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Search Results: 1 - 10 of 878 matches for " Olivia Oxlade "
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Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India?
Olivia Oxlade, Megan Murray
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0047533
Abstract: Background Although poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB. Methods Using individual level data from 198,754 people from the 2006 Demographic Health Survey (DHS) for India, we assessed self-reported TB status, TB determinants and household socioeconomic status. We used these data to calculate the population attributable fractions (PAF) for each key TB risk factor based on the prevalence of determinants and estimates of the effect of these risk factors derived from published sources. We conducted a mediation analysis using principal components analysis (PCA) and regression to demonstrate how the association between poverty and TB prevalence is mediated. Results The prevalence of self-reported TB in the 2006 DHS for India was 545 per 100,000 and ranged from 201 in the highest quintile to 1100 in the lowest quintile. Among those in the poorest population, the PAFs for low body mass index (BMI) and indoor air pollution were 34.2% and 28.5% respectively. The PCA analysis also showed that low BMI had the strongest mediating effect on the association between poverty and prevalent TB (12%, p = 0.019). Conclusion TB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease—specifically low BMI and indoor air pollution.
How Methodologic Differences Affect Results of Economic Analyses: A Systematic Review of Interferon Gamma Release Assays for the Diagnosis of LTBI
Olivia Oxlade, Marcia Pinto, Anete Trajman, Dick Menzies
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0056044
Abstract: Introduction Cost effectiveness analyses (CEA) can provide useful information on how to invest limited funds, however they are less useful if different analysis of the same intervention provide unclear or contradictory results. The objective of our study was to conduct a systematic review of methodologic aspects of CEA that evaluate Interferon Gamma Release Assays (IGRA) for the detection of Latent Tuberculosis Infection (LTBI), in order to understand how differences affect study results. Methods A systematic review of studies was conducted with particular focus on study quality and the variability in inputs used in models used to assess cost-effectiveness. A common decision analysis model of the IGRA versus Tuberculin Skin Test (TST) screening strategy was developed and used to quantify the impact on predicted results of observed differences of model inputs taken from the studies identified. Results Thirteen studies were ultimately included in the review. Several specific methodologic issues were identified across studies, including how study inputs were selected, inconsistencies in the costing approach, the utility of the QALY (Quality Adjusted Life Year) as the effectiveness outcome, and how authors choose to present and interpret study results. When the IGRA versus TST test strategies were compared using our common decision analysis model predicted effectiveness largely overlapped. Implications Many methodologic issues that contribute to inconsistent results and reduced study quality were identified in studies that assessed the cost-effectiveness of the IGRA test. More specific and relevant guidelines are needed in order to help authors standardize modelling approaches, inputs, assumptions and how results are presented and interpreted.
Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil
Ricardo Steffen,Dick Menzies,Olivia Oxlade,Marcia Pinto,Analia Zuleika de Castro,Paula Monteiro,Anete Trajman
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014014
Abstract: Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.
Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study
Chia-Lin Tseng, Olivia Oxlade, Dick Menzies, Anne Aspler, Kevin Schwartzman
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-55
Abstract: We conducted a decision analysis model-based simulation from the societal perspective, with a 3% discount rate and all costs expressed in 2007 US dollars. Health outcomes and costs were projected over a 30-year period, for persons born in Zambia (population 11,478,000 in 2005) in year 1. Initial development costs for single vaccination and prime-boost strategies were prorated to the Zambian share (0.398%) of global BCG vaccine coverage for newborns. Main outcome measures were TB-related morbidity, mortality, and costs over a range of potential scenarios for vaccine efficacy.Relative to the status quo strategy, a BCG replacement vaccine administered at birth, with 70% efficacy in preventing rapid progression to TB disease after initial infection, is estimated to avert 932 TB cases and 422 TB-related deaths (prevention of 199 cases/100,000 vaccinated, and 90 deaths/100,000 vaccinated). This would result in estimated net savings of $3.6 million over 30 years for 468,073 Zambians born in year 1 of the simulation. The addition of a booster at age 10 results in estimated savings of $5.6 million compared to the status quo, averting 1,863 TB cases and 1,011 TB-related deaths (prevention of 398 cases/100,000 vaccinated, and of 216 deaths/100,000 vaccinated). With vaccination at birth alone, net savings would be realized within 1 year, whereas the prime-boost strategy would require an additional 5 years to realize savings, reflecting a greater initial development cost.Investment in an improved TB vaccine is predicted to result in considerable cost savings, as well as a reduction in TB morbidity and TB-related mortality, when added to existing control strategies. For a vaccine with waning efficacy, a prime-boost strategy is more cost-effective in the long term.Nearly a third of the world's population harbors the Mycobacterium tuberculosis bacillus, and about 1.7 million people die of tuberculosis (TB) each year [1]. Since the early 1990s, inconsistent treatment and the consequ
Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
Vary Jacquet, Willy Morose, Kevin Schwartzman, Olivia Oxlade, Graham Barr, Franque Grimard, Dick Menzies
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-209
Abstract: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.Between 1997 and 2002 the incidence of active TB increased in most low and middle income countries [1]. This occurred despite the availability of adequate tools for diagnosis and treatment, and an effective TB control strategy – which has been labelled DOTS. This strategy, originally developed in sub-Saharan Africa, is being promoted by the World Health Organisation (WHO) [2] because it is feasible in high-burden settings [3], cost-effective even in low income countries [4], and can result in substantial reduction in TB incidence [5].However, between $290 – $500 millio
Hepatitis B Screening and Vaccination Strategies for Newly Arrived Adult Canadian Immigrants and Refugees: A Cost-Effectiveness Analysis
Carmine Rossi, Kevin Schwartzman, Olivia Oxlade, Marina B. Klein, Chris Greenaway
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078548
Abstract: Background Immigrants have increased mortality from hepatocellular carcinoma as compared to the host populations, primarily due to undetected chronic hepatitis B virus (HBV) infection. Despite this, there are no systematic programs in most immigrant-receiving countries to screen for chronic HBV infection and immigrants are not routinely offered HBV vaccination outside of the universal childhood vaccination program. Methods and findings A cost-effective analysis was performed to compare four HBV screening and vaccination strategies with no intervention in a hypothetical cohort of newly-arriving adult Canadian immigrants. The strategies considered were a) universal vaccination, b) screening for prior immunity and vaccination, c) chronic HBV screening and treatment, and d) combined screening for chronic HBV and prior immunity, treatment and vaccination. The analysis was performed from a societal perspective, using a Markov model. Seroprevalence estimates, annual transition probabilities, health-care costs (in Canadian dollars), and utilities were obtained from the published literature. Acute HBV infection, mortality from chronic HBV, quality-adjusted life years (QALYs), and costs were modeled over the lifetime of the cohort of immigrants. Costs and QALYs were discounted at a rate of 3% per year. Screening for chronic HBV infection, and offering treatment if indicated, was found to be the most cost-effective intervention and was estimated to cost $40,880 per additional QALY gained, relative to no intervention. This strategy was most cost-effective for immigrants < 55 years of age and would cost < $50,000 per additional QALY gained for immigrants from areas where HBV seroprevalence is ≥ 3%. Strategies that included HBV vaccination were either prohibitively expensive or dominated by the chronic HBV screening strategy. Conclusions Screening for chronic HBV infection from regions where most Canadian immigrants originate, except for Latin America and the Middle East, was found to be reasonably cost-effective and has the potential to reduce HBV-associated morbidity and mortality.
Fatores associados ao atraso no diagnóstico da tuberculose pulmonar no estado do Rio de Janeiro
Machado, Audry Cristina de Fátima Teixeira;Steffen, Ricardo Ewbank;Oxlade, Olivia;Menzies, Dick;Kritski, Afranio;Trajman, Anete;
Jornal Brasileiro de Pneumologia , 2011, DOI: 10.1590/S1806-37132011000400014
Abstract: objective: to estimate the total time elapsed between symptom onset and diagnosis of pulmonary tuberculosis (patient delay plus health care system delay), analyzing the factors associated with delayed diagnosis in the state of rio de janeiro, brazil. methods: we conducted a questionnaire-based survey involving 218 pulmonary tuberculosis patients treated for two months at 20 health care clinics and 3 hospitals in eight cities within the state of rio de janeiro. we collected socioeconomic and demographic data, as well as data regarding the health care system and the medical history of the patients. results: the median time elapsed from the onset of symptoms to diagnosis was 68 days (interquartile range [iqr]: 35-119 days). the median patient delay (time from symptom onset to initial medical visit) was 30 days (iqr: 15-60 days), and the median health care system delay (time from initial medical visit to diagnosis) was 21 days (iqr: 8-47 days). a cut-off point of 21 days was adopted. the factors independently associated with patient delay were female gender, cough, and unemployment [adjusted or (95% ci) = 2.7 (1.3-5.6); 11.6 (2.3-58.8); and 2.0 (1.0-3.8), respectively], whereas only female gender was independently associated with health care system delay (or= 3.2; 95% ci: 1.7-6.0). conclusions: delayed diagnosis of pulmonary tuberculosis remains a problem in rio de janeiro, increasing the risk of transmission and mortality, that risk being greater for women and the socioeconomically disadvantaged. patients might not recognize the significance of chronic cough as a health problem. tuberculosis education programs targeting women might improve this situation.
The Impact of Political Reforms in Improving Quality Health Services: The Case Study of Shamva District  [PDF]
Olivia Gumbo
Open Journal of Political Science (OJPS) , 2019, DOI: 10.4236/ojps.2019.92023
Abstract: Zimbabweans continue to experience challenges in combating communicable diseases such as tuberculosis, diarrheal diseases, and HIV/AIDS. The country’s health sector decentralisation implementation is moving at a snail’s speed, triggering complaints of unsatisfactory service delivery at rural health centres. The study examined the impact of political reforms in improving quality health services in Shamva District. The identified political reforms were decentralisation and the second republic that emerged in November 2018 that embraced the 100-day plans approach, civil service reform agenda, development of transitional stabilisation plan and vision 2030 agenda. The study was guided by interpretive and critical post-modernist paradigms. Qualitative methodology was utilised; key informant interviews, focus group discussion and desk reviews were data generation tools that were utilised. The data generated were analysed using grounded theory. The key findings are that decentralisation enabled district health officials to interact with communities through social accountability strategies such as community scorecard, results-based financing and village health worker model that is implemented in Shamva District by Civil Society Organisations. The second republic political reforms enforced the user fee policy in the health sector and focused on improving primary health care. The political reforms led to improved health rights knowledge of communities and quality health services in Shamva District. The study concluded that lack of continuous funding and sustainable plans led to the reversal of positive results that were brought in by the political reforms. The major recommendation is that government should understand that service delivery is not poor by accident; rather it is a symptom of the
Antimicrobial Resistance and β-Lactamase Production among Hospital Dumpsite Isolates  [PDF]
Olivia Sochi Egbule
Journal of Environmental Protection (JEP) , 2016, DOI: 10.4236/jep.2016.77094

Metallo-β-Lactamases (MBLs) and Extended Spectrum β-Lactamses (ESBLs) have emerged world-wide as a significant source of β-lactam resistance. The emergence of MBLs and ESBLs encoded on plasmids among Gram-negative pathogens in hospital dumpsites was investigated. Soils of different government and private hospitals were collected and processed following standard bacteriological techniques. Antimicrobial susceptibility testing was carried out by the disk-diffusion technique using Ceftazidime (30 μg), Cefuroxime (30 μg), Cefotaxime (30 μg), Cefixime (5 μg), Trimethprim-sulfamethoxazole (25 μg), Gentamycin (100 μg) Amoxicillin-Clavunalate (30 μg), Ciprofloxacin (5 μg), Ofloxacin (5 μg), Nitrofurantoin (300 μg) and Imipenem (10 μg). The role of plasmids in resistance was evaluated by subjecting isolates to curing using Sodium Dodecyl Sulfate (SDS). ESBLs production by Double-Disk Synergy Test (DDST) was carried out. Isolates resistant to Imipenem were subjected to a confirmatory test using Modified Hodge’s test and to MBLs production by DDST. Eighty-two Gram-negative isolates comprising of 32 (39.02%) Escherichia coli, 20 (24.39%) Serratia marcescens, 14 (17.07%) Klebsiella pneumonia, 10 (12.28%) Proteus mirabilis and 6 (7.32%) Enterobacter aerogenes were obtained. Susceptibility results revealed a 100% resistance of all isolates to Ceftazidime, Cefuroxime, Cefixime, Amoxycillin-clavulanate and Cefotaxime. A total of 66 (80.48%) isolates harboured plasmids out of which 26 (31.71%) isolates were ESBL producers. MBLs production was observed in 8 (25.00%) E. coli, 2 (2.41%) Klebsiella pneumonia and 2 (2.41%) Proteus mirabilis isolates. All MBLs producing isolates were ESBLs producers. The finding of highly resistant isolates producing ESBLs and MBLs in a hospital environment is quite disturbing and should be addressed urgently.

Detection and Transfer of Extended Spectrum Beta Lactamase Enzymes from Untreated Hospital Waste Water  [PDF]
Olivia Sochi Egbule
Advances in Microbiology (AiM) , 2016, DOI: 10.4236/aim.2016.67051
Abstract: Untreated Hospital wastewater piped into septic tanks contributes to the spread of antibiotic resistance in developing countries. This study was conducted to determine the resistant profile, and Extended Spectrum Beta-Lactamases (ESBLs) production in isolates from hospital waste water, of 2 hospitals in Delta State, Nigeria. A total of 147 organisms were isolated from 32 waste water samples. One hundred and twenty three isolates were Gram negative and 24 were Gram positive. Escherichia coli was the most prevalent in the two locations. Antimicrobial susceptibility by standard disk diffusion method was performed. All isolates were resistant to 4 or more antimicrobial agents. Out of the 123 Gram negative Bacteria, 33 were pan drug resistant and were selected for plasmid curing, DNA extraction and phenotypic detection of ESBL. Transfer of resistant by broth mating technique was performed. Plasmid curing and extraction result indicated that isolates carried resistance on the plasmid and harboured similar multiple high molecular weight plasmids of 23.13 kb and 9.4 kb. ESBL production was detected in 15.15%. Transfer of resistant genes between ESBL producing and non-ESBL producing isolates was observed. Incidence of ESBL in untreated hospital waste water has public health implications. Therefore establishment of treatment plants in our hospital is paramount in achieving sustainable health.
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