Water-Borne diseases, cost of illness and willingness to pay for diseases interventions in rural communities of developing countries

Almost one third of the global population is living in developing South Asia where disease occurrence is high especially in rural areas and people are unaware of water-borne diseases and cost of illness. The quantitative approach involved questionnaire based study [n=50 households]. The community awareness, the occurrence of water-borne diseases with related cost of illness and community participation for the introduction of health interventions for water-borne diseases were evaluated through cross-tabulations, correlations, and ANOVA. Majority [40%] of the community had no knowledge of water-borne diseases except some had little knowledge of diarrhea and typhoid. Diarrhea followed by stomach diseases was widespread in the community. Population below poverty level was bearing the cost of illness around US[dollar sign] 0.6-1.2 [Rs 50-100] per day followed by low and average income level with direct cost of US[dollar sign] 2.3 [Rs 200] per day. The indirect cost of illness had showed increasing trend between US[dollar sign] 2.3-4.7 [Rs 200-400] per day with increase in income levels. Maximum willingness to pay [WTP] for water supply and sewerage system was US[dollar sign] 3.6 [Rs 300] and US[dollar sign] 1.2 [Rs 100] per month respectively. Income and water supply demand was strongly correlated with acceptability to pay for the facilities [r = 0.319, 0.307; P< 0.05]. Income had a strong influence on WTP for water and sewerage system [r = 0.805, 0.797; P< 0.05]. To maintain rural health, water-borne diseases can be reduced by introducing health interventions like proper water and sanitation facilities

Intensified pulse polio immunization: Time spent and cost incurred at a primary healthcare centre.

Background. Despite launching the polio eradication initiative in 1995, India is among the world’s largest reservoir of wild poliovirus with 559 cases of poliomyelitis reported in 2008. This continued failure has been criticised for its negative impact on routine healthcare delivery. We assessed the impact of the pulse polio immunization programme at the primary health level in terms of services, time and cost. Methods. All activities during a single round of intensified pulse polio immunization were modelled on actual requirements at the primary health centre at Dayalpur in Haryana. Total person-hours and cost per child vaccinated at the primary health centre were computed. Results. Almost all routine healthcare services at the primary health centre were suspended during the round. Total person-hours consumed were 4446 and the total direct cost was Rs 24.2 per child vaccinated during a single round of the intensified pulse polio immunization programme. Conclusion. A single round of intensified pulse polio immunization consumes a substantial number of person-hours and leads to a temporary suspension of routine services provided at the primary health centre. This should be factored in while planning any future strategy of polio eradication or control and suggests the need to re-think the ‘intensified pulse polio strategy’.

Bioética e pandemia de Influenza / Bioethics and influenza pandemic

A presente pandemia de Influenza A (H1N1) tem gerado inúmeros questionamentos sobre aspectos técnicos, éticos, legais e sociais envolvidos. Estas questões envolvem as medidas sanitárias a serem tomadas, como uso de medicamentos, recursos ambulatoriais e hospitalares, suspensão de aulas, quarentenas e outras restrições. Outro ponto extremamente relevante é o que se refere a atuação dos profissionais de saúde nesta situação de excepcionalidade. É fundamental refletir sobre este tema com clareza e imparcialidade no sentido de tentar reduzir a ambigüidade das informações.

This influenza A (H1N1) pandemic generates many questions about technical, ethical, legal and social issues. These issues involve health measures to be taken, such as the use of medications, outpatient and hospital resources, school closure, quarantines and other restrictions. Another extremely important point is the healthcare workers' attitudes towards working during pandemic influenza. It is critical to reflect on this subject with clarity and fairness trying to reduce the ambiguity of information.

Avian flu and possible human pandemic.

Avian flu is affecting the poultry animals world over since first outbreak in 1997 in Hong Kong and has resulted in 92 human deaths and culling of more than 150 million poultry animals in Asia and Europe. The loss to the economy has also been enormous. 13 new countries, including India, reported occurrence of the disease in poultry animals in February 2006 only, to the World Health Organisation. This rapid rate of spread of virus along with notoriety of the virus for frequent genetic re-assortment, which might enable H5N1 to infect human beings, threatens of possible influenza pandemic since the last pandemic in 1968. The human influenza caused by this subtype of the virus (H5N1) has high case fatality of 54% and majority of affected humans are between the age of 5 to 23 years. Lack of effective vaccine, poor knowledge about treatment, and with scarcity of public health measures in developing countries are major causes of concern. The real threat of impending pandemic can be avoided only if we act immediately on the basis of currently available source of information and apply scientific knowledge rationally for containment and prevention of bird flu and treat human cases promptly.

Estrategia de trabajo en la central de esterilización durante la epidemia de dengue / Working strategy at the sterilization department during an dengue epidemic

Se realizó un estudio descriptivo y retrospectivo de los gastos en materiales, equipos y recursos humanos ocasionados por la atención brindada a los pacientes con dengue en el Hospital General Santiago durante 1997, que permitió establecer diferencias entre los consumos normales y los que requirió la epidemia. Se depuraron los gastos provocados por los servicios de pruebas diagnósticas y se demostró que los gastos en el Departamento Central de Esterilización se elevaron en condiciones anormales como las del período epidémico investigado, siendo los servicios de atención priorizada y de medios diagnósticos los mayormente afectados; de ahí la necesidad de que el personal de la Central de Esterilización sea una fuerza de trabajo diestra, capaz de ejecutar su labor con calidad y actuar en cada caso con precisión y sin ocasionar demoras innecesarias, que garanticen la más óptima atención a los pacientes, dada la masividad con que éstos llegan al hospital. Las roturas de materiales obedecieron generalmente a la participación activa, en función de la atención directa a los pacientes, por personal de apoyo de otras unidades que no mantenían la misma disciplina del hospital, así como la incorporación de alumnos de medicina y enfermería de diferentes niveles