old. In this area of Kenya disease risks decline with increasing age, however, adult populations consume over 40% of prescribed or purchased anti-malarial drugs. In light of the proposed new, more costly anti-malarial drug combinations these findings have major implications for the effective allocation of limited financial resources at household and government levels.

Asunto(s)

Analgésicos no Narcóticos/uso terapéutico , Fiebre/tratamiento farmacológico , Malaria/complicaciones , Adolescente , Adulto , Anciano , Altitud , Antimaláricos/uso terapéutico , Niño , Preescolar , Fiebre/epidemiología , Fiebre/parasitología , Humanos , Lactante , Kenia/epidemiología , Malaria/tratamiento farmacológico , Malaria/epidemiología , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Estaciones del Año

RESUMEN

Malaria remains a major health problem in Africa. One preventative strategy currently advocated is the use of bednets, preferably treated with insecticide. Many approaches to bednet delivery have been adopted in Kenya, including an employer-based malaria control strategy (EBMC). The cost and sustainability of this approach have not previously been assessed. This paper presents the financial cost (cash expenditure) of the EBMC programme implemented in the Coastal and Western regions of Kenya by the African Medical and Research Foundation (AMREF) between April 1998 and February 2002. Getting a bednet and insecticide to an employee was estimated to cost the provider US$15.8. This could be reduced by US$0.5 if the remaining stocks were liquidated and by an additional US$1.3 if the salvage of capital items is considered. The venture of distributing bednets to employees through the programme proved lucrative to organized community groups (OCGs), for they made between 24 and 29% gross profit from the nets they sold. Consequently, OCGs in nine of the 13 companies involved had retained enough funds from which they could buy and sell bednets without further donor financial support, and this portrays some elements of a sustainable supply system.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Costos y Análisis de Costo , Costos de Salud para el Patrón/estadística & datos numéricos , Insecticidas , Malaria/prevención & control , Equipos de Seguridad/economía , Animales , Participación de la Comunidad , Culicidae , Humanos , Kenia

RESUMEN

In 2001, Unicef procured 70000 bednets and insecticide treatments to be distributed free to pregnant women attending antenatal clinics in 35 (of 69) districts in Kenya. 1 year later, we interviewed 294 pregnant women who had received a free net. 267 (91%) nets had remained in the target homesteads, and only one of the nets had been sold. In a district with high malarial transmission, 93 (84%) of 111 women who had not previously been sleeping under a bednet had used the net while pregnant, and 97 (91%) of the 107 surviving babies were also protected; in another district, which had low transmission, 73 (58%) of 126 women used the nets during pregnancy and 91 (80%) of 114 infants were protected by the nets. These data suggest that bednets given free to pregnant women are used by recipients and their newborn children, and should be regarded as an important delivery system in increasing access to and use of insecticide-treated bednets in vulnerable groups.

Asunto(s)

Ropa de Cama y Ropa Blanca , Insecticidas/administración & dosificación , Malaria/prevención & control , Control de Mosquitos/métodos , Complicaciones Parasitarias del Embarazo/prevención & control , Adolescente , Adulto , Ropa de Cama y Ropa Blanca/estadística & datos numéricos , Femenino , Gastos en Salud , Humanos , Recién Nacido , Kenia/epidemiología , Malaria/epidemiología , Malaria/transmisión , Embarazo , Prevalencia

RESUMEN

Insecticide-treated nets (ITNs) have been shown to reduce the burden of malaria in African villages by providing personal protection and, if coverage of a community is comprehensive, by reducing the infective mosquito population. We do not accept the view that scaling-up this method should be by making villagers pay for nets and insecticide, with subsidies limited so as not to discourage the private sector. We consider that ITNs should be viewed as a public good, like vaccines, and should be provided via the public sector with generous assistance from donors. Our experience is that teams distributing free ITNs, replacing them after about 4 years when they are torn and retreating them annually, have high productivity and provide more comprehensive and equitable coverage than has been reported for marketing systems. Very few of the free nets are misused or sold. The estimated cost would be an annual expenditure of about US$295 million to provide for all of rural tropical Africa where most of the world's malaria exists. This expenditure is affordable by the world community as a whole, but not by its poorest members. Recently, funding of this order of magnitude has been committed by donor agencies for malaria control.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Insecticidas/economía , Malaria/prevención & control , África , Animales , Femenino , Humanos , Insecticidas/administración & dosificación , Masculino , Control de Mosquitos/métodos , Pobreza , Sector Público , Población Rural

RESUMEN

Large-scale chemotherapy programmes for helminth control continue to rely heavily on donor support. This is despite more than a 10-fold reduction in delivery costs from integrating drug distribution through the school system rather than using mobile teams and a marked decline in the price of albendazole and praziquantel. Even at these low prices (

Asunto(s)

Antihelmínticos/economía , Antihelmínticos/uso terapéutico , Helmintiasis/economía , Helmintiasis/prevención & control , Albendazol/economía , Albendazol/uso terapéutico , Animales , Antihelmínticos/administración & dosificación , Helmintiasis/epidemiología , Helmintiasis/transmisión , Humanos , Kenia/epidemiología , Praziquantel/economía , Praziquantel/uso terapéutico , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración

RESUMEN

WHO has proposed malaria control as a means to alleviate poverty. One of its targets includes a 30-fold increase in insecticide-treated nets (ITNs) in the next 5 years. How this service will be financed remains unclear. In July 2000, 390 homesteads in rural highland Kenya were interviewed on their willingness to pay for ITNs. The costs to a household of protecting themselves with ITNs were compared with current household expenditure. Homesteads expressed a willingness to pay for ITNs, but the amounts offered were not sufficient to cover the costs of providing this service without donor support to meet the difference. Furthermore, as most household expenditure was allocated to basic needs these interventions were 'unaffordable'. The cost of protecting a household with ITNs would be equivalent to sending three children to primary school for a year. The aspiration by poor rural homesteads to protect themselves with ITNs is not compatible with their ability to pay. One option to have an immediate equitable impact on ITN coverage and break the cycle between malaria and poverty is to provide this service free of charge.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Servicios de Salud Comunitaria/economía , Insecticidas/administración & dosificación , Pobreza , Población Rural , Actitud Frente a la Salud , Honorarios y Precios , Financiación Personal , Humanos , Renta , Entrevistas como Asunto , Kenia , Malaria/prevención & control

RESUMEN

Malaria in the highlands of Kenya is traditionally regarded as unstable and limited by low temperature. Brief warm periods may facilitate malaria transmission and are therefore able to generate epidemic conditions in immunologically naive human populations living at high altitudes. The adult:child ratio (ACR) of malaria admissions is a simple tool we have used to assess the degree of functional immunity in the catchment population of a health facility. Examples of ACR are collected from inpatient admission data at facilities with a range of malaria endemicities in Kenya. Two decades of inpatient malaria admission data from three health facilities in a high-altitude area of western Kenya do not support the canonical view of unstable transmission. The malaria of the region is best described as seasonal and meso-endemic. We discuss the implications for malaria control options in the Kenyan highlands.

Asunto(s)

Malaria Falciparum/epidemiología , Adolescente , Adulto , Factores de Edad , Altitud , Animales , Niño , Humanos , Kenia/epidemiología , Modelos Logísticos , Estudios Longitudinales , Malaria Falciparum/transmisión , Plasmodium falciparum/aislamiento & purificación , Estudios Retrospectivos , Estaciones del Año

RESUMEN

Epidemic detection algorithms are being increasingly recommended for malaria surveillance in sub-Saharan Africa. We present the results of applying three simple epidemic detection techniques to routinely collected longitudinal pediatric malaria admissions data from three health facilities in the highlands of western Kenya in the late 1980s and 1990s. The algorithms tested were chosen because they could be feasibly implemented at the health facility level in sub-Saharan Africa. Assumptions of these techniques about the normal distribution of admissions data and the confidence intervals used to define normal years were also investigated. All techniques identified two "epidemic" years in one of the sites. The untransformed Cullen method with standard confidence intervals detected the two "epidemic" years in the remaining two sites but also triggered many false alarms. The performance of these methods is discussed and comments made about their appropriateness for the highlands of western Kenya.

Asunto(s)

Algoritmos , Brotes de Enfermedades , Métodos Epidemiológicos , Malaria Falciparum/epidemiología , Plasmodium falciparum/aislamiento & purificación , Adolescente , Altitud , Animales , Niño , Preescolar , Intervalos de Confianza , Humanos , Lactante , Kenia/epidemiología , Lluvia , Estudios Retrospectivos , Estaciones del Año

RESUMEN

Kenya's National Malaria Strategy states that insecticide-treated nets (ITNs) would be considered as a free service to pregnant women assuming sufficient financial commitment from donors. In 2001, United Nation's Children's Fund (UNICEF) and the Government of Kenya brokered support to procure and distribute nets and K-O TABs (deltamethrin) to 70 000 pregnant women in 35 districts throughout Kenya around Africa Malaria Day. This intervention represented the single largest operational distribution of ITN services in Kenya to date, and this study evaluates its success, limitations and costs. The tracking process from the central level through to antenatal clinic (ANC) facilities suggests that of the 70 000 nets procured, 37 206 nets (53%) had been distributed to pregnant women throughout the country within 12 weeks. One-fifth of the nets procured (14 117) had gone out to individuals other than pregnant women, most of these at the request of the district teams, with only 2870 nets estimated to have gone astray at the ANC facilities. At 12 weeks, the remaining 18 677 nets were still in storage awaiting distribution, with more than two-thirds having reached the district, and nearly half already being held at ANC facilities. The cost of getting a net and K-O TAB to an ANC facility ready for distribution to a pregnant woman was US$ 3.81. Accounting for the 14 117 nets that had gone to other users, the cost for an ITN received by a pregnant woman was US$ 5.26. Delivering ITNs free to pregnant women through ANCs uses an existing system (with positive spin-offs of low delivery cost and simple logistics), is equitable (as it not only targets those who can afford it) and can have the added benefits of strengthening ANC service, delivery and use.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Insecticidas/economía , Insecticidas/uso terapéutico , Ropa de Cama y Ropa Blanca/estadística & datos numéricos , Análisis Costo-Beneficio , Atención a la Salud/economía , Atención a la Salud/estadística & datos numéricos , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitales de Distrito/economía , Hospitales de Distrito/estadística & datos numéricos , Maternidades/economía , Maternidades/estadística & datos numéricos , Humanos , Kenia/epidemiología , Malaria/prevención & control , Embarazo , Complicaciones Parasitarias del Embarazo/prevención & control , Salud de la Mujer

RESUMEN

Estimates of global disease burden remain high on the international research and policy agenda as a forum for ranking health priorities. Within this, the quality of life or years lived with varying degrees of disability has been recognized as an important outcome that should be considered alongside estimates of mortality. Recent studies into the long-term consequences of diarrhoeal diseases on physical and mental development suggest that the disability adjusted life year calculations for these conditions could require updating.

Asunto(s)

Diarrea/fisiopatología , Parasitosis Intestinales/fisiopatología , Años de Vida Ajustados por Calidad de Vida , Factores de Edad , Animales , Costo de Enfermedad , Países en Desarrollo , Diarrea/mortalidad , Personas con Discapacidad , Humanos , Parasitosis Intestinales/mortalidad , Esperanza de Vida , Salud Pública , Calidad de Vida

RESUMEN

This study compares the effectiveness and cost-effectiveness of indoor residual house-spraying (IRS) and insecticide-treated bednets (ITNs) against infection with Plasmodium falciparum as part of malaria control in the highlands of western Kenya. Homesteads operationally targeted for IRS and ITNs during a district-based emergency response undertaken by an international relief agency were selected at random for evaluation. Five hundred and ninety homesteads were selected (200 with no vector control, 200 with IRS and 190 with ITNs). In July 2000, residents in these homesteads were randomly sampled according to three age-groups: 6 months-4 years, 5-15 years, and > 15 years for the presence of P. falciparum antigen (Pf HRP-2) using the rapid whole blood immunochromatographic test (ICT). The prevalence of P. falciparum infection amongst household members not protected by either IRS or ITN was 13%. Sleeping under a treated bednet reduced the risk of infection by 63% (58-68%) and sleeping in a room sprayed with insecticide reduced the risk by 75% (73-76%). The economic cost per infection case prevented by IRS was US$ 9 compared to US$ 29 for ITNs. This study suggests that IRS may be both more effective and cheaper than ITNs in communities subjected to low, seasonal risks of infection and as such should be considered as part of the control armamentarium for malaria prevention.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Servicios de Salud Comunitaria/organización & administración , Insecticidas/uso terapéutico , Malaria Falciparum/prevención & control , Adolescente , Ropa de Cama y Ropa Blanca/estadística & datos numéricos , Niño , Preescolar , Análisis Costo-Beneficio , Humanos , Lactante , Insecticidas/economía , Kenia/epidemiología , Malaria Falciparum/epidemiología , Estudios Retrospectivos

RESUMEN

For centuries, bednets have been used as a physical barrier against biting insects. Recent epidemiological investigations into their protective effects against malaria were quickly overtaken by studies focusing on the benefits of impregnating bednets with insecticide. The operational problems encountered in re-treating bednets with insecticide are often cited as an impediment to wide-scale implementation. The evidence for a protective effect of untreated nets against malaria is presented here alongside an analysis of how well untreated nets would need to work in order to compete with treated nets within a cost-effectiveness framework.

Asunto(s)

Ropa de Cama y Ropa Blanca/economía , Control de Insectos/economía , Control de Insectos/métodos , Insecticidas/farmacología , Malaria Falciparum/prevención & control , Animales , Niño , Preescolar , Análisis Costo-Beneficio , Humanos , Lactante , Malaria Falciparum/mortalidad , Resultado del Tratamiento

Asunto(s)

Malaria/prevención & control , Control de Mosquitos/economía , Animales , Análisis Costo-Beneficio/economía , DDT/administración & dosificación , DDT/farmacología , Humanos , Insectos Vectores , Control de Mosquitos/métodos , Tailandia , Resultado del Tratamiento

Asunto(s)

Antihelmínticos , Albendazol , Praziquantel , Anemia , Infecciones por Uncinaria , Esquistosomiasis , Niño , Servicios de Salud Escolar , Estudios Transversales , Modelos Logísticos , Análisis de Regresión , Tanzanía

RESUMEN

This paper reviews three different approaches to modelling the cost-effectiveness of schistosomiasis control. Although these approaches vary in their assessment of costs, the major focus of the paper is on the evaluation of effectiveness. The first model presented is a static economic model which assesses effectiveness in terms of the proposition of cases cured. This model is important in highlighting that the optimal choice of chemotherapy regime depends critically on the level of budget constraint, the unit costs of screening and treatment, the rates of compliance with screening and chemotherapy and the prevalence of infection. The limitations of this approach is that it models the cost-effectiveness of only one cycle of treatment, and effectiveness reflects only the immediate impact of treatment. The second model presented is a prevalence-based dynamic model which links prevalence rates from one year to the next, and assesses effectiveness as the proportion of cases prevented. This model was important as it introduced the concept of measuring the long-term impact of control by using a transmission model which can be assess reduction in infection through time, but is limited to assessing the impact only on the prevalence of infection. The third approach presented is a theoretical framework which describes the dynamic relationship between infection and morbidity, and which assesses effectiveness in terms of case-years prevented of infection and morbidity. The use of this model in assessing the cost-effectiveness of age-targeted treatment in controlling Schistosoma mansoni is explored in detail, with respect to varying frequencies of treatment and the interaction between drug price and drug efficacy.

Asunto(s)

Análisis Costo-Beneficio , Morbilidad , Esquistosomiasis