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Biomedical subjects

D Evans

Publications and source records attributed to D Evans.

At least 379 records · Page 21Linked to original sources
PubMedDate not supplied

Cost-effectiveness analysis of alternative treatments of African gambiense trypanosomiasis in Uganda.

African trypanosomiasis, or sleeping sickness, is a tropical disease caused by trypanosome parasites transmitted by tsetse flies. The focus of this paper is on the cost-effectiveness of alternative drug treatments for patients in the late stage of the disease. Melarsoprol has been used for many decades. More recently, eflornithine has been developed. It has fewer side effects and improves the overall cure rate. It is much more expensive than melarsoprol, however. The objective of the present cost-effectiveness is to identify the costs and benefits that would be involved in switching from melarsoprol to eflornithine in the treatment of late stage sleeping sickness. Benefits are expressed in lives saved as well as in disability adjusted life years (DALYs). The analysis is applied to the case of Uganda. The implications for affordability are also considered, by taking account of how the treatment costs would be shared between the national government, donors and patients. The baseline results indicate that melarsoprol treatment is associated with an incremental cost per life and DALY saved of $209 and $8, respectively. Each additional life saved by switching from melarsoprol alone to a combination of melarsoprol and eflornithine would cost an extra $1,033 per life saved, and an extra $40.9 per DALY gained. Shifting from this second alternative to treatment of all patients with eflornithine leads to an incremental cost per life saved of $4,444 and an incremental cost of $166.8 per DALY gained.

Animals↗
PubMedDate not supplied

The quantitation of cultured cellular surface coverage: applications for transparent and opaque surfaces.

A planimetric technique is described for the analysis of cellular linings cultured on vascular prostheses and tissue culture plates. The method is not destructive of the cells and uses a calibrated eyepiece grid and an inverted microscope. The technique allows a rapid assessment of the percent of the prosthetic surface covered by cells, the average size of the cellular islands, and their distribution. In addition, the cells may be counted, their average surface area computed, and growth curves constructed for cells grown on tissue culture plates without the need for multiple concurrent cultures. Different cell types may be counted on the same surface. The method is more accurate than methods that require the resuspension of cells for counting, and it saves time and cells.

Animals↗
PubMedDate not supplied

Cutaneous leishmaniasis in south-western Ethiopia: Ocholo revisited.

The borough of Ocholo, on the western side of the Ethiopian Rift Valley, is an endemic focus for Leishmania aethiopica infection and has been surveyed thrice between 1987 and 1990. In 1989, 3022 inhabitants (> 95% of the population) were interviewed and examined. The overall prevalence of localized cutaneous leishmaniasis (LCL) was 3.6-4.0%, with a peak value of 8.5% in the 0-10 years old age group. In half of the patients the active disease was estimated to last for 9.6 +/- 6 months; in 10%, it exceeded 3 years. Scars of LCL were present in 34.3% of the residents. Leishmanin skin tests were positive in 54% of 120 school-children without signs of the disease. Therefore, in Ocholo a minimum of 71.6% of the population has been exposed to L. aethiopica infection. Two cases of the diffuse form of cutaneous leishmaniasis were observed. In this highland biotope, Phlebotomus pedifer was found to be the major, and possibly the only, vector for L. aethiopica.

Adolescent↗
PubMedDate not supplied

A population dynamic approach to the cost-effectiveness analysis of mass anthelmintic treatment: effects of treatment frequency on Ascaris infection.

This study examines the cost-effectiveness of different frequencies of mass chemotherapy in reducing helminth infection and morbidity at the community level. The cost-effectiveness framework utilities a dynamic model of helminth transmission which permits the effectiveness of treatment to be expressed as some long-term reduction in infection and disease. Cost analysis is incorporated into this framework using an itemized cost menu and cost data from an actual control programme. The cost-effectiveness of mass treatment is investigated using epidemiological measures considered appropriate to Ascaris lumbricoides infection in both a high and low transmission area. The optimal strategy for control is shown to be dependent on the control objectives, the rate of transmission, and existing budget constraints. The analysis suggests that if the aim of control is to reduce morbidity due to ascariasis and mass treatment is the approach selected, then it is more cost-effective to intervene in a high transmission area than in a low transmission area, and that relatively long intervals between treatments offer the most cost-effective strategy.

Animals↗
PubMedDate not supplied

Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.

BACKGROUND: In sub-Saharan Africa in the 1990s, more than 600,000 people had epidemic meningococcal meningitis, of whom 10% died. The current recommended treatment by WHO is short-course long-acting oily chloramphenicol. Continuation of the production of this drug is uncertain, so simple alternatives need to be found. We assessed whether the efficacy of single-dose treatment of ceftriaxone was non-inferior to that of oily chloramphenicol for epidemic meningococcal meningitis. METHODS: In 2003, we undertook a randomised, open-label, non-inferiority trial in nine health-care facilities in Niger. Participants with suspected disease who were older than 2 months were randomly assigned to receive either chloramphenicol or ceftriaxone. Primary outcome was treatment failure (defined as death or clinical failure) at 72 h, measured with intention-to-treat and per-protocol analyses. FINDINGS: Of 510 individuals with suspected disease, 247 received ceftriaxone, 256 received chloramphenicol, and seven were lost to follow-up. The treatment failure rate at 72 h for the intention-to-treat analysis was 9% (22 patients) for both drug groups (risk difference 0.3%, 90% CI -3.8 to 4.5). Case fatality rates and clinical failure rates were equivalent in both treatment groups (14 [6%] ceftriaxone vs 12 [5%] chloramphenicol). Results were also similar for both treatment groups in individuals with confirmed meningitis caused by Neisseria meningitidis. No adverse side-effects were reported. INTERPRETATION: Single-dose ceftriaxone provides an alternative treatment for epidemic meningococcal meningitis--its efficacy, ease of use, and low cost favour its use. National and international health partners should consider ceftriaxone as an alternative first-line treatment to chloramphenicol for epidemic meningococcal meningitis.

Adolescent↗