Journal of health, population, and nutrition
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J Health Popul Nutr · Sep 2004
Costs of illness due to typhoid fever in an Indian urban slum community: implications for vaccination policy.
Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. ⋯ The study highlights the need for affordable typhoid vaccines efficacious at 2-5 years of age. Currently-available Vi vaccine is affordable but is unlikely to be efficacious in the first two years of life. Ways must be found to make Vi-conjugate vaccine, which is efficacious at this age, available to children of developing-countries.
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J Health Popul Nutr · Sep 2004
A cost-benefit analysis of typhoid fever immunization programmes in an Indian urban slum community.
Many economic analyses of immunization programmes focus on the benefits in terms of public-sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public-health sector can be used in the economic analysis of vaccination-programme options. ⋯ If public-health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which different vaccination programmes will make economic sense. The findings show that this is especially true when public decision-makers recognize that (a) the incidence of typhoid fever is underestimated by blood culture-positive cases and (b) avoided costs of illness represent a significant underestimate of the actual economic benefits to individuals of vaccination.
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J Health Popul Nutr · Sep 2004
Evaluation of serogroup A meningococcal vaccines in Africa: a demonstration project.
Endemic and epidemic meningococcal disease constitutes a major public-health problem in African countries of the 'meningitis belt' where incidence rates of the disease are many-fold higher (up to 25 cases per 100,000 population) than those in industrialized countries, and epidemics of meningococcal disease occur with rates as high as 1,000 cases per 100,000 people. Using the precedent established during the licensing of conjugate vaccines against Haemophilus influenzae type b and serogroup C meningococci and components of currently-licensed meningococcal polysaccharide vaccines, new meningococcal conjugate vaccines will likely be licensed using immunological endpoints as surrogates for clinical protection. Post-licensure evaluation of vaccine effectiveness will, therefore, be of increased importance. ⋯ This paper summarizes the general steps required for vaccine development, reviews the use of immunogenicity criteria as a licensing strategy for new meningococcal vaccines, and discusses plans for evaluating the impact of a meningococcal A conjugate vaccine in Africa. Impact of this vaccine will be measured during a vaccine-demonstration project that will primarily measure the effectiveness of vaccine. Other studies will include evaluations of safety, vaccine coverage, impact on carriage and herd immunity, and prevention-effectiveness studies.
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The study was undertaken to assess the prevalence and patterns of tobacco use and also assess the factors affecting tobacco use among the female population of Dharan. A cross-sectional survey of a representative sample of 2,340 female participants aged 15 years and above was conducted in Dharan municipality in 2001. Cluster sampling with probability proportionate to size technique was used. ⋯ Health problems among females did not have any significant relationship with tobacco-chewing, but smokers were nearly twice as likely to suffer from any health problem than non-smokers. Gastrointestinal problems were the most common complaint among the tobacco users. An effective awareness programme is required to discourage the use of tobacco and encourage women to take regular health check-ups.
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J Health Popul Nutr · Dec 2003
Comparative StudyImpact of coffee and other selected factors on general mortality and mortality due to cardiovascular disease in Croatia.
In Croatia, the mortality rate is higher than that in the countries of the European Union (EU), and consumption of coffee is moderate compared to the EU countries. The study examined the effects of coffee consumption on all-cause (general) mortality, mortality due to cardiovascular disease, and survival. Analyses were based on data obtained from an epidemiological longitudinal study started in 1969 with follow-ups in 1972, including 1,571 men and 1,793 women aged 35-59 years, and in 1982, including 1,093 men and 1,330 women. ⋯ Women who regularly drank coffee 1-2 cup(s) per day had a significantly lower risk of all-cause death adjusted for age, region, smoking, diastolic blood pressure, feeling of well-being, and history of stomach ulcer (relative risk = 0.631; p = 0.0033; confidence interval: 0.464-0.857). The role of coffee consumption on mortality was less relevant than other variables. However, it cannot be completely neglected in women.