La bibliothèque des étudiants en santé

9415 ressources

• Article libreArticleEn anglais

  Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries

  Eduardo Massad, Ben C Behrens, Francisco AB Coutinho, Ronald H Behrens

  BackgroundIn a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was usedMethodsUsing a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational.ResultsThe threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission.ConclusionsThe cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

  Parasitologie et mycologieMaladies infectieuses et tropicalesLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness analysis of malaria chemoprophylaxis for travellers to West-Africa

  Lukas L Widmer, Patricia R Blank, Koen Van Herck, Christoph Hatz, Patricia Schlagenhauf

  BackgroundThe importation of malaria to non-endemic countries remains a major cause of travel-related morbidity and a leading cause of travel-related hospitalizations. Currently they are three priority medications for malaria prophylaxis to West Africa: mefloquine, atovaquone/proguanil and doxycycline. We investigate the cost effectiveness of a partial reimbursement of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers to high risk areas of malaria transmission compared with the current situation of no reimbursement.MethodsThis study is a cost-effectiveness analysis based on malaria cases imported from West Africa to Switzerland from the perspective of the Swiss health system. We used a decision tree model and made a literature research on the components of travel related malaria. The main outcome measure was the cost effectiveness of malaria chemoprophylaxis reimbursement based on malaria and deaths averted.ResultsUsing a program where travellers would be reimbursed for 80% of the cost of the cheapest malaria chemoprophylaxis is dominant (i.e. cost saving and more effective than the current situation) using the assumption that currently 68.7% of travellers to West Africa use malaria chemoprophylaxis. If the current usage of malaria chemoprophylaxis would be higher, 82.4%, the incremental cost per malaria case averted is € 2'302. The incremental cost of malaria death averted is € 191'833.The most important factors influencing the model were: the proportion of travellers using malaria chemoprophylaxis, the probability of contracting malaria without malaria chemoprophylaxis, the cost of the mefloquine regimen, the decrease in the number of travellers without malaria chemoprophylaxis in the reimbursement strategy.ConclusionsThis study suggests that a reimbursement of 80% of the cost of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers from Switzerland to West Africa is highly effective in terms of malaria cases averted

  Parasitologie et mycologieMaladies infectieuses et tropicalesLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso

  Frida Kasteng, Joanna Murray, Simon Cousens, Sophie Sarrassat, Jennifer Steel, Nicolas Meda, Moctar Ouedraogo, Roy Head, Josephine Borghi

  IntroductionChild health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale.MethodsWe collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012–2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention’s incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD.ResultsThe provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI −38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018–2020, varied between $7 in Malawi to $27 in Burundi.ConclusionThis study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale.Trial registration numberNCT01517230; Res

  Biostatistiques et épidémiologiePédiatrieGynécologie-obstétriqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is pr

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso

  Tom Palmer, Abbie Clare, Pasco Fearon, Roy Head, Zelee Hill, Bassirou Kagone, Betty Kirkwood, Alexander Manu, Jolene Skordis

  IntroductionApproximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and challenging to deliver at scale. Mass media may offer an alternative approach to ECD intervention. This protocol describes the planned economic evaluation of a cluster-randomised controlled trial of a radio campaign promoting responsive caregiving and opportunities for early learning during the first 3 years of life in rural Burkina Faso (SUNRISE trial).Methods and analysisThe economic evaluation of the SUNRISE trial will be conducted as a within-trial analysis from the provider’s perspective. Incremental costs and health outcomes of the radio campaign will be compared with standard broadcasting (ie, ‘do nothing’ comparator). All costs associated with creating and broadcasting the radio campaign during intervention start-up and implementation will be captured. The cost per child under 3 years old reached by the intervention will be calculated. Incremental cost-effectiveness ratios will be calculated for the trial’s primary outcome (ie, incremental cost per SD of cognitive gain). A cost-consequence analysis will also be presented, whereby all relevant costs and outcomes are tabulated. Finally, an analysis will be conducted to assess the equity impact of the intervention.Ethics and disseminationThe SUNRISE trial has ethical approval from the ethics committees of the Ministry of Health, Burkina Faso, University College London and the London School of Hygiene and Tropical Medicine. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberThe SUNRISE trial was registered with ClinicalTrials.gov on 19 April 2019 (identifier: NCT05335395).

  Biologie cellulaire et moléculaireGénétiquePédiatrieLicence : https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original w

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt

  BackgroundNeisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children.ObjectiveTo evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination.MethodsWe developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$.ResultsAt an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly cost-effective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi.ConclusionRoutine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.

  Microbiologie (bactériologie, virologie)ImmunologieMaladies infectieuses et tropicalesLicence : Creative Commons Attribution License This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness of human papillomavirus (HPV) vaccination in Burkina Faso: a modelling study

  Joël Arthur Kiendrébéogo, Annick Raissa O. Sidibe, Ghislain Bertrand Compaoré, Relwendé Nacanabo, Orokia Sory, Issa Ouédraogo, Saira Nawaz, Anne E Schuind, Andrew Clark

  BackgroundAfrica has some of the highest cervical cancer incidence and mortality rates globally. Burkina Faso launched a human papillomavirus (HPV) vaccination programme for 9-year-old girls in 2022 with support from Gavi, the Vaccine Alliance (Gavi). An economic evaluation of HPV vaccination is required to help sustain investment and inform decisions about optimal HPV vaccine choices.MethodsWe used a proportionate outcomes static cohort model to evaluate the potential impact and cost-effectiveness of HPV vaccination for 9-year-old girls over a ten-year period (2022–2031) in Burkina Faso. The primary outcome measure was the cost (2022 US$) per disability-adjusted life year (DALY) averted from a limited societal perspective (including all vaccine costs borne by the government and Gavi, radiation therapy costs borne by the government, and all other direct medical costs borne by patients and their families). We evaluated four vaccines (CERVARIX®, CECOLIN®, GARDASIL-4®, GARDASIL-9®), comparing each to no vaccination (and no change in existing cervical cancer screening and treatment strategies) and to each other. We combined local estimates of HPV type distribution, healthcare costs, vaccine coverage and costs with GLOBOCAN 2020 disease burden data and clinical trial efficacy data. We ran deterministic and probabilistic uncertainty analyses.ResultsHPV vaccination could prevent 37–72% of cervical cancer cases and deaths. CECOLIN® had the most favourable cost-effectiveness (cost per DALY averted < 0.27 times the national gross domestic product [GDP] per capita). When cross-protection was included, CECOLIN® remained the most cost-effective (cost per DALY averted < 0.20 times the national GDP per capita), but CERVARIX® provided greater health benefits (66% vs. 48% reduction in cervical cancer cases and deaths) with similar cost-effectiveness (cost per DALY averted < 0.28 times the national GDP per capita, with CECOLIN® as the comparator). We estimated the annual cost of the

  Biostatistiques et épidémiologieImmunologieSanté publiqueLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-Effectiveness of Preemptive Switching to Efavirenz-Based Antiretroviral Therapy for Children With Human Immunodeficiency Virus

  Sophie Desmonde, Simone C Frank, Ashraf Coovadia, Désiré L Dahourou, Taige Hou, Elaine J Abrams, Madeleine Amorissani-Folquet, Rochelle P Walensky, Renate Strehlau, Martina Penazzato, Kenneth A Freedberg, Louise Kuhn, Valeriane Leroy, Andrea L Ciaranello

  AbstractBackgroundThe NEVEREST-3 (South Africa) and MONOD-ANRS-12206 (Côte d’Ivoire, Burkina Faso) randomized trials found that switching to efavirenz (EFV) in human immunodeficiency virus–infected children >3 years old who were virologically suppressed by ritonavir-boosted lopinavir (LPV/r) was noninferior to continuing o LPV/r. We evaluated the cost-effectiveness of this strategy using the Cost-Effectiveness of Preventing AIDS Complications–Pediatric model.MethodsWe examined 3 strategies in South African children aged ≥3 years who were virologically suppressed by LPV/r: (1) continued LPV/r, even in case of virologic failure, without second-line regimens; continued on LPV/r with second-line option after observed virologic failure; and preemptive switch to EFV-based antiretroviral therapy (ART), with return to LPV/r after observed virologic failure. We derived data on 24-week suppression (<1000 copies/mL) after a switch to EFV (98.4%) and the subsequent risk of virologic failure (LPV/r, 0.23%/mo; EFV, 0.15%/mo) from NEVEREST-3 data; we obtained ART costs (LPV/r, $6–$20/mo; EFV, $3–$6/mo) from published sources. We projected discounted life expectancy (LE) and lifetime costs per person. A secondary analysis used data from MONOD-ANRS-12206 in Côte d’Ivoire.ResultsContinued LPV/r led to the shortest LE (18.2 years) and the highest per-person lifetime cost ($19 470). LPV/r with second-line option increased LE (19.9 years) and decreased per-person lifetime costs($16 070). Switching led to the longest LE (20.4 years) and the lowest per-person lifetime cost ($15 240); this strategy was cost saving under plausible variations in key parameters. Using MONOD-ANRS-12206 data in Côte d’Ivoire, the Switch strategy remained cost saving only compared with continued LPV/r, but the LPV/r with second-line option strategy was cost-effective compared with switching.ConclusionFor children ≥3 years old and virologically suppressed by LPV/r-based ART, preemptive switching to EFV can improv

  ImmunologieMaladies infectieuses et tropicalesPédiatrieLicence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost-effectiveness of Vitamin A supplementation among children in three sub-Saharan African countries: An individual-based simulation model using estimates from Global Burden of Disease 2019

  BackgroundVitamin A Supplementation (VAS) is a cost-effective intervention to decrease mortality associated with measles and diarrheal diseases among children aged 6–59 months in low-income countries. Recently, experts have suggested that other interventions like large-scale food fortification and increasing the coverage of measles vaccination might provide greater impact than VAS. In this study, we conducted a cost-effectiveness analysis of a VAS scale-up in three sub-Saharan African countries.MethodsWe developed an individual-based microsimulation using the Vivarium simulation framework to estimate the cost and effect of scaling up VAS from 2019 to 2023 in Nigeria, Kenya, and Burkina Faso, three countries with different levels of baseline coverage. We calibrated the model with disease and risk factor estimates from the Global Burden of Disease 2019 (GBD 2019). We obtained baseline coverage, intervention effects, and costs from a systematic review. After the model was validated against GBD inputs, we modeled an alternative scenario where we scaled-up VAS coverage from 2019 to a level that halved the exposure to lack of VAS in 2023. Based on the simulation outputs for DALYs averted and intervention cost, we determined estimates for the incremental cost-effectiveness ratio (ICER) in USD/DALY.FindingsOur estimates for ICER are as follows: $860/DALY [95% UI; 320, 3530] in Nigeria, $550/DALY [240, 2230] in Kenya, and $220/DALY [80, 2470] in Burkina Faso. Examining the data for DALYs averted for the three countries over the time span, we found that the scale-up led to 21 [5, 56] DALYs averted per 100,000 person-years in Nigeria, 21 [5, 47] DALYs averted per 100,000 person-years in Kenya, and 14 [0, 37] DALYs averted per 100,000 person-years in Burkina Faso.ConclusionsVAS may no longer be as cost-effective in low-income regions as it has been previously. Updated estimates in GBD 2019 for the effect of Vitamin A Deficiency on causes of death are an additional driver of thi

  ImmunologiePédiatrieSanté publiqueLicence : Creative Commons Attribution License This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Cost‐Efficiency and Cost‐Effectiveness of Alternative Bouillon Fortification Programs: Evidence for Burkina Faso, Nigeria, and Senegal

  Stephen A. Vosti, Michael Jarvis, Lauren Thompson, Emily Becher, Maguette Beye, Faith Ishaya, Karim Koudougou, Reina Engle‐Stone, Katherine P. Adams

  ABSTRACTCost‐efficiency and cost‐effectiveness of fortification programs are not single, fixed numbers, but rather depend on dietary intake patterns and choices regarding the numbers and amounts of fortificants in premixes. We modeled the cost‐efficiency and cost‐effectiveness of alternative bouillon fortification formulations with vitamins A, B9, and B12, iron, and zinc in Burkina Faso, Nigeria, and Senegal. Cost per consumer reached varied by nutrient and context; for example, cost‐efficiency for vitamin A (96 µg/g) ranged from ∼$0.05 (Burkina Faso) to ∼$0.12 (Nigeria). In Nigeria, the cost per woman effectively covered by vitamin A‐fortified bouillon delivering 40−250 µg/g ranged from ∼$2.00 to ∼$6.50; in Burkina Faso, this metric fell from ∼$3.25 to ∼$1.25 for the same programs. Cost per child‐life saved by bouillon co‐fortified with vitamin A (96 µg/g), zinc (1.68 mg/g), and folic acid (28.8 µg/g) ranged from ∼$1272 (Burkina Faso) to ∼$3234 (Senegal). Cost functions tended to be linear in the amounts of fortificants in premixes; nutritional and child mortality benefit curves tended to be nonlinear, with context‐specific shapes. Identifying fortification levels at which marginal benefits become small could help inform the design of efficient programs; design should also consider technical issues, program objectives, affordability, and sustainability. Achieving dietary adequacy in vitamin A, zinc, and/or folate can save child‐lives. Different amounts and combinations of micronutrients have different costs and different effects on child mortality. This study presents ten bouillon fortification options for Nigeria. Scenarios 7 and 8 are the most cost‐effective, but save relatively few child‐lives. Scenario 9 is the least cost‐effective. Scenarios 1, 3, 6, and 10 are similarly cost‐effective; Scenario 1 saves the most child‐lives. This information is relevant for policy discussions.

  PédiatrieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of theLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costing curative outpatient care for the poorest in Burkina Faso: informing universal health coverage and leaving no one behind

  Yvonne Beaugé, Valéry Ridde, Sidibé Souleymane, Joël Arthur Kiendrébéogo, Hoa Thi Nguyen, Emmanuel Bonnet, Manuela De Allegri

  IntroductionThe poorest in Burkina Faso face numerous barriers to healthcare access, including financial and geographic obstacles, as well as a high burden of chronic conditions and multimorbidity. This study estimates the average cost of providing curative outpatient consultations at first-level healthcare facilities to the poorest in Burkina Faso. It also estimates the budgetary impact of scaling up free access to these services nationwide. The findings provide essential evidence on cost structures to inform decision-makers in developing policies aimed at achieving universal health coverage and ensuring that no one is left behind.MethodsWe conducted a micro-costing study to estimate the economic costs of providing curative outpatient healthcare services to the poorest at first-level healthcare facilities, considering a health system perspective. We measured the consumption of capital costs (building and equipment) using survey data from 32 primary health facilities and recurrent costs (drugs and consumables) from medical records of 1380 poor patients in Diébougou district. These individuals were targeted and exempted from user fees through a community-based targeting approach. We obtained unit costs from official price lists, pharmacy registries, and expert interviews. We calculated the national budget for providing curative care services to the exempted poorest based on the average cost per first-level consultation.ResultsThe estimated capital and recurrent costs of providing curative care services ranged between USD 0.59 - USD 0.61 and USD 2.58 - USD 5.00, respectively. The total cost ranged between USD 3.17 - USD 5.61 per first-level consultation. Providing curative care to the bottom 20% of the population, assuming 0.25 healthcare contacts per person per year, would result in an annual expense ranging from USD 2.77 M to USD 5.38 M (0.74-1.43% of the healthcare budget in 2019). With 2 healthcare contacts per person per year, costs increase to USD 22.19 M to USD

  Biostatistiques et épidémiologiePharmacologieSanté publiqueLicence : Open Access http://creativecommons.org/licenses/by/4.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original autho

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costing RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda: A generalizable approach drawing on publicly available data

  Katya Galactionova, Melanie Bertram, Jeremy Lauer, Fabrizio Tediosi

  Recent results from the phase 3 trial of RTS,S/AS01 malaria vaccine show that the vaccine induced partial protection against clinical malaria in infants and children; given the high burden of the disease it is currently considered for use in malaria endemic countries. To inform adoption decisions the paper proposes a generalizable methodology to estimate the cost of vaccine introduction using routinely collected and publicly available data from the cMYP, UNICEF, and WHO-CHOICE. Costing is carried out around a set of generic activities, assumptions, and inputs for delivery of immunization services adapted to a given country and deployment modality to capture among other factors the structure of the EPI program, distribution model, geography, and demographics particular to the setting. The methodology is applied to estimate the cost of RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda. At an assumed vaccine price of $5 per dose and given our assumptions on coverage and deployment strategy, we estimate total economic program costs for a 6–9 months cohort within $23.11–$28.28 per fully vaccinated child across the 6 countries. Net of procurement, costs at country level are substantial; for instance in Tanzania these could add as much as $4.2 million per year or an additional $2.4 per infant depending on the level of spare capacity in the system. Differences in cost of vaccine introduction across countries are primarily driven by differences in cost of labour. Overall estimates generated with the methodology result in costs within the ranges reported for other new vaccines introduced in SSA and capture multiple sources of heterogeneity in costs across countries. Further validation with data from field trials will support use of the methodology while also serving as a validation for cMYP and WHO-CHOICE as resources for costing health interventions in the region.

  Biostatistiques et épidémiologieParasitologie et mycologieImmunologieLicence : This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs and consequences of abortions to women and their households: a cross-sectional study in Ouagadougou, Burkina Faso

  Patrick G C Ilboudo, Giulia Greco, Johanne Sundby, Gaute Torsvik

  Little is known about the costs and consequences of abortions to women and their households. Our aim was to study both costs and consequences of induced and spontaneous abortions and complications. We carried out a cross-sectional study between February and September 2012 in Ouagadougou, the capital city of Burkina Faso. Quantitative data of 305 women whose pregnancy ended with either an induced or a spontaneous abortion were prospectively collected on sociodemographic, asset ownership, medical and health expenditures including pre-referral costs following the patient’s perspective. Descriptive analysis and regression analysis of costs were performed. We found that women with induced abortion were often single or never married, younger, more educated and had earlier pregnancies than women with spontaneous abortion. They also tended to be more often under parents’ guardianship compared with women with spontaneous abortion. Women with induced abortion paid much more money to obtain abortion and treatment of the resulting complications compared with women with spontaneous abortion: US$89 (44 252 CFA ie franc of the African Financial Community) vs US$56 (27 668 CFA). The results also suggested that payments associated with induced abortion were catastrophic as they consumed 15% of the gross domestic product per capita. Additionally, 11–16% of total households appeared to have resorted to coping strategies in order to face costs. Both induced and spontaneous abortions may incur high expenses with short-term economic repercussions on households’ poverty. Actions are needed in order to reduce the financial burden of abortion costs and promote an effective use of contraceptives.

  Biologie cellulaire et moléculaireGénétiqueGynécologie-obstétriqueLicence : http://creativecommons.org/licenses/by/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study

  IntroductionThis study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso.MethodsThe direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol’s iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019).ResultsThe study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31–41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0.ConclusionDepending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases.

  Biostatistiques et épidémiologieImmunologieMaladies infectieuses et tropicalesLicence : Creative Commons Attribution License This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs and cost-efficiency of a mobile cash transfer to prevent child undernutrition during the lean season in Burkina Faso: a mixed methods analysis from the MAM’Out randomized controlled trial

  Chloe Puett, Cécile Salpéteur, Freddy Houngbe, Karen Martínez, Dieynaba S. N’Diaye, Audrey Tonguet-Papucci

  BackgroundThis study assessed the costs and cost-efficiency of a mobile cash transfer implemented in Tapoa Province, Burkina Faso in the MAM’Out randomized controlled trial from June 2013 to December 2014, using mixed methods and taking a societal perspective by including costs to implementing partners and beneficiary households.MethodsData were collected via interviews with implementing staff from the humanitarian agency and the private partner delivering the mobile money, focus group discussions with beneficiaries, and review of accounting databases. Costs were analyzed by input category and activity-based cost centers. cost-efficiency was analyzed by cost-transfer ratios (CTR) and cost per beneficiary. Qualitative analysis was conducted to identify themes related to implementing electronic cash transfers, and barriers to efficient implementation.ResultsThe CTR was 0.82 from a societal perspective, within the same range as other humanitarian transfer programs; however the intervention did not achieve the same degree of cost-efficiency as other mobile transfer programs specifically. Challenges in coordination between humanitarian and private partners resulted in long wait times for beneficiaries, particularly in the first year of implementation. Sensitivity analyses indicated a potential 6% reduction in CTR through reducing beneficiary wait time by one-half. Actors reported that coordination challenges improved during the project, therefore inefficiencies likely would be resolved, and cost-efficiency improved, as the program passed the pilot phase.ConclusionsDespite the time required to establish trusting relationships among actors, and to set up a network of cash points in remote areas, this analysis showed that mobile transfers hold promise as a cost-efficient method of delivering cash in this setting. Implementation by local government would likely reduce costs greatly compared to those found in this study context, and improve cost-efficiency especially by subsi

  PédiatrieSanté publiqueLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (), which permits unrestricted use, distribution, and reproduction in any medium, provid

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs of administering injectable contraceptives through health workers and self-injection: evidence from Burkina Faso, Uganda, and Senegal☆☆☆

  Laura Di Giorgio, Mercy Mvundura, Justine Tumusiime, Allen Namagembe, Amadou Ba, Danielle Belemsaga-Yugbare, Chloe Morozoff, Elizabeth Brouwer, Marguerite Ndour, Jennifer Kidwell Drake

  ObjectiveTo evaluate the 12-month total direct costs (medical and nonmedical) of delivering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) under three strategies — facility-based administration, community-based administration and self-injection — compared to the costs of delivering intramuscular DMPA (DMPA-IM) via facility- and community-based administration.Study designWe conducted four cross-sectional microcosting studies in three countries from December 2015 to January 2017. We estimated direct medical costs (i.e., costs to health systems) using primary data collected from 95 health facilities on the resources used for injectable contraceptive service delivery. For self-injection, we included both costs of the actual research intervention and adjusted programmatic costs reflecting a lower-cost training aid. Direct nonmedical costs (i.e., client travel and time costs) came from client interviews conducted during injectable continuation studies. All costs were estimated for one couple year of protection. One-way sensitivity analyses identified the largest cost drivers.ResultsTotal costs were lowest for community-based distribution of DMPA-SC (US$7.69) and DMPA-IM ($7.71) in Uganda. Total costs for self-injection before adjustment of the training aid were $9.73 (Uganda) and $10.28 (Senegal). After adjustment, costs decreased to $7.83 (Uganda) and $8.38 (Senegal) and were lower than the costs of facility-based administration of DMPA-IM ($10.12 Uganda, $9.46 Senegal). Costs were highest for facility-based administration of DMPA-SC ($12.14) and DMPA-IM ($11.60) in Burkina Faso. Across all studies, direct nonmedical costs were lowest for self-injecting women.ConclusionsCommunity-based distribution and self-injection may be promising channels for reducing injectable contraception delivery costs. We observed no major differences in costs when administering DMPA-SC and DMPA-IM under the same strategy.ImplicationsDesigning interventions to bring contraceptive serv

  Santé publiqueLicence : This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs of insensitive acetylcholinesterase insecticide resistance for the malaria vector Anopheles gambiae homozygous for the G119S mutation

  Luc Djogbénou, Valérie Noel, Philip Agnew

  BackgroundThe G119S mutation responsible for insensitive acetylcholinesterase resistance to organophosphate and carbamate insecticides has recently been reported from natural populations of Anopheles gambiae in West Africa. These reports suggest there are costs of resistance associated with this mutation for An. gambiae, especially for homozygous individuals, and these costs could be influential in determining the frequency of carbamate resistance in these populations.MethodsLife-history traits of the AcerKis and Kisumu strains of An. gambiae were compared following the manipulation of larval food availability in three separate experiments conducted in an insecticide-free laboratory environment. These two strains share the same genetic background, but differ in being homozygous for the presence or absence of the G119S mutation at the ace-1 locus, respectively.ResultsPupae of the resistant strain were significantly more likely to die during pupation than those of the susceptible strain. Ages at pupation were significantly earlier for the resistant strain and their dry starved weights were significantly lighter; this difference in weight remained when the two strains were matched for ages at pupation.ConclusionsThe main cost of resistance found for An. gambiae mosquitoes homozygous for the G119S mutation was that they were significantly more likely to die during pupation than their susceptible counterparts, and they did so across a range of larval food conditions. Comparing the frequency of G119S in fourth instar larvae and adults emerging from the same populations would provide a way to test whether this cost of resistance is being expressed in natural populations of An. gambiae and influencing the dynamics of this resistance mutation.

  Biologie cellulaire et moléculaireGénétiqueMicrobiologie (bactériologie, virologie)Licence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Lien vers la sourceArticleEn anglais

  Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso

  Anaïs Colombini, Caroline Trotter, Yvette Madrid, Andromachi Karachaliou, Marie-Pierre Preziosi

  Background. Five years since the successful introduction of MenAfriVac in a mass vaccination campaign targeting 1- to 29-year-olds in Burkina Faso, consideration must be given to the optimal strategies for sustaining population protection. This study aims to estimate the economic impact of a range of vaccination strategies in Burkina Faso.Methods. We performed a cost-of-illness study, comparing different vaccination scenarios in terms of costs to both households and health systems over a 26-year time horizon. These scenarios are (1) reactive vaccination campaign (baseline comparator); (2) preventive vaccination campaign; (3) routine immunization at 9 months; and (4) a combination of routine and an initial catchup campaign of children under 5. Costs were estimated from a literature review, which included unpublished programmatic documents and peer-reviewed publications. The future disease burden for each vaccination strategy was predicted using a dynamic transmission model of group A Neisseria meningitidis.Results. From 2010 to 2014, the total costs associated with the preventive campaign targeting 1- to 29-year-olds with MenAfriVac were similar to the estimated costs of the reactive vaccination strategy (approximately 10 million US dollars [USD]). Between 2015 and 2035, routine immunization with or without a catch-up campaign of 1- to 4-year-olds is cost saving compared with the reactive strategy, both with and without discounting costs and cases. Most of the savings are accrued from lower costs of case management and household costs resulting from a lower burden of disease. After the initial investment in the preventive strategy, 1 USD invested in the routine strategy saves an additional 1.3 USD compared to the reactive strategy.Conclusions. Prevention strategies using MenAfriVac will be significantly cost saving in Burkina Faso, both for the health system and for households, compared with the reactive strategy. This will protect households from catastrophic expend

  Microbiologie (bactériologie, virologie)ImmunologieMaladies infectieuses et tropicalesLicence : http://creativecommons.org/licenses/by/3.0/igo/legalcode This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any r

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Costs of Treating Uncomplicated Sickle Cell Complications in a Day Hospital Setting in Equatorial Africa

  Sickle cell disease (SCD) is a major public health concern in Africa. SCD healthcare expenses are covered by personal finances in the Congo due to the absence of universal public health insurance. Various strategies have been implemented to minimize this economic burden, including an outpatient management strategy. The present study evaluated the costs associated with outpatient management of uncomplicated sickle cell crises. Patients presenting to the National Sickle Cell Center’s emergency room between December 2023 and February 2024 were included in this study for a total of 114 subjects with uncomplicated crises from SCD. Chief complaint, diagnosis, treatment, health insurance coverage, and cost of care were recorded for each subject. We further assessed the consistency of treatment with published standards of care. Mean patient age was 16 ± 13 years, where more than one‐third were adults (36.5%). The ratio of males to females was 1.09. Only 26.2% were employed. Monthly income was lower in individuals with SCD ($310.32 ± 120.93) compared to those without SCD ($386.92 ± 471). Managing uncomplicated SCD as an outpatient costs an average of $99.86 ± 49, where medications represented 55.7% of the total expense. Sixty‐six patients (57%) received prescription medications and investigation with no rational basis, resulting in an inflated cost of $15.96 per person. The present study did not demonstrate any financial benefits to managing uncomplicated SCD in outpatient settings.

  HématologieLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of the, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticle

  Coude flottant associant une fracture de Monteggia Bado 4 à une fracture de la palette humérale

  Soufiane Guelzim, Mustapha Mahfoud

  Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?

  Massa dit Achille Bonko, Ibrahima Karama, Francois Kiemde, Palpouguini Lompo, Zakaria Garba, Sibidou Yougbaré, Petra F. Mens, Halidou Tinto, Marc Christian Tahita, Henk. D. F. H. Schallig

  BackgroundFebrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics.MethodsClinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing.ResultsIn total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropr

  Microbiologie (bactériologie, virologie)Parasitologie et mycologiePharmacologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as

  Lire dans MyLaafi
• Lien vers la sourceArticle

  Could Cytochrome P450 2D6, 3A4 and 3A5 Polymorphisms Explain the Variability in Clinical Response to Clomiphene Citrate of Anovulatory PCOS Women?

  Camille Robin, Benjamin Hennart, Franck Broly, Philippine Gruchala, Geoffroy Robin, Sophie Catteau-Jonard

  Introduction: Cytochrome P450 2D6, 3A4 and 3A5 are involved in the metabolism of many drugs. These enzymes have a genetic polymorphism responsible for different metabolic phenotypes. They play a role in the metabolism of clomiphene citrate (CC), which is used to induce ovulation. Response to CC treatment is variable, and no predictive factors have thus far been identified. ObjectiveTo study a possible link between the cytochrome P450 2D6, 3A4 and 3A5 polymorphisms and clinical response to CC.Study DesignSeventy-seven women with anovulatory Polycystic Ovarian Syndrome (PCOS) treated with CC were included which determined their cytochrome P450 2D6, 3A4 and 3A5 genotypes and used the results to predict ovarian response to this drug. Predicted responses based on the cytochrome genotypes were compared with the observed clinical responses using the calculation of a weighted Kappa coefficient.Main Outcome MeasuresNumber of dominant follicles assessed by ultrasound at the end of the follicular phase and confirmation of ovulation by blood progesterone assay in the luteal phase. Results: Concordance between the predicted and observed responses for the combination of the three cytochromes was 36.71%, with a negative Kappa coefficient (K = -0.0240), which corresponds to a major disagreement. Similarly, for predictions based on the cytochrome P450 2D6 genotype alone, only 39.24% of predictions were verified (coefficient K = -0.0609). ConclusionThe genetic polymorphism of cytochromes P450 2D6, 3A4 and 3A5 does not appear to influence clinical response to CC used to induce ovulation in anovulatory PCOS women.

  Biologie cellulaire et moléculaireGénétiquePharmacologieLicence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Could the Decision of Trial Participation Precede the Informed Consent Process? Evidence From Burkina Faso

  BackgroundOver the last years, the number of clinical trials carried out in low-income countries with poor medical infrastructure and limited access to health care has increased. In these settings, the decision of participating in a clinical study may be influenced by factors related to participants’ vulnerability that limit the efficacy of the informed consent.MethodsA mixed methods social science study, based on the triangulation of qualitative and quantitative data, was carried out in a socio-economically disadvantaged and semi-urban area of Bobo Dioulasso, Burkina Faso. The study aimed at assessing the relevance of the informed consent procedure on the decision-making process of the parents and/or guardians of potential participants in a pediatric malaria trial.ResultsFor most parents (70.4%), the decision of participating had already been taken before undergoing the informed consent process and was based on the information conveyed through the community. Access to free and good quality health care often inspired this decision. In addition, the parents’ willingness to have their child included in the trial made them develop active strategies to achieve this purpose.DiscussionIn a context of socio-economic vulnerability and poor access to free health care, the process of informed consent does not always accomplish its goal of informing people and enabling them to make a free and informed decision. This information role is somehow anticipated by the community and trial participation becomes a strategic action to secure otherwise unavailable health resources leading community members to decide on participation even prior to the informed consent process.

  Parasitologie et mycologieMaladies infectieuses et tropicalesPédiatrieLicence : This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Could you have said no? A mixed-methods investigation of consent to HIV tests in four African countries

  Carla Makhlouf Obermeyer, Cairn Verhulst, Khalil Asmar

  IntroductionAlthough most studies report high frequencies of consent to HIV tests, critics argue that clients are subject to pressure, that acceptors later indicate they could not have refused, and that provider-initiated HIV testing raises serious ethical issues. We examine the meaning of consent and why clients think they could not have refused.MethodsClients in Burkina Faso, Kenya, Malawi and Uganda were asked about consenting to HIV tests, whether they thought they could have refused and why. Textual responses were analyzed using qualitative and statistical methods.ResultsAmong 926 respondents, 77% reported they could not have said no, but in fact, 60% actively consented to test, 24% had no objection and only 7% tested without consent. There were few significant associations between categories of consent and their covariates.ConclusionsRetrospectively asking clients if they could have refused to test for HIV overestimates coercion. Triangulating qualitative and quantitative data suggests a considerable degree of agency.

  ImmunologieMaladies infectieuses et tropicalesSanté publiqueLicence : This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Countries' experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis

  Sonia Hernández‐Cordero, Rafael Pérez‐Escamilla, Paul Zambrano, Isabelle Michaud‐Létourneau, Vania Lara‐Mejía, Bianca Franco‐Lares

  AbstractScaling up effective interventions, policies and programmes can improve breastfeeding (BF) outcomes. Furthermore, considerable interest exists in learning from relatively recent successful efforts that can inform further scaling up, with appropriate adaptations, across countries. The purpose of this four‐country case studies analysis was to examine why and how improvements in BF practices occurred across four contrasting countries; Burkina Faso, the Philippines, Mexico and the United States of America. Literature reviews and key informant interviews were conducted to document BF trends over time, in addition to why and how BF protection, promotion and support policies and programmes were implemented at a national level. A qualitative thematic analysis was conducted. The ‘Breastfeeding Gear Model’ and RE‐AIM (Reach; Effectiveness; Adoption; Implementation; and Maintenance) frameworks were used to understand and map the factors facilitating or hindering the scale up of the national programmes and corresponding improvements in BF practices. Each of the studied countries had different processes and timing to implement and scale up programmes to promote, protect and support breastfeeding. However, in all four countries, evidence‐based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for BF. Furthermore, in all countries, lack of adequate maternity protection and the aggressive marketing of the breast‐milk substitutes industry remains a strong source of negative feedback loops that are undermining investments in BF programmes. Country‐specific best practices included innovative legislative measures (Philippines), monitoring and evaluation systems (United States of America), engagement of civil society (Mexico) and behavior change communication BF promotion (Burkina Faso) initiatives. There is an urgent need to improve maternity protection and to strongly enforce the WHO Code

  Gynécologie-obstétriqueSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of theLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi