scholarly journals Benefit–Cost Analysis of Community-Led Total Sanitation: Incorporating Results from Recent Evaluations

2020 ◽  
Vol 11 (3) ◽  
pp. 380-417 ◽  
Author(s):  
Mark Radin ◽  
Marc Jeuland ◽  
Hua Wang ◽  
Dale Whittington
Keyword(s):  
Case Fatality ◽  
Sub Saharan Africa ◽  
Positive Health ◽  
Benefit Cost Analysis ◽  
Statistical Life ◽  
Diarrhea Incidence ◽  
Sub Saharan ◽  
Benefit Cost ◽  
Additional Reduction ◽  
Rate Case

AbstractWe analyze the economic costs and benefits of “community-led total sanitation” (CLTS), a sanitation intervention that relies on community-level behavioral change, in a hypothetical rural region in sub-Saharan Africa with 200 villages and 100,000 people. The analysis incorporates data on the effectiveness of CLTS from recent randomized controlled trials and other evaluations. The net benefits of this intervention are estimated both with and without the inclusion of a positive health externality, that is, the additional reduction in diarrhea for an individual when a sufficient proportion of other individuals in the community construct and use latrines and thereby decrease the overall load of waterborne pathogens and fecal bacteria in the environment. We find that CLTS interventions would pass a benefit–cost test in many situations, but that outcomes are not as favorable as some previous studies suggest. The model results are sensitive to baseline conditions, including the value of time, income level used to calculate the value of a statistical life, discount rate, case fatality rate, diarrhea incidence, and time spent traveling to defecation sites. We conclude that many communities likely have economic investment opportunities that are more attractive than CLTS, and recommend careful economic analysis of CLTS in specific locations.

scholarly journals The seasonality of cholera in sub-Saharan Africa

2021 ◽  
Author(s):  
Javier Perez-Saez ◽  
Justin Lessler ◽  
Elizabeth C. Lee ◽  
Francisco J. Luquero ◽  
Espoir B. Malembaka ◽  
...  
Keyword(s):  
Large Scale ◽  
Task Force ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
National Differences ◽  
Sub Saharan ◽  
Eastern And Southern Africa ◽  
Positive Correlations ◽  
Gates Foundation

Background Cholera remains a major threat in Sub-Saharan Africa (SSA) where some of the highest case fatality risks are reported. Knowing in what months and where cholera tends to occur across the continent can aid in improving efforts to eliminate cholera as a public health concern; though largely due to lack of unified large-scale datasets, no continent-wide estimates exist. In this study we aim to estimate cholera seasonality across SSA. Methods We leverage the Global Task Force on Cholera Control (GTFCC) global cholera database with statistical models to synthesize data across spatial and temporal scale in order to infer the seasonality of excess suspected cholera occurrence in SSA. We developed a Bayesian statistical model to infer the monthly risk of excess cholera at the first and/or second administrative levels. Seasonality patterns were then grouped into spatial clusters. Finally, we studied the association between seasonality estimates and hydro-climatic variables. Findings The majority of studied countries (24/34) have seasonal patterns in excess cholera, corresponding to approximately 85% of the SSA population. Most countries (19/24) also had sub-national differences in seasonality patterns, with strong differences in seasonality strength between regions. Seasonality patterns clustered into two macro-regions (West Africa and the Sahel vs. Eastern and Southern Africa), which were composed of sub-regional clusters with varying degrees of seasonality. Exploratory association analysis found most consistent and positive correlations between cholera seasonality and precipitation, and to a lesser extent with temperature and flooding. Interpretation Widespread cholera seasonality in SSA offers opportunities for intervention planning. Further studies are needed to study the association between cholera and climate. Funding The NASA Applied Sciences Program and the Bill and Melinda Gates Foundation.

scholarly journals Comparing the Application of CEA and BCA to Tuberculosis Control Interventions in South Africa

2019 ◽  
Vol 10 (S1) ◽  
pp. 132-153 ◽  
Author(s):  
Thomas Wilkinson ◽  
Fiammetta Bozzani ◽  
Anna Vassall ◽  
Michelle Remme ◽  
Edina Sinanovic
Keyword(s):  
South Africa ◽  
South African ◽  
Methodological Approach ◽  
Value Of Statistical Life ◽  
Policy Recommendations ◽  
Benefit Cost Analysis ◽  
Tb Control ◽  
Statistical Life ◽  
Benefit Cost ◽  
The Impact

Achieving ambitious targets to address the global tuberculosis (TB) epidemic requires consideration of the impact of competing interventions for improved identification of patients with TB. Cost-effectiveness analysis (CEA) and benefit-cost analysis (BCA) are two approaches to economic evaluation that assess the costs and effects of competing alternatives. However, the differing theoretical basis and methodological approach to CEA and BCA is likely to result in alternative analytical outputs and potentially different policy interpretations. A BCA was conducted by converting an existing CEA on various combinations of TB control interventions in South Africa using a benefits transfer approach to estimate the value of statistical life (VSL) and value of statistical life year (VSLY). All combinations of interventions reduced untreated active disease compared to current TB control, reducing deaths by between 5,000 and 75,000 and resulting in net benefits of Int$3.2–Int$137 billion (ZAR18.1 billion to ZAR764 billion) over a 20-year period. This analysis contributes to development and application of BCA methods for health interventions and demonstrates that further investment in TB control in South Africa is expected to yield significant benefits. Further work is required to guide the appropriate analytical approach, interpretation and policy recommendations in the South African policy perspective and context.

Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry

2019 ◽  
Vol 15 (6) ◽  
pp. 666-667 ◽  
Author(s):  
F Abass Cisse ◽  
C Damien ◽  
M Haba ◽  
ML Touré ◽  
M Barry ◽  
...  
Keyword(s):  
Case Fatality ◽  
Sub Saharan Africa ◽  
Stroke Registry ◽  
Stroke Prevalence ◽  
Sub Saharan

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.

scholarly journals Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis

2019 ◽  
Vol 10 (S1) ◽  
pp. 15-50 ◽  
Author(s):  
Lisa A. Robinson ◽  
James K. Hammitt ◽  
Lucy O’Keeffe
Keyword(s):  
Mortality Risk ◽  
Income Elasticity ◽  
Lower Income ◽  
Middle Income ◽  
Income Differences ◽  
Benefit Cost Analysis ◽  
Middle Income Countries ◽  
Statistical Life ◽  
The Past ◽  
Benefit Cost

The estimates used to value mortality risk reductions are a major determinant of the benefits of many public health and environmental policies. These estimates (typically expressed as the value per statistical life, VSL) describe the willingness of those affected by a policy to exchange their own income for the risk reductions they experience. While these values are relatively well studied in high-income countries, less is known about the values held by lower-income populations. We identify 26 studies conducted in the 172 countries considered low- or middle-income in any of the past 20 years; several have significant limitations. Thus there are few or no direct estimates of VSL for most such countries. Instead, analysts typically extrapolate values from wealthier countries, adjusting only for income differences. This extrapolation requires selecting a base value and an income elasticity that summarizes the rate at which VSL changes with income. Because any such approach depends on assumptions of uncertain validity, we recommend that analysts conduct a standardized sensitivity analysis to assess the extent to which their conclusions change depending on these estimates. In the longer term, more research on the value of mortality risk reductions in low- and middle-income countries is essential.

Genetic engineering and social justice: A reflection on Amartya Sen’s capability approach

2020 ◽  
pp. 205789112090768
Author(s):  
Gerry F Arambala
Keyword(s):  
Developing Countries ◽  
Genetic Engineering ◽  
Health Care Services ◽  
Medical Science ◽  
Sub Saharan Africa ◽  
Poor People ◽  
Positive Health ◽  
Social Phenomena ◽  
The Past ◽  
Sub Saharan

Over the past decades, biomedical researchers have made great progress in finding the treatment for many diseases which have been considered in the past as incurable. The struggle for longevity and positive health has been addressed by medical science. People who can afford it are assured by the promise of genetic engineering. But while there has been considerable development in the treatment of diseases, the number of mortalities in poor countries remains high, especially in Sub-Saharan Africa and East Asia. Around 8 million people die each year worldwide due to poverty-related health issues. Despite the advancement in the treatment of diseases, poor people in most of the developing countries worldwide are dying each year. This article will argue that human poverty and the existence of infectious diseases are inseparable social phenomena that affect the fate of the poor in developing countries. Following Amartya Sen, this article will argue that access to advanced health care services should be affordable to all, and should form part of individual freedoms that the national policies of a country must secure.

Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa

AIDS ◽  
2001 ◽  
Vol 15 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Ya Diul Mukadi ◽  
Dermot Maher ◽  
Anthony Harries
Keyword(s):  
Case Fatality ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Tuberculosis Case ◽  
Sub Saharan

scholarly journals COVID-19 Mortality in Women and Men in Sub-Saharan Africa: A Cross Sectional Study

2021 ◽  
Author(s):  
Jyoti Dalal ◽  
Isotta Triulzi ◽  
Ananthu James ◽  
Benedict Nguimbis ◽  
Gabriela Guizzo Dri ◽  
...  
Keyword(s):  
Public Health ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Age Group ◽  
Sectional Study ◽  
Public Health Response ◽  
Cross Sectional ◽  
Credible Intervals ◽  
Sub Saharan

Objective: To investigate differences of COVID-19 related mortality among women and men across sub-Saharan Africa (SSA) from the beginning of the pandemic. Design: A cross sectional study. Setting: Data from 20 member nations of the WHO African region until September 1, 2020. Participants: 69,580 cases of COVID-19, stratified by sex (men, n=43071; women, n=26509) and age (0-39 years, n=41682; 40-59 years, n=20757; 60+ years, n=7141). Main outcome measures: We computed the SSA- and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach. Results: A total of 1,656 (2.4% of total cases reported; 1656/69580) deaths were reported, with men accounting for 1168/1656 (70.5%) of total deaths. In SSA, women had a lower CFR than men (mean CFR<diff> = -0.9%; 95% credible intervals -1.1% to -0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 or more (40-59 age-group: mean CFR<diff> = -0.7%; 95% credible intervals -1.1% to -0.2%; 60+ age-group: mean CFR<diff> = -3.9%; 95% credible intervals -5.3% to -2.4%). At the country level, seven of the twenty SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ age-group in seven countries and 40-59 age-group in one country. Conclusions: Sex and age are important predictors of COVID-19 mortality. Countries should prioritize the collection and use of sex-disaggregated data to understand the evolution of the pandemic. This is essential to design public health interventions and ensure that policies promote a gender sensitive public health response.

scholarly journals Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists

2020 ◽  
Vol 5 ◽  
pp. 163
Author(s):  
Gisele Umviligihozo ◽  
Lucy Mupfumi ◽  
Nelson Sonela ◽  
Delon Naicker ◽  
Ekwaro A. Obuku ◽  
...  
Keyword(s):  
Public Health ◽  
Case Fatality ◽  
Early Career ◽  
Health Interventions ◽  
Sub Saharan Africa ◽  
Public Health Interventions ◽  
African Countries ◽  
Scientific Publications ◽  
First Case ◽  
Sub Saharan

Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the African continent, in Egypt on February 14th, 2020. Although the global number of COVID-19 infections has increased exponentially since the beginning of the pandemic, the number of new infections and deaths recorded in African countries have been relatively modest, suggesting slower transmission dynamics of the virus on the continent, a lower case fatality rate, or simply a lack of testing or reliable data. Notably, there is no significant increase in unexplained pneumonias or deaths on the continent which could possibly indicate the effectiveness of interventions introduced by several African governments. However, there has not yet been a comprehensive assessment of sub-Saharan Africa’s (SSA) preparedness and response to the COVID-19 pandemic that may have contributed to prevent an uncontrolled outbreak so far. As a group of early career scientists and the next generation of African scientific leaders with experience of working in medical and diverse health research fields in both SSA and resource-rich countries, we present a unique perspective on the current public health interventions to fight COVID-19 in Africa. Our perspective is based on extensive review of the available scientific publications, official technical reports and announcements released by governmental and non-governmental health organizations as well as from our personal experiences as workers on the COVID-19 battlefield in SSA. We documented public health interventions implemented in seven SSA countries including Uganda, Kenya, Rwanda, Cameroon, Zambia, South Africa and Botswana, the existing gaps and the important components of disease control that may strengthen SSA response to future outbreaks.

scholarly journals An Overview of Cholera Epidemiology: A Focus on Africa; with a Keen Interest on Nigeria

2020 ◽  
pp. 1-17
Author(s):  
Tarh, Jacqueline Ebob
Keyword(s):  
Local Government ◽  
Task Force ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Polluted Water ◽  
The People ◽  
Sanitation And Hygiene ◽  
The World ◽  
Sub Saharan ◽  
Sanitary Conditions

Cholera is still a problem in the world today. A huge population of deaths due to cholera disease still occur in Sub-Saharan Africa (Nigeria most especially), Asia, the Americas and other developing countries, where approximately 1.7 billion inhabitants are still served by faecally polluted water sources. Approximately, 2.4 billion inhabitants of these areas of the world lack the majorly required sanitary conditions of living. Legros, asserts that, as of 2019, about forty-seven countries of the globe, are still affected by cholera. Raw or undercooked, contaminated seafood, serves as a vehicle for the transmission (especially to non-endemic areas). A Case Fatality Rate of 4.87% was recorded from 34 Local Government Areas of Bauchi, Borno, Kaduna, Kano and Zamfara state in Nigeria by the 34th week, in 2018, while 298 confirmed cases and 38 deaths (CFR 1.5%) were recorded from three Local Government Areas in two States (Adamawa & Borno) by Epidemiological week 41 in 2019. Cholera in some cases is regarded as a “disease of the poor” because the populations most affected are those that cannot afford to provide the basic health facilities for themselves. For example, waste management systems, and good accommodation with toilet facilities (the living and health conditions of the people) are wanting. In 2017, A Global Roadmap to 2030 was launched by the Global Task Force on Cholera Control (GTFCC Ending Cholera) to decrease the death rate due to cholera by 90%. By so doing, the disease can be eradicated from at least half of the 47 cholera-affected countries. The objectives of this roadmap are: to fortify health systems, water, sanitation and hygiene (WASH), and to coordinate different ways by which cholera can be controlled in these countries by 2030 (ensuring early detection and prompt response to contain outbreaks). This review aimed to understand the epidemiology of cholera in Nigeria, Africa and the world at large, to access the level of spread, management and preventive measures so far implemented in the endemic regions.

Stroke admission and case-fatality in an urban medical unit in sub-Saharan Africa: A fourteen year trend study from 1999 to 2012

2015 ◽  
Vol 350 (1-2) ◽  
pp. 24-32 ◽  
Author(s):  
Alain Lekoubou ◽  
Clovis Nkoke ◽  
Anastase Dzudie ◽  
Andre Pascal Kengne
Keyword(s):  
Case Fatality ◽  
Sub Saharan Africa ◽  
Trend Study ◽  
Medical Unit ◽  
Sub Saharan
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