Wim Van Damme | ITM - Instituto Tecnológico Metropolitano (original) (raw)
Papers by Wim Van Damme
Health policy and planning, 2010
To reduce the burden of out-of-pocket payments on households in India, the government has introdu... more To reduce the burden of out-of-pocket payments on households in India, the government has introduced community health insurance (CHI) as part of its National Rural Health Mission. Indian CHI schemes have been shown to provide financial protection and have the potential to improve quality of care, but do not seem to improve access. This study examines this dimension of CHI performance and explores conditions under which a CHI scheme can improve access to hospital care for the poor. We conducted a panel survey at the ACCORD-AMS-ASHWINI (AAA) CHI scheme in India. The AAA CHI scheme protects the poorest sections of society against hospitalization expenses. 297 insured and 248 matched uninsured households were observed by village volunteers on a weekly basis for 12 months. Any patient presenting with a 'major ailment' in these households was interviewed using a structured questionnaire. Outcomes measured were utilization of hospital services, cost of treatment and quality of treatment received. The two cohorts were similar regarding demographic, social and economic parameters. More insured than uninsured households expressed trust in the CHI scheme organizers. Both groups had similar levels of minor ailments, but the insured had higher incidence of chronic and major ailments. Insured patients had a hospital admission rate 2.2 times higher than uninsured patients, independent of confounding factors. This higher rate among the insured was also found in children and those with pre-existing conditions. Vulnerable sections of the insured population-children, pregnant women, the poorest-had the highest admission rates. Most admissions, in both cohorts, took place in the ASHWINI hospital. Credible and trustworthy organizers, effective providers, low co-payments, and low indirect costs contributed to this result. A well-designed CHI scheme has the potential to improve access to hospital care, even for vulnerable sections of the community-the poorest, individuals with pre-existing conditions like diabetes and hypertension, and pregnant women.
BMC health services research, 2011
Background-Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan Afric... more Background-Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in six rural programs in Southern Africa with limited access to viral load monitoring and second-line ART.
AIDS patient care and STDs, 2010
Expanding access to HIV counseling and testing (HCT) and antiretroviral treatment (ART) has reduc... more Expanding access to HIV counseling and testing (HCT) and antiretroviral treatment (ART) has reduced morbidity and mortality in people living with HIV/AIDS. As a result, many countries are scaling up HIV/AIDS services. In this paper we discuss challenges experienced during the move toward universal access to HCT and ART services in Ethiopia. We reviewed routine reports from the Ministry of Health and implementing partners. We also had interviews, about linkage to and retention in care of patients, with 10 HIV/AIDS program managers, as well as 2 to 7 health care providers and 5 to 15 patients in each of 23 health centers and 32 hospitals in all regions of the country. We found that the number of people tested for HIV increased 10-fold from 435,854 in 2005 to 4,559,954 in 2008. Only 61% of the HIV-positive patients were linked to chronic care immediately after tested for HIV. The number of patients initiated on ART annually increased from 26,021 in 2005 to 53,696 in 2008. Attrition of patients increased from 18% in 2005 to 26% in 2008. Our interviews indicated that fear of stigma, transport cost, feeling healthy and opting for traditional medicines were the main reasons for poor linkage to and retention in care. Lack of nutrition and feeling better were also reasons for poor retention. In conclusion, in spite of the rapid scale-up of HCT and ART services in Ethiopia, linkage and retention were not adequate. Therefore, strategies should be developed and implemented to improve linkage and retention.
Journal of the International AIDS Society, 2011
Lancet, 2011
objectives To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation a... more objectives To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation and integration of PMTCT with routine maternal and child health services in two districts of KwaZulu-Natal; to report PMTCT coverage, to compare recorded and reported information, and to describe responsibilities of nurses and lay counsellors.
Globalization and health, 2011
Journal of acquired immune deficiency syndromes (1999), 2011
In many sub-Saharan countries, the health workforce shortage has been a major constraint in the s... more In many sub-Saharan countries, the health workforce shortage has been a major constraint in the scale-up of antiretroviral treatment. This human resource crisis has led to profound adjustments of the antiretroviral treatment care delivery model in several countries in the region. It also inspired some governments to take swift measures to substantially increase human resources capacity. This article draws on the experience of Malawi and Ethiopia, which have been able to successfully increase their health workforce over a relatively short period, allowing scaling up of antiretroviral treatment. Additional international HIV funding and strong political commitment made possible this exceptional response. Both countries implemented a combination of measures to tackle the human resource crisis: the delegation of medical and administrative tasks to lower health cadres and lay workers, the introduction of new health cadres, the reinforcement of pre-service training, and improving health staff remuneration. In particular, the involvement of community and lay health workers in HIV-related service delivery substantially increased the health workforce. The involvement of lay cadres has important long-term implications. To sustain results, continued political commitment, ongoing training and supervision to maintain quality of care, and strategies to avoid attrition among lay cadres will be essential. Although task shifting and involvement of lay cadres allowed bridging of the human resource gap in a short time, other strategies have to be considered simultaneously, and all interventions must be maintained over a longer period to yield results.
PloS one, 2010
Background: There is substantial evidence that ill-health is a major cause of impoverishment in d... more Background: There is substantial evidence that ill-health is a major cause of impoverishment in developing countries. Major illnesses can have a serious economic impact on poor households through treatment costs and income loss. However, available methods for measuring the impact of ill-health on household welfare display several shortcomings and new methods are thus needed. To understand the potential complex impact of major illnesses on household livelihoods, a study on poverty and illness was conducted in rural Cambodia, as part of an international comparative research project. A crosssectional survey was performed to identify households affected by major illness for further in-depth interviews.
Health policy and planning, 2011
In spite of all efforts to build national health services, health systems of many low-income coun... more In spite of all efforts to build national health services, health systems of many low-income countries are today highly pluralistic. Households use a vast range of public and private health care providers, many of whom are not controlled by national health authorities. Experts have called on Ministries of Health to re-establish themselves as stewards of the entire health system. Modern stewardship will require national and decentralized health authorities to have an overall view of their pluralistic health system, especially of the components outside the public sector. Little guidance has been provided so far on how to develop such a view. In this paper, we explore whether household surveys could be a source of information. The study builds on secondary data analysis of a household survey carried out in three health districts in rural Cambodia and of two national surveys. Cambodia is indeed an interesting case, as massive efforts by donors in favour of the public sector go hand in hand with a dominant role of the private sector in the provision of health care services. The study confirms that the health care sector in Cambodia is now highly pluralistic, and that the great majority of health seeking behaviour takes place outside the public health system. Our analysis of the survey also shows that the disaffection of the population with public health facilities varies across places, socio-economic groups and health problems. We illustrate how such knowledge could allow stewards to better identify challenges for existing or future health policies. We argue that a whole research programme on the composition of pluralistic health systems still needs to be developed. We identify some challenges and opportunities.
Health Policy and Planning, 2002
American Journal of Public Health, 1997
Lancet, 1995
We are so busy saving lives that by the time we get around to thinking, we have made so many mist... more We are so busy saving lives that by the time we get around to thinking, we have made so many mistakes it is too late".
Tropical Medicine & International Health, 2007
Objectives To compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) ... more Objectives To compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) with that of a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.Method Randomized open-label non-inferiority study over 64 days.Results Four hundred and sixty-four patients were included in the study. The polymerase chain reaction genotyping-adjusted cure rates on day 63 were 97.5% (95% confidence interval, CI, 93.8–99.3) for DHA–PQP and 97.5% (95% CI, 93.8–99.3) for MAS3, P = 1. There were no serious adverse events, but significantly more episodes of vomiting (P = 0.03), dizziness (P = 0.002), palpitations (P = 0.04), and sleep disorders (P = 0.03) reported in the MAS3 treatment group, consistent with the side-effect profile of mefloquine.Conclusions DHA–PQP was as efficacious as MAS3, but much better tolerated, making it more appropriate for use in a routine programme setting. This highly efficacious, safe and more affordable fixed-dose combination could become the treatment of choice for Plasmodium falciparum malaria in Cambodia.Objectifs Comparer l'efficacité et la tolérance du dihydroartémisinine-pipéraquine (DHA–PQP) à celles d'un régime à base de méfloquine de trois jours (MAS3) pour le traitement de la malaria falciparum non compliquée au Cambodge.Methode Etude Randomisée ouverte de non infériorité sur 64 jours.Resultats 464 patients ont été inclus dans l’étude. Les taux guérison au jour 63 ajustés par les résultats du génotypage par la réaction en chaîne de la polymérase étaient de 97,5% (IC95%: 93.8–99.3) pour le DHA–PQP et de 97,5% (IC95%: 93,8–99,3) pour le MAS3, P = 1. Il n'y avait aucun effet adverse sérieux, mais de façon significative, des épisodes de vomissement (P = 0,03), des vertiges (P = 0,002), des palpitations (P = 0,04), et des troubles de sommeil (P = 0.03) ont été rapportés dans le groupe du traitement au MAS3, ce qui était consistant avec les profiles d'effets secondaires du méfloquine.Conclusion le DHA–PQP était aussi efficace que le MAS3, mais bien mieux toléré, le rendant ainsi plus approprié pour l'usage en routine dans le cadre d'un programme. Cette combinaison à dose fixe de grande efficacité, sûre et plus accessible pourrait devenir le traitement de choix pour la malaria àPlasmodium falciparum au Cambodge.Objectifs Comparer l'efficacité et la tolérance du dihydroartémisinine-pipéraquine (DHA–PQP) à celles d'un régime à base de méfloquine de trois jours (MAS3) pour le traitement de la malaria falciparum non compliquée au Cambodge.Methode Etude Randomisée ouverte de non infériorité sur 64 jours.Resultats 464 patients ont été inclus dans l’étude. Les taux guérison au jour 63 ajustés par les résultats du génotypage par la réaction en chaîne de la polymérase étaient de 97,5% (IC95%: 93.8–99.3) pour le DHA–PQP et de 97,5% (IC95%: 93,8–99,3) pour le MAS3, P = 1. Il n'y avait aucun effet adverse sérieux, mais de façon significative, des épisodes de vomissement (P = 0,03), des vertiges (P = 0,002), des palpitations (P = 0,04), et des troubles de sommeil (P = 0.03) ont été rapportés dans le groupe du traitement au MAS3, ce qui était consistant avec les profiles d'effets secondaires du méfloquine.Conclusion le DHA–PQP était aussi efficace que le MAS3, mais bien mieux toléré, le rendant ainsi plus approprié pour l'usage en routine dans le cadre d'un programme. Cette combinaison à dose fixe de grande efficacité, sûre et plus accessible pourrait devenir le traitement de choix pour la malaria àPlasmodium falciparum au Cambodge.Objetivos Comparar la eficacia y la tolerabilidad de la dihidroartemisinina-piperaquina (DHA–PQP) con la de un régimen de 3 días de mefloquina (MAS3), para el tratamiento de la malaria no complicada por falciparum en CambodiaMétodo Estudio aleatorizado, abierto, de no-inferioridad, durante 64 días.Resultados Se incluyeron 464 pacientes en el estudio. Las tasas de curación en el día 63, ajustadas por genotipaje mediante PCR, fueron del 97.5% (95% IC: 93.8–99.3) para DHA–PQP y del 97.5% (95%IC: 93.8–99.3) para MAS3, P = 1. No se observaron eventos adversos serios, pero si se reportó un número significativo de episodios de vómitos (P = 0.03), mareos (P = 0.002), palpitaciones (P = 0.04), y desórdenes del sue,no (P = 0.03) entre el grupo de tratamiento con MAS3, algo consistente con el perfil de efectos secundarios de la mefloquina.Conclusiones La DHA–PQP fue tan eficaz como la MAS3, además de ser mejor tolerada, siendo más apropiada para el uso dentro del marco de un programa de rutina. Esta combinación de dosis fija, altamente eficaz, segura y más asequible, podría convertirse en el tratamiento de elección para malaria por Plasmodium falciparum en Cambodia.Objetivos Comparar la eficacia y la tolerabilidad de la dihidroartemisinina-piperaquina (DHA–PQP) con la de un régimen de 3 días de mefloquina (MAS3), para el tratamiento de la malaria no complicada por falciparum en CambodiaMétodo Estudio aleatorizado, abierto, de no-inferioridad, durante 64 días.Resultados Se incluyeron 464 pacientes en el estudio. Las tasas de curación en el día 63, ajustadas por genotipaje mediante PCR, fueron del 97.5% (95% IC: 93.8–99.3) para DHA–PQP y del 97.5% (95%IC: 93.8–99.3) para MAS3, P = 1. No se observaron eventos adversos serios, pero si se reportó un número significativo de episodios de vómitos (P = 0.03), mareos (P = 0.002), palpitaciones (P = 0.04), y desórdenes del sue,no (P = 0.03) entre el grupo de tratamiento con MAS3, algo consistente con el perfil de efectos secundarios de la mefloquina.Conclusiones La DHA–PQP fue tan eficaz como la MAS3, además de ser mejor tolerada, siendo más apropiada para el uso dentro del marco de un programa de rutina. Esta combinación de dosis fija, altamente eficaz, segura y más asequible, podría convertirse en el tratamiento de elección para malaria por Plasmodium falciparum en Cambodia.
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2000
... other authors on laboratory series of banked sera (EL SAPI EVANS, 1989; HAILU, 1990; CHOWDHUR... more ... other authors on laboratory series of banked sera (EL SAPI EVANS, 1989; HAILU, 1990; CHOWDHURY et al., 1993b; SINGLA et al ... would abide by parasitology only, and opted for not treating DAT posi tiveparasitologically negative patients (J Seaman, per sonal communication ...
Lancet, 1996
THE LANCET correctly cites as odds ratio of 1·15, but the confidence intervals were wide enough t... more THE LANCET correctly cites as odds ratio of 1·15, but the confidence intervals were wide enough to extend well below unity (95% CI 0·69-1·93). Further, the point estimate from matched analysis was 1·01/100 Bq m Ϫ3 , not 1·02 (the CIs cited were correct).
Lancet, 1999
Safe motherhood. By - Maurice King.
AIDS research and treatment, 2012
Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong ... more Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.
Bulletin of the World Health Organization, 2012
BMC health services research, 2012
Background: Borrowing money is a common strategy to cope with health care costs. The impact of bo... more Background: Borrowing money is a common strategy to cope with health care costs. The impact of borrowing on households can be severe, leading to indebtedness and further impoverishment. However, the available literature on borrowing practices for health is limited. We explore borrowing practices for paying for health care by the poor in Cambodia and provide a typology, associated conditions, and the extent of the phenomenon.
Health policy and planning, 2010
To reduce the burden of out-of-pocket payments on households in India, the government has introdu... more To reduce the burden of out-of-pocket payments on households in India, the government has introduced community health insurance (CHI) as part of its National Rural Health Mission. Indian CHI schemes have been shown to provide financial protection and have the potential to improve quality of care, but do not seem to improve access. This study examines this dimension of CHI performance and explores conditions under which a CHI scheme can improve access to hospital care for the poor. We conducted a panel survey at the ACCORD-AMS-ASHWINI (AAA) CHI scheme in India. The AAA CHI scheme protects the poorest sections of society against hospitalization expenses. 297 insured and 248 matched uninsured households were observed by village volunteers on a weekly basis for 12 months. Any patient presenting with a 'major ailment' in these households was interviewed using a structured questionnaire. Outcomes measured were utilization of hospital services, cost of treatment and quality of treatment received. The two cohorts were similar regarding demographic, social and economic parameters. More insured than uninsured households expressed trust in the CHI scheme organizers. Both groups had similar levels of minor ailments, but the insured had higher incidence of chronic and major ailments. Insured patients had a hospital admission rate 2.2 times higher than uninsured patients, independent of confounding factors. This higher rate among the insured was also found in children and those with pre-existing conditions. Vulnerable sections of the insured population-children, pregnant women, the poorest-had the highest admission rates. Most admissions, in both cohorts, took place in the ASHWINI hospital. Credible and trustworthy organizers, effective providers, low co-payments, and low indirect costs contributed to this result. A well-designed CHI scheme has the potential to improve access to hospital care, even for vulnerable sections of the community-the poorest, individuals with pre-existing conditions like diabetes and hypertension, and pregnant women.
BMC health services research, 2011
Background-Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan Afric... more Background-Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in six rural programs in Southern Africa with limited access to viral load monitoring and second-line ART.
AIDS patient care and STDs, 2010
Expanding access to HIV counseling and testing (HCT) and antiretroviral treatment (ART) has reduc... more Expanding access to HIV counseling and testing (HCT) and antiretroviral treatment (ART) has reduced morbidity and mortality in people living with HIV/AIDS. As a result, many countries are scaling up HIV/AIDS services. In this paper we discuss challenges experienced during the move toward universal access to HCT and ART services in Ethiopia. We reviewed routine reports from the Ministry of Health and implementing partners. We also had interviews, about linkage to and retention in care of patients, with 10 HIV/AIDS program managers, as well as 2 to 7 health care providers and 5 to 15 patients in each of 23 health centers and 32 hospitals in all regions of the country. We found that the number of people tested for HIV increased 10-fold from 435,854 in 2005 to 4,559,954 in 2008. Only 61% of the HIV-positive patients were linked to chronic care immediately after tested for HIV. The number of patients initiated on ART annually increased from 26,021 in 2005 to 53,696 in 2008. Attrition of patients increased from 18% in 2005 to 26% in 2008. Our interviews indicated that fear of stigma, transport cost, feeling healthy and opting for traditional medicines were the main reasons for poor linkage to and retention in care. Lack of nutrition and feeling better were also reasons for poor retention. In conclusion, in spite of the rapid scale-up of HCT and ART services in Ethiopia, linkage and retention were not adequate. Therefore, strategies should be developed and implemented to improve linkage and retention.
Journal of the International AIDS Society, 2011
Lancet, 2011
objectives To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation a... more objectives To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation and integration of PMTCT with routine maternal and child health services in two districts of KwaZulu-Natal; to report PMTCT coverage, to compare recorded and reported information, and to describe responsibilities of nurses and lay counsellors.
Globalization and health, 2011
Journal of acquired immune deficiency syndromes (1999), 2011
In many sub-Saharan countries, the health workforce shortage has been a major constraint in the s... more In many sub-Saharan countries, the health workforce shortage has been a major constraint in the scale-up of antiretroviral treatment. This human resource crisis has led to profound adjustments of the antiretroviral treatment care delivery model in several countries in the region. It also inspired some governments to take swift measures to substantially increase human resources capacity. This article draws on the experience of Malawi and Ethiopia, which have been able to successfully increase their health workforce over a relatively short period, allowing scaling up of antiretroviral treatment. Additional international HIV funding and strong political commitment made possible this exceptional response. Both countries implemented a combination of measures to tackle the human resource crisis: the delegation of medical and administrative tasks to lower health cadres and lay workers, the introduction of new health cadres, the reinforcement of pre-service training, and improving health staff remuneration. In particular, the involvement of community and lay health workers in HIV-related service delivery substantially increased the health workforce. The involvement of lay cadres has important long-term implications. To sustain results, continued political commitment, ongoing training and supervision to maintain quality of care, and strategies to avoid attrition among lay cadres will be essential. Although task shifting and involvement of lay cadres allowed bridging of the human resource gap in a short time, other strategies have to be considered simultaneously, and all interventions must be maintained over a longer period to yield results.
PloS one, 2010
Background: There is substantial evidence that ill-health is a major cause of impoverishment in d... more Background: There is substantial evidence that ill-health is a major cause of impoverishment in developing countries. Major illnesses can have a serious economic impact on poor households through treatment costs and income loss. However, available methods for measuring the impact of ill-health on household welfare display several shortcomings and new methods are thus needed. To understand the potential complex impact of major illnesses on household livelihoods, a study on poverty and illness was conducted in rural Cambodia, as part of an international comparative research project. A crosssectional survey was performed to identify households affected by major illness for further in-depth interviews.
Health policy and planning, 2011
In spite of all efforts to build national health services, health systems of many low-income coun... more In spite of all efforts to build national health services, health systems of many low-income countries are today highly pluralistic. Households use a vast range of public and private health care providers, many of whom are not controlled by national health authorities. Experts have called on Ministries of Health to re-establish themselves as stewards of the entire health system. Modern stewardship will require national and decentralized health authorities to have an overall view of their pluralistic health system, especially of the components outside the public sector. Little guidance has been provided so far on how to develop such a view. In this paper, we explore whether household surveys could be a source of information. The study builds on secondary data analysis of a household survey carried out in three health districts in rural Cambodia and of two national surveys. Cambodia is indeed an interesting case, as massive efforts by donors in favour of the public sector go hand in hand with a dominant role of the private sector in the provision of health care services. The study confirms that the health care sector in Cambodia is now highly pluralistic, and that the great majority of health seeking behaviour takes place outside the public health system. Our analysis of the survey also shows that the disaffection of the population with public health facilities varies across places, socio-economic groups and health problems. We illustrate how such knowledge could allow stewards to better identify challenges for existing or future health policies. We argue that a whole research programme on the composition of pluralistic health systems still needs to be developed. We identify some challenges and opportunities.
Health Policy and Planning, 2002
American Journal of Public Health, 1997
Lancet, 1995
We are so busy saving lives that by the time we get around to thinking, we have made so many mist... more We are so busy saving lives that by the time we get around to thinking, we have made so many mistakes it is too late".
Tropical Medicine & International Health, 2007
Objectives To compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) ... more Objectives To compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) with that of a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.Method Randomized open-label non-inferiority study over 64 days.Results Four hundred and sixty-four patients were included in the study. The polymerase chain reaction genotyping-adjusted cure rates on day 63 were 97.5% (95% confidence interval, CI, 93.8–99.3) for DHA–PQP and 97.5% (95% CI, 93.8–99.3) for MAS3, P = 1. There were no serious adverse events, but significantly more episodes of vomiting (P = 0.03), dizziness (P = 0.002), palpitations (P = 0.04), and sleep disorders (P = 0.03) reported in the MAS3 treatment group, consistent with the side-effect profile of mefloquine.Conclusions DHA–PQP was as efficacious as MAS3, but much better tolerated, making it more appropriate for use in a routine programme setting. This highly efficacious, safe and more affordable fixed-dose combination could become the treatment of choice for Plasmodium falciparum malaria in Cambodia.Objectifs Comparer l'efficacité et la tolérance du dihydroartémisinine-pipéraquine (DHA–PQP) à celles d'un régime à base de méfloquine de trois jours (MAS3) pour le traitement de la malaria falciparum non compliquée au Cambodge.Methode Etude Randomisée ouverte de non infériorité sur 64 jours.Resultats 464 patients ont été inclus dans l’étude. Les taux guérison au jour 63 ajustés par les résultats du génotypage par la réaction en chaîne de la polymérase étaient de 97,5% (IC95%: 93.8–99.3) pour le DHA–PQP et de 97,5% (IC95%: 93,8–99,3) pour le MAS3, P = 1. Il n'y avait aucun effet adverse sérieux, mais de façon significative, des épisodes de vomissement (P = 0,03), des vertiges (P = 0,002), des palpitations (P = 0,04), et des troubles de sommeil (P = 0.03) ont été rapportés dans le groupe du traitement au MAS3, ce qui était consistant avec les profiles d'effets secondaires du méfloquine.Conclusion le DHA–PQP était aussi efficace que le MAS3, mais bien mieux toléré, le rendant ainsi plus approprié pour l'usage en routine dans le cadre d'un programme. Cette combinaison à dose fixe de grande efficacité, sûre et plus accessible pourrait devenir le traitement de choix pour la malaria àPlasmodium falciparum au Cambodge.Objectifs Comparer l'efficacité et la tolérance du dihydroartémisinine-pipéraquine (DHA–PQP) à celles d'un régime à base de méfloquine de trois jours (MAS3) pour le traitement de la malaria falciparum non compliquée au Cambodge.Methode Etude Randomisée ouverte de non infériorité sur 64 jours.Resultats 464 patients ont été inclus dans l’étude. Les taux guérison au jour 63 ajustés par les résultats du génotypage par la réaction en chaîne de la polymérase étaient de 97,5% (IC95%: 93.8–99.3) pour le DHA–PQP et de 97,5% (IC95%: 93,8–99,3) pour le MAS3, P = 1. Il n'y avait aucun effet adverse sérieux, mais de façon significative, des épisodes de vomissement (P = 0,03), des vertiges (P = 0,002), des palpitations (P = 0,04), et des troubles de sommeil (P = 0.03) ont été rapportés dans le groupe du traitement au MAS3, ce qui était consistant avec les profiles d'effets secondaires du méfloquine.Conclusion le DHA–PQP était aussi efficace que le MAS3, mais bien mieux toléré, le rendant ainsi plus approprié pour l'usage en routine dans le cadre d'un programme. Cette combinaison à dose fixe de grande efficacité, sûre et plus accessible pourrait devenir le traitement de choix pour la malaria àPlasmodium falciparum au Cambodge.Objetivos Comparar la eficacia y la tolerabilidad de la dihidroartemisinina-piperaquina (DHA–PQP) con la de un régimen de 3 días de mefloquina (MAS3), para el tratamiento de la malaria no complicada por falciparum en CambodiaMétodo Estudio aleatorizado, abierto, de no-inferioridad, durante 64 días.Resultados Se incluyeron 464 pacientes en el estudio. Las tasas de curación en el día 63, ajustadas por genotipaje mediante PCR, fueron del 97.5% (95% IC: 93.8–99.3) para DHA–PQP y del 97.5% (95%IC: 93.8–99.3) para MAS3, P = 1. No se observaron eventos adversos serios, pero si se reportó un número significativo de episodios de vómitos (P = 0.03), mareos (P = 0.002), palpitaciones (P = 0.04), y desórdenes del sue,no (P = 0.03) entre el grupo de tratamiento con MAS3, algo consistente con el perfil de efectos secundarios de la mefloquina.Conclusiones La DHA–PQP fue tan eficaz como la MAS3, además de ser mejor tolerada, siendo más apropiada para el uso dentro del marco de un programa de rutina. Esta combinación de dosis fija, altamente eficaz, segura y más asequible, podría convertirse en el tratamiento de elección para malaria por Plasmodium falciparum en Cambodia.Objetivos Comparar la eficacia y la tolerabilidad de la dihidroartemisinina-piperaquina (DHA–PQP) con la de un régimen de 3 días de mefloquina (MAS3), para el tratamiento de la malaria no complicada por falciparum en CambodiaMétodo Estudio aleatorizado, abierto, de no-inferioridad, durante 64 días.Resultados Se incluyeron 464 pacientes en el estudio. Las tasas de curación en el día 63, ajustadas por genotipaje mediante PCR, fueron del 97.5% (95% IC: 93.8–99.3) para DHA–PQP y del 97.5% (95%IC: 93.8–99.3) para MAS3, P = 1. No se observaron eventos adversos serios, pero si se reportó un número significativo de episodios de vómitos (P = 0.03), mareos (P = 0.002), palpitaciones (P = 0.04), y desórdenes del sue,no (P = 0.03) entre el grupo de tratamiento con MAS3, algo consistente con el perfil de efectos secundarios de la mefloquina.Conclusiones La DHA–PQP fue tan eficaz como la MAS3, además de ser mejor tolerada, siendo más apropiada para el uso dentro del marco de un programa de rutina. Esta combinación de dosis fija, altamente eficaz, segura y más asequible, podría convertirse en el tratamiento de elección para malaria por Plasmodium falciparum en Cambodia.
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2000
... other authors on laboratory series of banked sera (EL SAPI EVANS, 1989; HAILU, 1990; CHOWDHUR... more ... other authors on laboratory series of banked sera (EL SAPI EVANS, 1989; HAILU, 1990; CHOWDHURY et al., 1993b; SINGLA et al ... would abide by parasitology only, and opted for not treating DAT posi tiveparasitologically negative patients (J Seaman, per sonal communication ...
Lancet, 1996
THE LANCET correctly cites as odds ratio of 1·15, but the confidence intervals were wide enough t... more THE LANCET correctly cites as odds ratio of 1·15, but the confidence intervals were wide enough to extend well below unity (95% CI 0·69-1·93). Further, the point estimate from matched analysis was 1·01/100 Bq m Ϫ3 , not 1·02 (the CIs cited were correct).
Lancet, 1999
Safe motherhood. By - Maurice King.
AIDS research and treatment, 2012
Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong ... more Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.
Bulletin of the World Health Organization, 2012
BMC health services research, 2012
Background: Borrowing money is a common strategy to cope with health care costs. The impact of bo... more Background: Borrowing money is a common strategy to cope with health care costs. The impact of borrowing on households can be severe, leading to indebtedness and further impoverishment. However, the available literature on borrowing practices for health is limited. We explore borrowing practices for paying for health care by the poor in Cambodia and provide a typology, associated conditions, and the extent of the phenomenon.