The importance of "throwing money at" the problem of global health.

More funding from wealthy countries is required to improve health care and the infectious disease situation in developing countries. Although progress has been made, funds for fighting AIDS, tuberculosis, and malaria remain inadequate. These treatable and preventable diseases together kill over 6 million people every year. Funds are needed to improve access to existing medicines as well as to increase research and development of drugs. The idea that "throwing money at the problem is not going to solve it" rightly holds that increased funding is not sufficient for solving the health care problems of developing countries. In order to work, funds must be spent wisely. This does not mean that increased funding is unnecessary.

Socio-economic dimensions of tuberculosis control: review of studies over two decades from Tuberculosis Research Center.

Tuberculosis (TB) affects the most productive age group and the resultant economic cost for society is high. Even though diagnostic and treatment services under TB control are offered free of cost, TB patients do incur out of pocket expenditure. Tuberculosis Research Centre under took a series of studies on economic aspects of TB. We interviewed TB patients enrolled under TB control programme in south India, and assessed the following: socio-economic status of patients (SLI - standard of living index) and economic impact on patients, families both before and after Revised TB Control Programme (RNTCP) and the impact of parental TB on children. In addition patient's perceptions of physical, mental, social well being during and after completion of treatment were also elicited. A TB patient incurs out of pocket expenditure of Rs 5986 amounting to about 13,000 crores a year for the country; 11% of children dropped out of school on account of parental illness and 20% of the children had to take up employment in order to supplement income especially if the father had TB. About 64% of TB patients registered under RNTCP were poor (low SLI). The provider cost to treat a TB patient under RNTCP was Rs 1587/- for Category I, Rs 1924/- for Category II and Rs 1417/- Category III. At the end of treatment even though 47% of patients continued to have respiratory symptoms, 54% of patients perceived 'happy mental status'. Majority of the patients registered under RNTCP were poor. Patients' and provider costs and the impact on patients including families on account of TB were enormous. About half of TB patients, despite completing treatment successfully had persistent respiratory ill health resulting in frequenting health facilities. This information is vital for programme planners indicating that the existing control programs have been ineffective. To achieve success in control programs, the existing ones should be amended as there is evolution of resistance in the parasite as well as the vector. Public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs should also be considered and checked out for better control measures.

Working towards TB elimination the WHO Regional Strategic Plan (2006-2015).

DOTS has expanded rapidly in the South-East Asia Region over the period of the Partnership's first Global Plan (2001-2005), with almost 100% geographical coverage achieved in 2005. All countries have made impressive progress in improving coverage and quality. This progress has been made possible through strong political commitment and large investments in TB control for improved infrastructure, reliable drug supply, increased staffing, improved laboratory services, and intensified training and supervision. Accomplishing the objectives outlined in this document will require sustaining the progress in all countries and particularly in the five high burden countries for achieving major regional and global impact. National TB programmes will need to be supported to maintain or surpass the 70% case detection and 85% treatment success rates. The achievement of the TB-related targets linked to the MDGs will also depend on how effectively initiatives such as DOTS-Plus, PPM DOTS and interventions for TB/ HIV among others, are implemented. National governments and development partners must fulfill their commitments to mobilizing and sustaining adequate resources to support the full range of activities envisaged. The benefits of full and effective implementation of all the planned interventions would be substantial. These will result in 20 to 25 million TB cases being treated in DOTS program mes and more than 150 000 drug-resistant cases receiving treatment through DOTS-Plus during the period 2006-2015. In addition, at least 250 000 HIV-infected TB patients may also receive anti-retroviral therapy. As a consequence, the prevalence of TB is expected to fall below 175/100 000 and the number of TB deaths is expected to fall to between 100 000 and 150 000 per year. There would also be substantial economic benefits given that TB disproportionately affects adults in their most productive years. Considering these aspects, it is expected that the TB incidence will decline significantly during this period so that the Millennium Development Goals would be met by or ahead of 2015.

Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India.

BACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures.

Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico

OBJECTIVE: In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. DESIGN AND METHODS: Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. RESULTS: In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50 percent and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50 percent and that costs less than US$ 4.50 per person would be expected to be cost-effective. CONCLUSIONS: Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks

Modeling factors influencing malaria incidence in Myanmar.

This is a documentary study to determine factors influencing malaria incidence in Myanmar. The period of study covered was from 1989 to 1998 using time series data. Multiple regression analysis was performed on the dependent variable, yearly incidence of malaria in Myanmar, with hypothesized independent variables including variables related to epidemiology, demography, service and socioeconomic status. Malaria incidence was inversely associated with the government budget for malaria control at the 5% level and with the case fatality rate of malaria at the 10% level. Other variables: yearly gross domestic product, yearly proportion of Plasmodium falciparum cases and yearly DDT use of spraying displayed expected signs but were not statistically significant.

Highlights on the World Bank Loan Schistosomiasis Control Program in China (1991-1998): a special focus on Hunan Province.

A region-wide sampling survey was conducted in 1995 in order to evaluate the current epidemiological status of schistosomiasis japonica in Hunan Province, China. A total of 45,590 humans and 3,726 domestic animals, from 52 villages, were examined parasitologically and/or serologically for current Schistosoma japonicum infections. In uncontrolled endemic areas (43 villages) the overall human prevalence of S. japonicum was 7.81% across the different geographical subtypes. The geometric mean intensity of infection was 17.71 eggs per gram (epg) among infected individuals and only 1.25 epg in the general population. The bovine prevalence, as determined by the hatching test, was 9.63% in the uncontrolled endemic villages. Only one sero-positive (by indirect hemagglutination assay) child was found among 1,072 children tested aged 10-14 years in the 9 endemic villages under effective control. No infection was confirmed by the Kato-Katz thick smear stool examination. When the results of this survey were compared to those seen at baseline (1989) an overall reduction of 45.65% was seen in the human prevalence but no significant change was apparent in the lake-beach ecotype. Additionally, there was more than a 60% reduction in the prevalence among bovines over the same sampling period. The results demonstrate that the World Bank Loan Schistosomiasis Program was successful in achieving its most basic objectives for this province - to reduce human and bovine infections by 40%.

Evaluación de un programa de control de la enfermedad de Chagas en el banco de sangre de un hospital de Santiago, Chile / Transfusional Chagas disease: evaluation of a control programme at the blood bank of an hospital in Santiago, Chile

Se evalúa el resultado inicial de un plan piloto aplicado en el Banco de Sangre del Hospital San juan de Dios, de Santiago, destinado a prevenir la transmisión iatrogénica transfusional de la Enfermedad de Chagas. Consistió en el análisis serológico de todos los donantes que concurrieron en el lapso de dos años, para detectar los infectados y la eliminación de las sangres respectivas. La pesquisa serológica fue efectuada mediante las reacciones de inmunofluorescencia indirecta (RIFI-IgG) y hemaglutinación indirecta (RHAI). de un total de 19.859 donantes examinados se encontró 443 positivos (2,2%). De acuerdo con los índices de riesgo establecidos por otros autores, la eliminación de las sangres positivas había significado evitar la transmisión transfusional de T cruzi en 80 casos, promedio. Como en las zonas de alta endemia del país se han encontrado cifras de hasta 30% de donantes infectados, el problema se estima grave en Chile, justificando la instauración de un programa preventivo similar en todos los bancos de sangre de la área endémica. Este estudio demuestra que dicho programa es factible y a un costo razonablemente moderado