Health Organization Threshold Research Articles

Evaluation of <i>Onchocerca volvulus</i> infectivity status of black flies in post-ivermectin regime in Kachia, Kaduna State, Nigeria

The infectivity status of Simulium species is an important factor in assessing the transmission of Onchocerca species. In this study, we determined the biting rate and presence of the larval stage of the parasite to determine the status of onchocerciasis in the post-ivermectin era in the study area. A total of 1.063 black flies were collected in September and October 2023. Dissection was carried out under a microscope to examine the internal organs for the presence of microfilaria and record their condition. The findings indicated that parous flies 311(29.3%) were markedly less prevalent compared to nulliparous flies 752(70.7%). Among the dissected flies, a total of 14 (1.3%) were found to be infected with Onchocerca species. The flies exhibited a bimodal biting pattern, with a peak in the morning occurring between 9 and 10 am and afternoon between 4:00 and 5:00 pm. The monthly biting rates of 5177.0 and 5807.3 in September and October respectively exceeded the World Health Organization's threshold of 1,000 bites per person per month. It is essential to investigate the potential resurgence of onchocerciasis in the study area, which may be attributed to the overlapping presence of cattle, Simulium vectors, and humans.

Childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals of Lusaka Zambia from 2015 to 2019.

Treatment outcomes of tuberculosis in children are rarely evaluated. Childhood tuberculosis has been a low priority for tuberculosis programs due to difficulties in diagnosis and treatment. This study evaluated childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals in Lusaka, Zambia from 2015 to 2019. This was a cross-sectional study conducted in eight public hospitals in Lusaka. All children aged 0-14 years, treated with tuberculosis and had treatment outcomes evaluated were included. The WHO tuberculosis treatment outcomes were grouped into successful treatment outcome (cured, treatment completed) and unsuccessful treatment outcome (death, loss to follow-up, failure). Taking unsuccessful treatment outcome as the outcome variable, logistic regression models were performed. All analyses were done at a 95% confidence interval. Out of 2,531 children managed for TB from 2015 to 2019, only 1,495 (59.1%) had treatment outcomes evaluated. Out of 1,495 participants, majority were 5 to 14 years old (50.9%), males (51.1%), HIV-negative (58.7%), and had pulmonary tuberculosis (74.2%). Bacteriological tests were performed on 59.8% of children, where 21.6% had positive bacteriological results. Bacteriologically confirmed TB was higher in children over 5 years (29.5%), pulmonary TB (25.6%), and retreatment (28.6%). The majority of children (84.2%) completed treatment, while 10.7% were cured, 1.5% were lost to follow-up, 3.1% died, and 0.5% failed treatment. Overall, unsuccessful treatment outcome was 5.1% while successful treatment outcome was 94.1%. Extrapulmonary tuberculosis was associated with unsuccessful treatment outcomes (AOR 1.64; 95% CI: 1.02-2.62). The tuberculosis successful treatment outcome met the World Health Organization's threshold goal of 90%. Children with extrapulmonary tuberculosis should be targeted as a high-risk group to improve treatment outcomes. Tracking children whose treatment outcomes were not evaluated would provide more precise estimates of TB treatment outcomes.

Impacts of unregulated dumpsites: a study on toxic soil contamination, associated risks, and call for sustainable environmental protection in Nnewi, Nigeria

The accumulation of leachates from unlined dumpsites laden soil-water environment with toxic elements poses imminent threats to both the environment and humans. This study evaluated the seasonal levels of potentially toxic elements (PTEs), their health-related risks, contamination factors (CF), pollution load index, geo-accumulation index (Igeo), ecological risk index, polymetallic contaminant index and Nemerow's synthetic pollution index of soils near a waste dump in Nnewi, Anambra State, Nigeria. The PTE results indicated that levels of Cd (1.54–3.40 mg/kg) were above the World Health Organization's threshold limit for soil. The studied soil samples had PTE levels higher than the control samples due to their proximity to the dumpsite. The CF of the PTE in the soil indicated moderate to considerable contamination, while the control areas showed moderate contamination for both seasons. The pollution load indices of the soil indicated heavy and moderate pollution for the study sample (2.207–2.517) and control samples (1.445–1.659). However, the ecological risk indices ranged from 85.72 to 164.84, indicating a low ecological risk. The Igeo of the PTE in the soil ranged from unpolluted, moderately polluted to very strongly polluted. The Nemerow's synthetic pollution index values ranged from 3.560 to 3.564 for the study samples and 2.070–2.502 for the control samples, indicating heavy and moderate pollution of the soil respectively. The polymetallic contaminant index values for the study samples (23.22–26.43) and control samples (15.02–17.23) showed high and considerable contamination respectively. Health risk examination highlighted that both adults and children have a low risk for non-cancer health threat via ingestion route, while a high risk was obtained for children for cancer health dangers via ingestion routes. For the dermal pathway, children and adults have minimal chances of exposure to cancer risks, while a high exposure to non-cancer risk was observed for children. Pearson's correlation and principal component loadings revealed the sources of pollution to be of similar origins linked to anthropogenic activities. Awareness programs are necessary to educate the populace about the dangers of using contaminated soil for farming or recreational activities. The use of sanitary dumpsites should be encouraged and adopted as a waste disposal method by the government to mitigate the spread of PTE into the environment.

Mercury distribution in fish organs sampled along the Mauritanian Atlantic coast and their potential human health risks

This paper aimed at assessing total mercury concentration in seven common fish species (Auxis rochei, Caranx rhonchus, Sardina pilchardus, Sardinella aurita, Sardinella maderensis, Scomber colias and Trachurus trecae) and a relationship between Hg organotropism and food regimes along the Mauritanian Atlantic coast. Results show that total mercury concentration in fish collected along five sites ranged from 0.027 to 0.533 mg/kg dry weight. Significant differences were observed among species depending on feeding behavior. Muscle tissues of carnivorous fish presented significantly higher levels of total mercury than that of omnivorous fish, except for Scomber colias, suggesting mercury biomagnification through the food chain. Significant differences in mercury concentrations were observed between muscle tissues and liver, for Auxis rochei, Trachurus trecae, and Caranx rhonchus.The mean concentrations in the different species are however low and none of the concentration values exceed the World Health Organization's threshold for human consumption.

Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma.

Health-care expenditures are a leading contributor to financial hardship in the United States. Traumatic orthopaedic injuries are unpredictable and result in substantial expense. Our objectives were to quantify the catastrophic health expenditure (CHE) risk of patients with orthopaedic trauma and to examine the impact of insurance status, socioeconomic status, sex, and race on CHE. We identified all isolated lower-extremity orthopaedic trauma cases at a safety-net, Level-1 trauma center from 2018 to 2020. We queried an institutional charge database to obtain total hospital charges, insurance status, and ZIP Code to determine out-of-pocket (OOP) expenditures. To evaluate financial hardship, we calculated the CHE risk as defined by the World Health Organization's threshold of OOP expenditures, ≥40% of estimated household post-subsistence income. In our cohort of 2,535 patients, 33% experienced a risk of CHE. A risk of CHE was experienced by 99% of patients who were uninsured, 35% of patients with private insurance, 2% of patients with Medicare, and 0% of patients with Medicaid. Multivariable regression modeling showed that patients who were uninsured were significantly more likely to experience a risk of CHE compared with patients with private insurance (odds ratio, 107.68 [95% confidence interval, 37.20 to 311.68]; p < 0.001). One-third of patients with lower-extremity orthopaedic trauma experience a risk of CHE, with patients who are uninsured facing a disproportionately higher risk of CHE compared with patients who are insured. Our results suggest that the expansion of public insurance options may provide substantial financial protection for those at the greatest risk for CHE. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Prevalence of periodontitis in obese patients in Bahrain: a cross-sectional study

BackgroundAdult obesity has been associated with various systemic diseases and is an increasing problem in Bahrain. Recent evidence indicates a correlation between adult obesity and periodontitis. Hence the aim of this study was to assess the prevalence of periodontitis in overweight/obese adults in Bahrain and to determine the factors associated with periodontitis in these obese adults.MethodThis cross-sectional study was conducted in overweight subjects attending Ministry of Health (MOH) Nutrition Clinics at primary health centers in Bahrain. After obtaining the institutional ethics approval, the demographic and anthropometric data, including Body Mass Index (BMI) and waist circumference (WC) using World Health Organization (WHO) thresholds for severity of obesity, were recorded. Periodontal status was measured using the Community Periodontal Index (CPI) and the extent and severity of periodontal disease were categorized according to the number of sextants with CPI codes 3 and 4.ResultsA total of 372 participated with a mean age 44.0 (± 10.5) years for males, and 42.5 (± 11.2) years for females. Periodontitis was present in 361 (97%) of participants. Hypertension and diabetes were the most prevalent co-morbidities at 23.4% and 16% respectively. Mean WC was significantly greater in males at 114 cm (± 15.6) compared to females 109.5 cm (± 12.5) (p < 0.001). BMI was not associated with severity or extent of periodontitis but WC was weakly correlated in males but not in females (Spearman rho = + 0.2, p < 0.05). In the logistic regression model using overall WC to predict the severity of periodontitis, the adjusted OR was 1.02 (95% CI 1.00–1.04) and for age it was 1.05 (95% CI 1.00–1.07).ConclusionThe prevalence of periodontitis was high in this sample of overweight Bahrainis. BMI was not correlated with periodontitis but WC had a weak positive correlation. Implementation of periodontal health screening as a routine part of a nutrition clinic program is recommended.

PIN27 Cost-utility Analysis Focused on Nosocomial Pneumonia Antimicrobial Therapy - Is Ceftolozane/Tazobactam an Option to Fight Antimicrobial Resistance Sustaining Public Health System Affordability in Brazil?

Gram-negative bacterial (GNB) infections have become increasingly difficult to treat due to raising antimicrobial resistance rates in certain geographic regions such as Latin America. Ceftolozane-tazobactam (C/T) is a beta-lactam-beta-lactamase inhibitor agent that can be considered a clinical option for nosocomial pneumonia in critically ill patients caused by suspected meropenem and piperacillin-tazobactam resistant isolates in public Brazilian hospitals. We applied a model previously described by Naik et al. for patients that could be at risk of nosocomial pneumonia (NP) caused by Enterobacterales or Pseudomonas aeruginosa and should receive empiric antimicrobial therapy. The pathogens’ distribution was adapted from a 2018-2019 Brazil subsample in a global pathogen surveillance database. Clinical outcomes were extracted from a phase 3 trial of NP patients comparing C/T against meropenem. Piperacillin-tazobactam and meropenem were selected as comparators, being the most used antimicrobials in NP. Costs considered in this model were obtained through publications and publicly available databases such as SIGTAP and SIH that represent the Brazilian public healthcare system perspective on costs and care. A 5% discount rate was applied to costs and outcomes. When compared to meropenem the use of C/T can reduce mortality from 32.7% to 29.0%. The use of C/T resulted in 0.28 additional LYs and 0.22 incremental QALYs with R$8,592.87 incremental costs resulting in an ICER of R$39,723.33/QALY. Considering piperacillin-tazobactam as comparator, C/T could reduce mortality from 36.3% to 29.0%, generating 1.12 incremental LYs and 0.93 additional QALYs with R$3,987.06 additional costs. Resulting in an ICER of R$4,286.93/QALY. Antimicrobials accounts for 29.1% of total costs when considering treatment, hospital resource use, adverse events and patient monitoring. Against both comparators the C/T arm patients presented shorter ventilator and ICU length of stay. C/T could be a cost-effective option for NP in the Brazilian public healthcare system according to the World Health Organization's threshold.

Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening

To determine whether screening for age-related macular degeneration (AMD) during a diabetic retinopathy (DR) screening program would be cost effective in Hong Kong. We compared and evaluated the impacts of screening, grading, and vitamin treatment for intermediate AMD compared with no screening using a Markov model. It was based on the natural history of AMD in a cohort with a mean age of 62 years, followed up until 100 years of age or death. Subjects attending a DR screening program were recruited. A cost-effectiveness analysis was undertaken from a public provider perspective. It included grading for AMD using the photographs obtained for DR screening and treatment with vitamin therapy for those with intermediate AMD. The measures of effectiveness were obtained largely from a local study, but the transition probabilities and utility values were from overseas data. Costs were all from local sources. The main assumptions and estimates were tested in sensitivity analyses. The outcome was cost per quality-adjusted life year (QALY) gained. Both costs and benefits were discounted at 3%. All costs are reported in United States dollars ($). The cost per QALY gained through screening for AMD and vitamin treatment for appropriate cases was $12,712 after discounting. This would be considered highly cost effective based on the World Health Organization's threshold of willingness to pay (WTP) for a QALY, that is, less than the annual per capita gross domestic product of $29,889. Because of uncertainty regarding the utility value for those with advanced AMD, we also tested an extreme, conservative value for utility under which screening remained cost effective. One-way sensitivity analyses revealed that, besides utility values, the cost per QALY was most sensitive to the progression rate from intermediate to advanced AMD. The cost-effectiveness acceptability curve showed a WTP for a QALY of $29,000 or more has a more than 86% probability of being cost effective compared with no screening. Our analysis demonstrated that AMD screening carried out simultaneously with DR screening for patients with diabetes would be cost effective in a Hong Kong public healthcare setting.

A Quick Test Based on Cataldo’s Method to Determine Nitrate in Fresh Tissue Extracts

Leafy vegetables could accumulate nitrate (NO3−) above limits safe for humans, hence it would be advisable to customarily determine their NO3− concentration. We wanted to develop a quick test to determine NO3− concentration in fresh tissue extracts and estimate the error of using this test to identify samples with NO3− concentrations above the World Health Organization (WHO) threshold. There was a positive linear relationship (P < 0.001) between NO3− concentrations determined by the quick test and by potentiometry in dry tissue extracts. Samples were classified as “acceptable” or “excessive” according to their potentiometric NO3− concentration, using a critical level of 75% (p) of the observed NO3− distribution. According to the Cate-Nelson model, the quick test identified as “acceptable” from 5.6% to 15.4% of samples that were in the “excessive” category. In spite of this error rate, the quick test use would improve consumers’ protection, because no controls on vegetables NO3− concentration are available in Uruguay.

Metal Correlations and Mobility in Sediment and Water from the Gwebi River in the Upper Manyame Catchment, Zimbabwe

Intermetallic correlation and the ameliorative effects of metals (Cd, Cr, Cu, Fe, Ni, Pb and Zn) were determined in water and sediments in the Gwebi River, a major tributary to Lake Manyame, which is a source of potable water to the City of Harare. Water and sediment were sampled at four selected sites in the wet (December- March) and dry (April-November) seasons and metal concentrations were analysed by flame atomic absorption spectroscopy (FAAS). Significantly high concentrations of zinc and copper were observed in water in both the wet and dry season. Concentrations of chromium, copper, zinc iron and nickel in water in both the wet and dry seasons surpassed World Health Organization (WHO) thresholds. The significant difference (ANOVA, p < 0.05) in seasonal/temporal variation in metal concentrations in water indicate different pollutant sources within the catchment of the river. Ameliorative effects of metals were also observed seasonally in the Gwebi River, with

Economic Evaluation of Universal Infant Vaccination with 7vPCV in Hong Kong

The purpose of this study was to evaluate the clinical and economic benefits of routine infant vaccination with seven-valent pneumococcal conjugate vaccine (7vPCV) in Hong Kong. A decision-analytic model was populated with local age-specific incidence data to simulate the expected health outcomes resulting from 7vPCV vaccination of a birth cohort of 57,100 children compared with an unvaccinated cohort over a 10-year horizon. Primary analyses were conducted from a payer perspective, using local inpatient and outpatient costs associated with the treatment of pneumococcal disease. Vaccine efficacy rates were consistent with results from pivotal clinical trials. The reduction in adult invasive pneumococcal disease (IPD) and associated cost avoidance due to the indirect effect of vaccination were estimated in line with published overseas rates. Universal 7vPCV vaccination was estimated to prevent 524 cases of IPD and more than 2580 cases of otitis media in the birth cohort over a 10-year period, leading to a reduction of HK$28.7 million (US$3.7 million) in direct medical costs. Additional cost savings from the indirect prevention of 919 adult cases of IPD during this time period also resulted. Overall, 7vPCV vaccination was estimated to have an incremental cost per life-year gained of HK$50,456 (US$6460) from a payer perspective or HK$46,308 (US$5929) when both direct and indirect costs were included. With reference to the World Health Organization's threshold for cost-effectiveness, results from this study indicate that routine infant vaccination with 7vPCV is a cost-effective intervention because of the added cost savings resulting from the indirect effect of vaccination on adult disease.

Economic impact of a rotavirus vaccination program in Mexico

To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico. A decision-analysis model was designed to take the Mexican health care system's perspective on a comparison of two alternatives: to vaccinate against rotavirus or not. Using published, national data, estimations were calculated for the rotavirus illnesses, deaths, and disability-adjusted life years (DALYs) that would be averted and the incremental cost-effectiveness ratios (US$/DALY) of a hypothetical annual birth cohort of 2 285 000 children, with certain assumptions made for cost, coverage, and efficacy rates. With 93% coverage and a vaccine price of US$ 16 per course (2 doses), a rotavirus vaccination program in Mexico would prevent an estimated 651 deaths (or 0.28 deaths per 1 000 children); 13 833 hospitalizations (6.05 hospitalizations per 1 000 children); and 414 927 outpatient visits (182 outpatient visits per 1 000 children) for rotavirus-related acute gastroenteritis (AGE). Vaccination is likely to reduce the economic burden of rotavirus AGE in Mexico by averting US$ 14 million (71% of the overall health care burden). At a vaccine price of US$ 16 per course, the cost-effectiveness ratio would be US$ 1 139 per DALY averted. A reduction in the price of the rotavirus vaccination program (US$ 8 per course) would yield a lower incremental cost-effectiveness ratio of US$ 303 per DALY averted. A national rotavirus vaccination program in Mexico is projected to reduce childhood incidence and mortality and to be highly cost-effective based on the World Health Organization's thresholds for cost-effective interventions.