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Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
HEALTH FOR THE MILLIONS. 1995 Jan-Feb; 21(1):29-33.In India, the standard regimen (SR) for treating tuberculosis consisted of a 2-month intensive treatment by 2-3 inexpensive drugs followed by a 10-month course using 2 drugs. In the 1980s, this course was shortened to 6 months owing to the powerful drugs rifampicin and pyrazinamide. Thiacetazone was also replaced by the more expensive but less toxic ethambutol. The result was a short-course chemotherapy (SCC) employing 4 drugs for 2 months, followed by 2-3 drugs for 4 months of follow-up. The SCC is being pilot-tested as the Revised National Tuberculosis Program (RNTP); this RNTP strategy is being implemented in Delhi, Bombay, and Mehsana with the assistance of the Swedish international agency. The World Bank also endorsed RNTP, as SCC regimens under it were cost-effective. The SR and SCC regimens were also compared for Malawi, Mozambique, and Tanzania, and relatively minor differences were found in lives saved for expenditures. The claim that the rates of default under SR and SCC remain unchanged over time and the cure rates of the regimens must be challenged. The estimated cure rates of 60% for SR and 85% for SCC do not correspond to the reality in India, where 41% of patients completed treatment under SR versus 47% under SCC. The cost of treatment under SR does not have to be a 5-drug regimen; re-treatment can be a 3-drug regimen, whereby the cost would be lower than assumed. The Ministry of Health and Family Welfare (MHF) was probing 253 district SCCs even in 1992-93 and accepted SCC because the World Health Organization recommended a vastly improved administration for implementation and there was a felt need from patients for speedy cure. If the SCC is administered properly, it may increase the cure rate, even if cost-ineffective; if poorly managed, increased drug resistance of TB bacteria could result, which may be the present situation.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1991 Jul; 43(3):S13-21.Tuberculosis (TB) has long been recognized as a complication of immune suppression. It poses a particularly major public health threat to developing countries. Many developing countries suffer high prevalence and incidence of TB infection. By suppressing host cell-mediated immunity, HIV exacerbates TB infection by helping to facilitate the transition of latent TB into active disease. Higher prevalence of active disease in population then leads to increasing rates of TB transmission. The World Bank estimates an annual incidence of greater than 7.1 million TB cases in the developing world. Cost-effective interventions have, however, been incorporated as components of national programs in Tanzania and other developing countries. The World Health Organization and World Bank are also working on new strategies to revitalize global efforts against tuberculosis. Finding TB cases early and treating them with chemotherapy are specifically recommended.
Washington, D.C., World Bank, 1992. vi, 123 p. (World Bank Technical Paper No. 167)The World Bank has complied a report of 7 case studies of successful tropical disease control programs. In Brazil, the Superintendency for Public Health Campaigns plans and implements tropical disease control programs (malaria, yellow fever, schistosomiasis, dengue, plague, and Chagas disease) based on previous campaign results. China operates a large and complex schistosomiasis control program which has a different task and strategy for each of the 3 targeted regions: the plans, hills and mountains, and marshlands and lakes. Egypt manages a schistosomiasis control program which protects 18 million people in 12 governates from the disease at a cost ofAdd to my documents.5070620
Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.