Echinococcosis and other parasitic infections in domestic dogs from urban areas of an argentinean Patagonian city

In urban populations of South America, dogs with free access to public areas represent a public health concern. The primary consequence of roaming dogs on human health is the transmission of infectious and parasitic diseases mainly through feces contamination. The main diseases likely to be transmitted are hydatidosis or echinococcosis, larva migrans, and giardiasis. In Argentina, hydatidosis ranks among the most prevalent zoonosis. Although it is considered a rural disease, the circulation of this parasite in urban areas has been documented. The aim of this work was to survey intestinal parasites in canine feces from two low-income urban neighborhoods of Bariloche city, Argentina, and to assess their seasonal variation. During 2016, 188 fresh dog feces were collected from sidewalks in 40 randomly selected blocks from the neighborhoods. Each sample was processed by Sheater flotation and tested for a coproantigen (CAg) by ELISA. The percentage of parasitized feces was 65.3% (95% CI: 55.9%-73.8%). Eleven parasite species were found, 3 protozoan, 3 cestodes, and 5 nematodes. Echinococcus sp. was present in 9.3% of the samples (95% CI: 4.7%-16.1%). Canine echinococcosis rates resulted similar to rates found previously in other neighborhoods of the city. The life cycle of Echinococcus sp. is sustained in urban areas by the entry of parasitized livestock, domiciliary slaughtering, and inadequate deposition of offal. The risk of Echinococcus sp. transmission to people in these neighborhoods is very high, due to high density of free-roaming dogs and high percentages of infected feces, similar to percentages observed in rural areas.

En las poblaciones urbanas de América del Sur, los perros con acceso libre a áreas públicas representan un problema de salud pública. La principal consecuencia es la transmisión de enfermedades infecciosas y parasitarias a través de la contaminación por heces. Las principales enfermedades que pueden transmitirse son hidatidosis, larva migrans y giardiasis. En Argentina, la hidatidosis es una de las zoonosis más prevalentes y aunque es considerada una enfermedad rural, algunos estudios muestran la circulación de este parásito en zonas urbanas. El objetivo fue registrar los parásitos intestinales en heces caninas de dos barrios de bajos ingresos de la ciudad de Bariloche, Argentina, y evaluar su variación estacional. Durante 2016, se recolectaron 188 heces frescas de perros en 40 manzanas seleccionados aleatoriamente. Las heces se procesaron mediante flotación de Sheater y una prueba ELISA de coproantigeno (CAg). El porcentaje de heces parasitadas fue del 65.3% (IC 95%: 55.9%-73.8%). Se encontraron 11 especies de parásitos, 3 protozoos, 3 cestodes y 5 nematodes. Echinococcus sp. estuvo presente en el 9.3% de las heces (IC 95%: 4.7% -16.1%). La equinococosis canina mostró valores similares a estudios previos en otros barrios de la ciudad. El ciclo de vida Echinococcus sp. se mantiene en las zonas urbanas por entrada de ganado parasitado, faena domiciliaria y deposición inadecuada de vísceras. El riesgo de transmisión de Echinococcus sp. en estos barrios es alto, debido a la alta densidad de perros sueltos y al alto porcentaje de heces infectadas, similar al de las zonas rurales.

Effects of User Fee Exemptions on the Provision and Use of Maternal Health Services: A Review of Literature.

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAIDcommissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria- based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.