Cost-effectiveness analysis of integrated community case management delivery models utilizing drug sellers and community health workers for treatment of under-five febrile cases of malaria, pneumonia, diarrhoea in rural Uganda

Background Malaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus CHWs in rural Uganda. Methods This study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analysed using the Amua modelling software. Results The costs per 100 treated U5 children were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated U5 children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an incremental cost-effectiveness ratio (ICER) of US$33.86 per appropriately treated U5 patient. Conclusion Since both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.

Cost-Effectiveness Analysis of Integrated Community Case Management Delivery Models Utilizing Drug Sellers and Community Health Workers for Treatment of Under-Five Febrile Cases of Malaria, Pneumonia, Diarrhea in Rural Uganda.

Background Malaria, pneumonia, and diarrhea continue to be the leading causes of death in children under the age of five in Uganda. To combat the above-mentioned febrile illnesses, integrated community case management (iCCM) delivery models utilizing CHWs or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus community health workers in rural Uganda.MethodologyThis study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analyzed using the Amua modeling software.ResultsThe costs per 100 treated U5 were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated under-five children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an ICER of US$33.86 per appropriately treated U5 patient.ConclusionSince both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.

Foreign Direct Investment and Crime Linkage: Drug Traffic and Kidnapping

We develop a theoretical model in which a country hosts foreign investment in the presence of a drug dealer, acting as a leader, and a drug seller, acting as a follower. A policy addressed to eradicate the drug trafficking encourages the kidnapping activity, and increase the security cost of firms. When the drug is not consumed in the host country the best policy is not to fight against drug trafficking. When the drug is consumed in the host country the optimal policy depends on the social marginal disutility of drug consumption respect to ransom paid by firms. In this case, when social marginal disutility is sufficiently larger than ransom, the government combats drug trafficking, otherwise, there is no policy at all.

MEDIKOLEGAL PENGOBATAN UNTUK DIRI SENDIRI (SWAMEDIKASI) SEBAGAI UPAYA MENYEMBUHKAN PENYAKIT

<p>It has become a habit of self-medication with non-prescription drugs done by most Indonesians. In the Regulation of the Minister of Health No. 924 / MENKES / PER / X / 1993 Regarding the Medication List of Pharmacies regulates certain hard drugs that pharmacists can give to people without a prescription. The purpose of the publication of Permenkes is to swamedikasi, a person can self- edicate rationally and supported by the pharmacy's mandatory drugs, although in general pharmacists can not sell hard drugs without a prescription, but there are certain hard drugs based on Permenkes may be sold without a doctor's prescription . The issue raised is how medikolegal swamedikasi in the perspective of healing disease? as well as how are the barriers and medicolegal swamedikasi solutions in the perspective of curing diseases? swamedikasi most places done in pharmacies, knowing drugs purchased through news media such as advertising the reason is the first attempt before treatment to health care facilities, swamedikasi actors get an explanation of doses and how to drink by pharmacist / clerk / drug seller, surveillance of swamedikasi drug use carried out with how to monitor / inspect pharmacies, the results obtained are frequent pharmacists are not in place at open pharmacy hours, selling OWA (Pharmacy Drug Compensation) without the presence of pharmacists and administrative violations. The obstacles are not yet optimal supervision from the government solution with counseling about the rule of law of drug delivery, the second barrier of the lack of awareness of drug sellers in pharmacies that do not fit the provisions of the solution by giving counseling to the owner of pharmacy facilities so as not to pursue Profit Oriented but pay attention to Patient Oriented, the third obstacle of lack of knowledge the swamediciator of the drug classes that the solution can buy is the government to increase socialization or counseling to the community about proper and responsible swamedication. </p>

Understanding the Link Between Race/Ethnicity, Drug Offending, and Juvenile Court Outcomes

Compared with criminal sentencing decisions, limited research has assessed the impact of an imagery of a “dangerous” offender on the interrelationships between race/ethnicity and juvenile court outcomes. Applying base premises from Steen, Engen, and Gainey’s perspective concerning the dangerous drug offender stereotype, the present study examines the case outcomes of White, Black, and Hispanic youth charged with drug offenses and who match the stereotype of a “dangerous drug offender” (male drug seller with a prior record). Findings suggest that youth who fully matched the stereotype were more likely to receive harsher dispositions compared with those who have some or none of the characteristics, but the magnitude of these effects for Whites did not exceed those of Blacks and Hispanics.