Neonatal tetanus (NNT) is a leading cause of neonatal mortality in developing countries and is frequently called 'the silent epidemic'. It is endemic in over 90 countries throughout the world. Incidence is often not known, obstructing cost-effective resource management for control measures. In many developing countries NNT is responsible for one-half of the neonatal mortality and up to one-quarter of infant mortality. Case-fatality rates (CFR) can, even with treatment, reach 80-90%. Operational tools for the rapid identification of NNT risk areas need to be developed for WHO's programme which calls for the elimination of NNT by 1995. Results of a rapid assessment technique, carried out in 1990, were compared with those found in a household survey, which was independently carried out in Jalisco, Mexico, in 1988. One approach used random sample survey techniques in rural communities, which in previous years had reported NNT. Of 40 neonatal deaths, 8 (20%) were attributable to NNT. The annual incidence rate was 4.6/1000 livebirths. Using this as the 'gold standard', a rapid assessment technique was evaluated. The NNT cases seen at health services were randomly matched with other neonatal illnesses obtained from health records and then mapped. Age-specific catchment areas for hospitals under investigation and risk areas for NNT were obtained. Areas without NNT cases but with other neonatal illnesses have been operationally considered to be at low risk for NNT. The use of health services by neonates with other pathologies supports the hypothesis that an NNT case, if it occurred within the same time period and area under investigation, would most probably have been admitted.(ABSTRACT TRUNCATED AT 250 WORDS)
Video observed treatment, an attractive option for the administration of tuberculosis therapy VOT (Video Observed Treatment) is a video certificated self-administration of therapy and could be complementary to DOT (Directly Observed Treatment) for the administration of ambulatory tuberculosis treatment at Primary Health Centers. Reviewed international experience and evidence indicates that VOT improves treatment adherence, empowers patients, reduces health system costs and saves patient´s transfer time to Therapy Centers. Given the high penetration of smartphones with videocall software in the Chilean population, the pre-requisites are provided to consider a VOT pilot research in Chile.
Primary prevention is a growing field of activity for both mandatory and private health insurance funds. Among other criteria the decision, whether to reimburse for preventive activities, has to be based on cost-benefit considerations. The question has not been studied, whether it is worthwhile for a private insurance fund to reimburse for such programs. The analysis focuses on smoking cessation as one of the most common interventions. A disease-model was developed that follows 50-year old male or female individuals, who initially smoked and then underwent smoking cessation, over a period of 10 years. In terms of health consequences of smoking the model included morbidity and mortality due to coronary heart disease (CHD), stroke, lung cancer and chronic obstructive lung disease (COLD). Beneficiaries were distributed over four distinct stages: "healthy", "diseased, surviving", "diseased, dying from disease" and "diseased, dying from other causes". Model parameters were derived from large cohort studies. Average annual treatment cost for the diseases were calculated by using a prevalence based top-down approach. The proportion of beneficiaries, who stayed abstinent for 10 years after participating in a smoking cessation program was 14%. The expected 10-years disease rate for a 50-year old ex-smoker was 16,0% for CHD (smokers 22,5%), 4,8% for stroke (smokers 6,8%), 2,6% for lung-cancer (smokers 3,9%) and 6,4% for COLD (smokers 12,7%). The expected 10-year saving in treatment cost per smoker, who underwent smoking cessation, was 77€ for CHD, 58€ for stroke, 34€ for lung-cancer and 20€ for COLD adding up to 189€ (baseline scenario). The amount of money saved in treatment cost roughly equals the amount to be spent for a smoking cessation intervention. Our model can be a helpful tool to assist decision making in the introduction of preventive services into the range of benefits provided by insurance funds.
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