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Biomedical subjects

Helen Guyatt

Publications and source records attributed to Helen Guyatt.

6 recordsLinked to original sources
PubMed2006

Early childhood diarrhea predicts impaired school performance.

OBJECTIVE: Diarrhea is a leading cause of mortality worldwide; however, its long-term morbidity is poorly understood. Recently, early childhood diarrhea (ECD) has been associated with impaired physical fitness, growth and cognitive function 6 to 9 years later. We studied the effects of ECD on school functioning in a shantytown in northeastern Brazil. DESIGN: We administered 77 educational surveys. Complete diarrhea surveillance (ie, >90%) in the first 2 years of life and demographic and anthropometric information were available for 73 children. Age at starting school was calculated for 62 children, whereas age appropriateness for the current grade (AFG) was calculated for all 73 children who were >6 years old. Stepwise regression was used to examine the independent effect of ECD on school functioning after controlling for socioeconomic factors, maternal education, breast feeding, growth and cognitive functioning. RESULTS: ECD correlated with age at starting school (r = 0.55, P = 0.0005) and remained a significant predictor even after controlling for family demographics, days of breast feeding, early growth and TONI-3 test of nonverbal intelligence. This was true despite significant correlations of ECD with growth shortfalls and impaired cognitive functioning. ECD also correlated with AFG (r = 0.38, P = 0.001). Only TONI-3 test scores explained this association, suggesting that ECD may hinder school performance, but only in part school readiness, by impairing cognitive function as measured by performance on the TONI-3 nonverbal intelligence test. CONCLUSIONS: These findings document effects of early childhood diarrhea on later school readiness and performance and hence potential long-term human and economic costs of ECD, which warrant further attention and far greater investment for the control of ECD and its consequences.

Age Factors↗
PubMed2003

Use of bednets given free to pregnant women in Kenya.

In 2001, Unicef procured 70000 bednets and insecticide treatments to be distributed free to pregnant women attending antenatal clinics in 35 (of 69) districts in Kenya. 1 year later, we interviewed 294 pregnant women who had received a free net. 267 (91%) nets had remained in the target homesteads, and only one of the nets had been sold. In a district with high malarial transmission, 93 (84%) of 111 women who had not previously been sleeping under a bednet had used the net while pregnant, and 97 (91%) of the 107 surviving babies were also protected; in another district, which had low transmission, 73 (58%) of 126 women used the nets during pregnancy and 91 (80%) of 114 infants were protected by the nets. These data suggest that bednets given free to pregnant women are used by recipients and their newborn children, and should be regarded as an important delivery system in increasing access to and use of insecticide-treated bednets in vulnerable groups.

Adolescent↗
PubMed2003

The cost of delivering and sustaining a control programme for schistosomiasis and soil-transmitted helminthiasis.

Large-scale chemotherapy programmes for helminth control continue to rely heavily on donor support. This is despite more than a 10-fold reduction in delivery costs from integrating drug distribution through the school system rather than using mobile teams and a marked decline in the price of albendazole and praziquantel. Even at these low prices (<US dollars 0.25 per child treated with albendazole), it seems that school-based programmes may not be affordable to governments or communities. It is estimated, for instance, that mass albendazole treatment of school-aged children in Kenya could cost over US dollars 3 million each year, which is 4% of current national expenditure on all health care. It has been suggested that a cost retrieval system could help ensure sustainability of these programmes. Some studies have shown that parents may be willing-to-pay for the treatment of their children but the actual amount that could be recovered and the ability of households to pay these amounts is uncertain. Furthermore, the costs incurred in implementing school-based delivery are likely to be much higher than the frequently quoted US dollars 0.03 per child by the Partnership for Child Development (PCD) programmes, as this estimate does not include the 'external costs' for the scientific co-ordinating centre which was responsible for supporting these approaches. Whether these school health programmes could run independently of this system at such a low cost remains to be seen.

Albendazole↗
PubMed2003

Scaling-up coverage with insecticide-treated nets against malaria in Africa: who should pay?

Insecticide-treated nets (ITNs) have been shown to reduce the burden of malaria in African villages by providing personal protection and, if coverage of a community is comprehensive, by reducing the infective mosquito population. We do not accept the view that scaling-up this method should be by making villagers pay for nets and insecticide, with subsidies limited so as not to discourage the private sector. We consider that ITNs should be viewed as a public good, like vaccines, and should be provided via the public sector with generous assistance from donors. Our experience is that teams distributing free ITNs, replacing them after about 4 years when they are torn and retreating them annually, have high productivity and provide more comprehensive and equitable coverage than has been reported for marketing systems. Very few of the free nets are misused or sold. The estimated cost would be an annual expenditure of about US$295 million to provide for all of rural tropical Africa where most of the world's malaria exists. This expenditure is affordable by the world community as a whole, but not by its poorest members. Recently, funding of this order of magnitude has been committed by donor agencies for malaria control.

Africa↗
PubMed2002

The worm turns.

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Journal Article↗