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Search Results: 1 - 10 of 397229 matches for " F. J. Luquero "
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Prognostic Accuracy of WHO Growth Standards to Predict Mortality in a Large-Scale Nutritional Program in Niger
Nathanael Lapidus,Francisco J Luquero,Valérie Gaboulaud,Susan Shepherd,Rebecca F Grais
PLOS Medicine , 2009, DOI: 10.1371/journal.pmed.1000039
Abstract: Background Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of the WHO standards and the NCHS reference in predicting death in a population of malnourished children in a large nutritional program in Niger. Methods and Findings We analyzed data from 64,484 children aged 6–59 mo admitted with malnutrition (<80% weight-for-height percentage of the median [WH]% [NCHS] and/or mid-upper arm circumference [MUAC] <110 mm and/or presence of edema) in 2006 into the Médecins Sans Frontières (MSF) nutritional program in Maradi, Niger. Sensitivity and specificity of weight-for-height in terms of Z score (WHZ) and WH% for both WHO standards and NCHS reference were calculated using mortality as the gold standard. Sensitivity and specificity of MUAC were also calculated. The receiver operating characteristic (ROC) curve was traced for these cutoffs and its area under curve (AUC) estimated. In predicting mortality, WHZ (NCHS) and WH% (NCHS) showed AUC values of 0.63 (95% confidence interval [CI] 0.60–0.66) and 0.71 (CI 0.68–0.74), respectively. WHZ (WHO) and WH% (WHO) appeared to provide higher accuracy with AUC values of 0.76 (CI 0.75–0.80) and 0.77 (CI 0.75–0.80), respectively. The relationship between MUAC and mortality risk appeared to be relatively weak, with AUC = 0.63 (CI 0.60–0.67). Analyses stratified by sex and age yielded similar results. Conclusions These results suggest that in this population of children being treated for malnutrition, WH indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference. The findings are valid for a population of already malnourished children and are not necessarily generalizable to a population of children being screened for malnutrition. Future work is needed to assess which criteria are best for admission purposes to identify children most likely to benefit from therapeutic or supplementary feeding programs.
Learning lessons from field surveys in humanitarian contexts: a case study of field surveys conducted in North Kivu, DRC 2006-2008
Rebecca F Grais, Francisco J Luquero, Emmanuel Grellety, Heloise Pham, Benjamin Coghlan, Pierre Salignon
Conflict and Health , 2009, DOI: 10.1186/1752-1505-3-8
Abstract: In media and agency reports on complex emergencies, an estimate of the number of people who have died, the prevalence of childhood malnutrition and other key health indicators are often quoted. Although a discriminating reader may understand that these are estimates, we rarely question how or from where these numbers come. In most cases, estimates are obtained by means of field surveys which are subject to a number of limitations. In the past, the application of standard survey methods by various humanitarian actors has been criticised [1]. Currently, different methods of conducting field surveys are the subject of debate among epidemiologists and their strengths and weakness have been described in the literature [2-6]. Beyond the technical arguments, decision makers may find it difficult to conceptualize what the estimates actually mean. For instance, what makes this particular situation an emergency? And how should the operational response - humanitarian, political, even military - be adapted accordingly [7,8]? This brings into question not only the quality of the survey methodology, but also the difficulties epidemiologists face in interpreting results and selecting the most important information to guide operations.As a case study, we reviewed publicly available field surveys of a current acute-on-chronic humanitarian crisis - North Kivu, Democratic Republic of Congo (DRC) - to examine the methodologies employed, the findings presented, the interpretation of the results and the recommendations made. The eastern DRC Province of North Kivu has been the scene of conflict that has erupted sporadically for over a decade (Figure 1). The most recent renewal of violence has forced some 250,000 people to flee their homes since August 2008 [9].We searched PubMed/Medline for articles published from January 1, 2006 to January 1, 2009, in English, French, German, and Spanish using the key words ["mortality" (major topic) OR "nutrition" (major topic)] AND ["Congo" (text word)
Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey
Anne-Laure Page, Sarah Hustache, Francisco J Luquero, Ali Djibo, Mahamane Manzo, Rebecca F Grais
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-389
Abstract: A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted.In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0) and 3.4% (95% CI: 2.2-4.6), respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1) reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household.The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital-based surveillance of severe diarrheal diseases would capture only a fraction of severe diarrhea. Lower levels of health structures should be considered to obtain informative data to ensure appropriate care and burden estimates.Although better sanitation, hygiene and access to care have successfully alleviated the burden of diarrheal diseases in developed countries [1,2], diarrhea remains the second leading cause of death in children under 5 years of age in the world, representing nearly one in five child deaths - about 1.5 million each year [3,4]. In sub-Saharan Africa, the etiology of diarrhea is se
Evaluación de la adecuación de las estancias en un hospital de tercer nivel Evaluation of the appropriateness of stays in a third level hospital
A. Pérez-Rubio,S. Santos,F. J. Luquero,S. Tamames
Anales del Sistema Sanitario de Navarra , 2007,
Abstract: Fundamento: The Appropriateness Evaluation Protocol (AEP) se ha mostrado como una herramienta útil para la revisión de la utilización de los recursos hospitalarios. El objetivo de este trabajo es conocer la proporción de ingresos y estancias inadecuadas, así como sus causas, en pacientes hospitalizados en el Hospital Clínico Universitario de Valladolid (HCUV). Material y métodos: Estudio observacional analítico de cohortes retrospectivo. El período de estudio ha sido de un a o (2004). Se seleccionó una muestra de 1.630 ingresos. La definición de caso, las variables de interés y el modelo de recogida de datos se han llevado a cabo conforme al AEP. Se han analizado las principales variables mediante un análisis basal y las posibles relaciones entre ellas. Resultados: El 54% de los ingresos presentaron al menos un día de estancia inadecuada, siendo la tasa de inadecuación global del 34,17%. Entre las causas responsables de la inadecuación, el 68,9% de los ingresos presentaron al menos un criterio englobado dentro de la responsabilidad del médico o del hospital, y el 51,3% debido a retrasos en el desarrollo del estudio o tratamiento. Conclusiones: La utilización de métodos de identificación del uso inapropiado como el AEP presenta aplicaciones tanto en planificación como en gestión hospitalaria, al permitir identificar problemas hospitalarios causantes de demoras, principalmente problemas de tipo organizativo, permitiendo el desarrollo de intervenciones encaminadas a la reducción del uso inapropiado. Background: The Appropriateness Evaluation Protocol (AEP) has proved to be a useful tool for reviewing the utilisation of hospital resources. The aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the Hospital Clínico Universitario de Valladolid (HCUV). Material and methods: A retrospective, analytical, observational, cohort study. The period of study was one year (2004). A sample of 1,630 admissions was gathered. Case definition, variables of interest and the model of data gathering were carried out in accordance with the AEP. The principal variables were analysed by means of a basal analysis and the possible relations between them. Results: Fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. Amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to dela
The Impact of a One-Dose versus Two-Dose Oral Cholera Vaccine Regimen in Outbreak Settings: A Modeling Study
Andrew S. Azman?,Francisco J. Luquero,Iza Ciglenecki?,Rebecca F. Grais?,David A. Sack?,Justin Lessler
PLOS Medicine , 2015, DOI: 10.1371/journal.pmed.1001867
Abstract: Background In 2013, a stockpile of oral cholera vaccine (OCV) was created for use in outbreak response, but vaccine availability remains severely limited. Innovative strategies are needed to maximize the health impact and minimize the logistical barriers to using available vaccine. Here we ask under what conditions the use of one dose rather than the internationally licensed two-dose protocol may do both. Methods and Findings Using mathematical models we determined the minimum relative single-dose efficacy (MRSE) at which single-dose reactive campaigns are expected to be as or more effective than two-dose campaigns with the same amount of vaccine. Average one- and two-dose OCV effectiveness was estimated from published literature and compared to the MRSE. Results were applied to recent outbreaks in Haiti, Zimbabwe, and Guinea using stochastic simulations to illustrate the potential impact of one- and two-dose campaigns. At the start of an epidemic, a single dose must be 35%–56% as efficacious as two doses to avert the same number of cases with a fixed amount of vaccine (i.e., MRSE between 35% and 56%). This threshold decreases as vaccination is delayed. Short-term OCV effectiveness is estimated to be 77% (95% CI 57%–88%) for two doses and 44% (95% CI ?27% to 76%) for one dose. This results in a one-dose relative efficacy estimate of 57% (interquartile range 13%–88%), which is above conservative MRSE estimates. Using our best estimates of one- and two-dose efficacy, we projected that a single-dose reactive campaign could have prevented 70,584 (95% prediction interval [PI] 55,943–86,205) cases in Zimbabwe, 78,317 (95% PI 57,435–100,150) in Port-au-Prince, Haiti, and 2,826 (95% PI 2,490–3,170) cases in Conakry, Guinea: 1.1 to 1.2 times as many as a two-dose campaign. While extensive sensitivity analyses were performed, our projections of cases averted in past epidemics are based on severely limited single-dose efficacy data and may not fully capture uncertainty due to imperfect surveillance data and uncertainty about the transmission dynamics of cholera in each setting. Conclusions Reactive vaccination campaigns using a single dose of OCV may avert more cases and deaths than a standard two-dose campaign when vaccine supplies are limited, while at the same time reducing logistical complexity. These findings should motivate consideration of the trade-offs between one- and two-dose campaigns in resource-constrained settings, though further field efficacy data are needed and should be a priority in any one-dose campaign.
Evaluación de la adecuación de las estancias en un hospital de tercer nivel
Pérez-Rubio,A.; Santos,S.; Luquero,F. J.; Tamames,S.; Cantón,B.; Castrodeza,J.J.;
Anales del Sistema Sanitario de Navarra , 2007, DOI: 10.4321/S1137-66272007000100003
Abstract: background: the appropriateness evaluation protocol (aep) has proved to be a useful tool for reviewing the utilisation of hospital resources. the aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the hospital clínico universitario de valladolid (hcuv). material and methods: a retrospective, analytical, observational, cohort study. the period of study was one year (2004). a sample of 1,630 admissions was gathered. case definition, variables of interest and the model of data gathering were carried out in accordance with the aep. the principal variables were analysed by means of a basal analysis and the possible relations between them. results: fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to delays in the development of study or treatment. conclusions: the utilisation of methods of identification of inappropriate use such as aep show applications both in planning and in hospital management, by making it possible to identify hospital problems causing delays, principally problems of an organisational type, making it possible to develop interventions aimed at reducing inappropriate use.
Measuring the Performance of Vaccination Programs Using Cross-Sectional Surveys: A Likelihood Framework and Retrospective Analysis
Justin Lessler ,C. Jessica E. Metcalf,Rebecca F. Grais,Francisco J. Luquero,Derek A. T. Cummings,Bryan T. Grenfell
PLOS Medicine , 2011, DOI: 10.1371/journal.pmed.1001110
Abstract: Background The performance of routine and supplemental immunization activities is usually measured by the administrative method: dividing the number of doses distributed by the size of the target population. This method leads to coverage estimates that are sometimes impossible (e.g., vaccination of 102% of the target population), and are generally inconsistent with the proportion found to be vaccinated in Demographic and Health Surveys (DHS). We describe a method that estimates the fraction of the population accessible to vaccination activities, as well as within-campaign inefficiencies, thus providing a consistent estimate of vaccination coverage. Methods and Findings We developed a likelihood framework for estimating the effective coverage of vaccination programs using cross-sectional surveys of vaccine coverage combined with administrative data. We applied our method to measles vaccination in three African countries: Ghana, Madagascar, and Sierra Leone, using data from each country's most recent DHS survey and administrative coverage data reported to the World Health Organization. We estimate that 93% (95% CI: 91, 94) of the population in Ghana was ever covered by any measles vaccination activity, 77% (95% CI: 78, 81) in Madagascar, and 69% (95% CI: 67, 70) in Sierra Leone. “Within-activity” inefficiencies were estimated to be low in Ghana, and higher in Sierra Leone and Madagascar. Our model successfully fits age-specific vaccination coverage levels seen in DHS data, which differ markedly from those predicted by na?ve extrapolation from country-reported and World Health Organization–adjusted vaccination coverage. Conclusions Combining administrative data with survey data substantially improves estimates of vaccination coverage. Estimates of the inefficiency of past vaccination activities and the proportion not covered by any activity allow us to more accurately predict the results of future activities and provide insight into the ways in which vaccination programs are failing to meet their goals. Please see later in the article for the Editors' Summary
Cholera Epidemic in Guinea-Bissau (2008): The Importance of “Place”
Francisco J. Luquero,Cunhate Na Banga,Daniel Remartínez,Pedro Pablo Palma,Emanuel Baron,Rebeca F. Grais
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0019005
Abstract: As resources are limited when responding to cholera outbreaks, knowledge about where to orient interventions is crucial. We describe the cholera epidemic affecting Guinea-Bissau in 2008 focusing on the geographical spread in order to guide prevention and control activities.
Feasibility of Mass Vaccination Campaign with Oral Cholera Vaccines in Response to an Outbreak in Guinea
Iza Ciglenecki ,Keita Sakoba,Francisco J. Luquero,Melat Heile,Christian Itama,Martin Mengel,Rebecca F. Grais,Francois Verhoustraeten,Dominique Legros
PLOS Medicine , 2013, DOI: 10.1371/journal.pmed.1001512
Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004
Pérez-Rubio,A.; Castrodeza Sanz,J.J.; Gil Costa,M.; Luquero Alcalde,F.J.; Eiros Bouza,J.; Ortiz de Lejarazu,R.;
Revista Espa?ola de Salud Pública , 2008, DOI: 10.1590/S1135-57272008000100009
Abstract: background: chicken pox is a mainly childhood contagious disease caused by the varicella zoster virus which gives rise to major healthcare and social costs. in 2005, castile and leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. this strategy does not modify the major mobility generated thereby at younger ages. this study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in castile and leon. methods: an economic cost-benefit evaluation has been set out by jeans of a decision-making tree. a fictitious cohort of 100,000 children in castile and leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. this study is approached from the social standpoint. the time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. a sensitivity analysis was made for evaluating the uncertainty of some variables... results: the cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. conclusions: from the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. the profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed.
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