Publish in OALib Journal

ISSN: 2333-9721

APC: Only $99


Any time

2015 ( 13 )

2014 ( 9 )

2013 ( 9 )

2012 ( 14 )

Custom range...

Search Results: 1 - 10 of 112 matches for " Ramanan Laxminarayan "
All listed articles are free for downloading (OA Articles)
Page 1 /112
Display every page Item
Cost-Effectiveness of “Golden Mustard” for Treating Vitamin A Deficiency in India
Jeffrey Chow,Eili Y. Klein,Ramanan Laxminarayan
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012046
Abstract: Vitamin A deficiency (VAD) is an important nutritional problem in India, resulting in an increased risk of severe morbidity and mortality. Periodic, high-dose vitamin A supplementation is the WHO-recommended method to prevent VAD, since a single dose can compensate for reduced dietary intake or increased need over a period of several months. However, in India only 34 percent of targeted children currently receive the two doses per year, and new strategies are urgently needed.
Unit Cost of Medical Services at Different Hospitals in India
Susmita Chatterjee, Carol Levin, Ramanan Laxminarayan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069728
Abstract: Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes.
The Socioeconomic and Institutional Determinants of Participation in India’s Health Insurance Scheme for the Poor
Arindam Nandi, Ashvin Ashok, Ramanan Laxminarayan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066296
Abstract: The Rashtriya Swasthya Bima Yojana (RSBY), which was introduced in 2008 in India, is a social health insurance scheme that aims to improve healthcare access and provide financial risk protection to the poor. In this study, we analyse the determinants of participation and enrolment in the scheme at the level of districts. We used official data on RSBY enrolment, socioeconomic data from the District Level Household Survey 2007–2008, and additional state-level information on fiscal health, political affiliation, and quality of governance. Results from multivariate probit and OLS analyses suggest that political and institutional factors are among the strongest determinants explaining the variation in participation and enrolment in RSBY. In particular, districts in state governments that are politically affiliated with the opposition or neutral parties at the centre are more likely to participate in RSBY, and have higher levels of enrolment. Districts in states with a lower quality of governance, a pre-existing state-level health insurance scheme, or with a lower level of fiscal deficit as compared to GDP, are significantly less likely to participate, or have lower enrolment rates. Among socioeconomic factors, we find some evidence of weak or imprecise targeting. Districts with a higher share of socioeconomically backward castes are less likely to participate, and their enrolment rates are also lower. Finally, districts with more non-poor households may be more likely to participate, although with lower enrolment rates.
Incentives for Reporting Disease Outbreaks
Ramanan Laxminarayan, Julian Reif, Anup Malani
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090290
Abstract: Background Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines. Methods We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO) from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO. Findings We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased. Interpretation These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.
“One-Size-Fits-All”? Optimizing Treatment Duration for Bacterial Infections
Patricia Geli, Ramanan Laxminarayan, Michael Dunne, David L. Smith
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0029838
Abstract: Historically, antibiotic treatment guidelines have aimed to maximize treatment efficacy and minimize toxicity, but have not considered the evolution of antibiotic resistance. Optimizing the duration and dosing of treatment to minimize the duration of symptomatic infection and selection pressure for resistance simultaneously has the potential to extend the useful therapeutic life of these valuable life-saving drugs without compromising the interests of individual patients. Here, using mathematical models, we explore the theoretical basis for shorter durations of treatment courses, including a range of ecological dynamics of bacteria that cause infections or colonize hosts as commensals. We find that immunity is an important mediating factor in determining the need for long duration of treatment. When immunity to infection is expected, shorter durations that reduce the selection for resistance without interfering with successful clinical outcome are likely to be supported. Adjusting drug treatment strategies to account for the impact of the differences in the ecological niche occupied by commensal flora relative to invasive bacteria could be effective in delaying the spread of bacterial resistance.
Ocular injuries in coal mines
Indian Journal of Ophthalmology , 1968,
Seasonal and Temperature-Associated Increases in Gram-Negative Bacterial Bloodstream Infections among Hospitalized Patients
Michael R. Eber,Michelle Shardell,Marin L. Schweizer,Ramanan Laxminarayan,Eli N. Perencevich
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0025298
Abstract: Knowledge of seasonal trends in hospital-associated infection incidence may improve surveillance and help guide the design and evaluation of infection prevention interventions. We estimated seasonal variation in the frequencies of inpatient bloodstream infections (BSIs) caused by common bacterial pathogens and examined associations of monthly BSI frequencies with ambient outdoor temperature, precipitation, and humidity levels.
Prospective strategies to delay the evolution of anti-malarial drug resistance: weighing the uncertainty
David L Smith, Eili Y Klein, F Ellis McKenzie, Ramanan Laxminarayan
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-217
Abstract: Here, the emergence and spread of resistance was modelled using a hybrid framework to evaluate prospective strategies, estimate the time to drug failure, and weigh uncertainty. The waiting time to appearance was estimated as the product of low mutation rates, drug pressure, and parasite population sizes during treatment. Stochastic persistence and the waiting time to establishment were simulated as an evolving branching process. The subsequent spread of resistance was simulated in simple epidemiological models.Using this framework, the waiting time to the failure of artemisinin combination therapy (ACT) for malaria was estimated, and a policy of multiple first-line therapies (MFTs) was evaluated. The models quantify the effects of reducing drug pressure in delaying appearance, reducing the chances of establishment, and slowing spread. By using two first-line therapies in a population, it is possible to reduce drug pressure while still treating the full complement of cases.At a global scale, because of uncertainty about the time to the emergence of ACT resistance, there was a strong case for MFTs to guard against early failure. Our study recommends developing operationally feasible strategies for implementing MFTs, such as distributing different ACTs at the clinic and for home-based care, or formulating different ACTs for children and adults.Plasmodium falciparum, which causes malaria, is the most important parasite species that infects humans with approximately 2.37 billion people at risk [1,2]. Prompt effective drug treatment can reduce the risk of mortality for those with clinical infections, and is a key component of malaria elimination and eradication plans both past and present [3]. Diminished therapeutic efficacy due to the evolution of resistance to previous first-line drugs, however, contributed to the failure of initial eradication efforts and resulted in increases in infection and mortality [4]. Drug stewardship, combination therapies, and other policies h
Clinically immune hosts as a refuge for drug-sensitive malaria parasites
Eili Y Klein, David L Smith, Maciej F Boni, Ramanan Laxminarayan
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-67
Abstract: The model is constructed as a two-stage susceptible-infected-susceptible (SIS) model of malaria transmission that assumes that individuals build up clinical immunity over a period of years. This immunity reduces the frequency and severity of clinical symptoms, and thus their use of drugs. It also reduces an individual's level of infectiousness, but does not impact the likelihood of becoming infected.Simulations found that with the introduction of resistance into a population, clinical immunity can significantly alter the fitness of the resistant parasite, and thereby impact the ability of the resistant parasite to spread from an initial host by reducing the effective reproductive number of the resistant parasite as transmission intensity increases. At high transmission levels, despite a higher basic reproductive number, R0, the effective reproductive number of the resistant parasite may fall below the reproductive number of the sensitive parasite.These results suggest that high-levels of clinical immunity create a natural ecological refuge for drug-sensitive parasites. This provides an epidemiological rationale for historical patterns of resistance emergence and suggests that future outbreaks of resistance are more likely to occur in low- or unstable-transmission settings. This finding has implications for the design of drug policies and the formulation of malaria control strategies, especially those that lower malaria transmission intensity.Malaria is the leading cause of death in children under five in sub-Saharan Africa [1]. Prompt treatment with effective antimalarial drugs could prevent much of the morbidity and mortality associated with clinical malaria, but the evolution of resistance has diminished the therapeutic efficacy of two previous first-line antimalarials, chloroquine (CQ) and sulphadoxine-pyrimethamine (SP). Historically, it has been suggested that resistance to both CQ and SP emerged from a limited number of de novo selection events in areas of low
Appendicitis as a cause of intestinal strangulation: a case report and review
Laxminarayan Bhandari, PG Mohandas
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-34
Abstract: We report a case of a 24 year old male presenting with classical features of intestinal obstruction. On laparotomy strangulated bowel was seen and appendix was found to be the cause. Although we obtained a history of appendicitis in this patient, it was not correlated to the present condition due to the rarity of such a scenario. We reviewed literature to find similar cases reported in the past.Intestinal obstruction is a common surgical emergency caused by varied conditions. Appendix as a cause of intestinal obstruction is uncommon and not usually suspected. Although it was described as early as 1901, very few reports are available which do a comprehensive review [1]. Intestinal strangulation caused by appendix is extremely rare with very few cases reported. Pre-operatively it is very difficult to diagnose this condition. The diagnosis is always made at the time of laparotomy. The treatment varies from appendicectomy to intestinal resection or even right hemicolectomy.We are reporting a case of intestinal strangulation caused by appendicitis, for which appendicectomy was done. This is a very rare complication of an extremely common disease. We reviewed the literature to find out about appendix producing intestinal obstruction in general and intestinal strangulation in particular.We have included a comprehensive discussion about appendicitis producing intestinal obstruction with regards to its various pathological types, different clinical presentations, diagnosis and management.A 24 year old man presented with on and off fever and diffuse abdominal pain since one week. He also had constipation, vomiting and abdominal distention since two days.He was apparently normal a week ago when he developed abdominal pain for which he visited a peripheral hospital. An Ultrasonography (USG) abdomen was done, which revealed the possibility of a mild appendicular inflammation. He was treated with oral antibiotics and analgesics following which his abdominal pain subsided. Few day
Page 1 /112
Display every page Item

Copyright © 2008-2017 Open Access Library. All rights reserved.