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Biomedical subjects

Eve Worrall

Publications and source records attributed to Eve Worrall.

6 recordsLinked to original sources
PubMed2005

Experience of targeting subsidies on insecticide-treated nets: what do we know and what are the knowledge gaps?

Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM 'Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa' promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM 'Workshop on mapping models for delivering ITNs through targeted subsidies' held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.

Africa↗
PubMed2005

Is malaria a disease of poverty? A review of the literature.

OBJECTIVE: To review the evidence on the link between malaria and poverty. METHODS: Review of the published and grey literature to identify (i) the data available on the socio-economic distribution of malaria incidence and vulnerability, and (ii) the uptake of malaria control interventions. RESULTS: We found mixed evidence on malaria incidence, with a number of studies identifying no relationship between socio-economic status and incidence, although a larger number of studies do find a link. There is strong evidence that uptake of preventive and treatment interventions is closely related to proxies for socio-economic status. More generally, the quality of the literature examining this issue is highly variable, with many different measures of socio-economic status and often inadequate descriptions of methods of data collection and analysis in relation to socio-economic status. CONCLUSIONS: Important socio-economic differentials exist in access to malaria interventions, increasing the vulnerability of the poorest. More information is needed about how other methods of delivering malaria treatment and prevention can redress these inequalities.

Africa↗
PubMed2004

The burden of malaria epidemics and cost-effectiveness of interventions in epidemic situations in Africa.

Attempts to quantify the epidemiologic and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost-effectiveness of interventions in epidemics is extremely limited. Answering such key questions in an epidemic prone context is more challenging than doing so in endemic areas. Using the limited data available, we estimate that in Africa, there are more than 12 million malaria episodes and 155,000-310,000 malaria deaths per year attributable to epidemics if control options are not implemented or well timed, which is equivalent to some 4% of estimated annual malaria cases worldwide and 12-25% of estimated annual worldwide malaria deaths, including up to 50% of the estimated annual worldwide malaria mortality in persons > 15 years of age. The possible economic impact of malaria epidemics is described and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.

Africa↗
PubMed2004

Do malaria control interventions reach the poor? A view through the equity lens.

Malaria, more than any other disease of major public health importance in developing countries, disproportionately affects poor people, with 58% of malaria cases occurring in the poorest 20% of the world's population. If malaria control interventions are to achieve their desired impact, they must reach the poorest segments of the populations of developing countries. Unfortunately, a growing body of evidence from benefit-incidence analyses has demonstrated that many public health interventions that were designed to aid the poor are not reaching their intended target. For example, the poorest 20% of people in selected developing countries were as much as 2.5 times less likely to receive basic public health services as the least-poor 20%. In the field of malaria control, a small number of studies have begun to shed light on differences by wealth status of malaria burden and of access to treatment and prevention services. These early studies found no clear difference in fever incidence based on wealth status, but did show significant disparities in both the consequences of malaria and in the use of malaria prevention and treatment services. Further study is needed to elucidate the underlying factors that contribute to these disparities, and to examine possible inequities related to gender, social class, or other factors. To achieve impact and overcome such inequities, malaria control efforts must begin to incorporate approaches relevant to equity in program design, implementation, and monitoring and evaluation.

Delivery of Health Care↗
PubMed2003

El Niño and health.

El Niño Southern Oscillation (ENSO) is a climate event that originates in the Pacific Ocean but has wide-ranging consequences for weather around the world, and is especially associated with droughts and floods. The irregular occurrence of El Niño and La Niña events has implications for public health. On a global scale, the human effect of natural disasters increases during El Niño. The effect of ENSO on cholera risk in Bangladesh, and malaria epidemics in parts of South Asia and South America has been well established. The strongest evidence for an association between ENSO and disease is provided by time-series analysis with data series that include more than one event. Evidence for ENSO's effect on other mosquito-borne and rodent-borne diseases is weaker than that for malaria and cholera. Health planners are used to dealing with spatial risk concepts but have little experience with temporal risk management. ENSO and seasonal climate forecasts might offer the opportunity to target scarce resources for epidemic control and disaster preparedness.

Climate↗