Biomedical subjects

Martin I Meltzer

Publications and source records attributed to Martin I Meltzer.

24 records · Page 2Linked to original sources

PubMed2003

Perceptions of bed nets and malaria prevention before and after a randomized controlled trial of permethrin-treated bed nets in western Kenya.

A study of mothers' perceptions regarding bed nets and malaria was conducted before and after a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya. Awareness about the trial and the rationale for bed net use increased by the end of the trial. Knowledge that mosquitoes caused malaria also increased; however, a higher proportion of mothers from control, rather than intervention villages, cited this (44.4% versus 27.9%; P < 0.001). Mothers from intervention villages were more knowledgeable about the use and maintenance of bed nets and re-treatment with insecticide. Both groups specified advantages of ITNs. Mothers from intervention villages noted practical advantages such as protection against bedbugs and falling roof debris. Few (< 1%) mothers indicated that ITNs protected children against malaria. Intervention homes used significantly fewer mosquito coils, insect spray, medicines, and burned cow dung less often compared with those in control villages. Mothers were willing to pay approximately 4.5 U.S. dollars for a regular bed net, but only 10.5 U.S. cents (intervention) and 0.036 (control) for re-treating a bed net. This study suggests that, despite two years of experience of use, bed nets and insecticides would not be purchased as a household priority in this impoverished rural community.

Adult↗

PubMed2003

The household-level economics of using permethrin-treated bed nets to prevent malaria in children less than five years of age.

We measured the two-week household-level economic impact of insecticide (permethrin)-treated bed nets (ITNs) used to prevent malaria among children less than five years of age in Asembo, Kenya. The ITNs induced a two-week reduction of 15 Kenyan shillings (KSH) (0.25 U.S. dollars; P < 0.0001) in health care expenditures, but a statistically insignificant 0.5 day (P = 0.280) reduction in household time lost due to caring for sick children. The equivalent annual threshold cost was estimated at 6.50 U.S. dollars (95% confidence interval = 3.12-9.86). If the actual purchase price and maintenance costs of ITNs were greater than this threshold, then households would pay more than they would save (and vice-versa). Both seasonal effects and number of children per household had larger impacts than ITNs on health care expenditures and time lost from household activities. Health care expenditures by a household without ITNs and one child were only 32 KSH per two weeks (0.50 U.S. dollars; P = 0.002), leaving little opportunity for household-level, ITN-induced direct savings. The widespread adoption of the ITNs will therefore probably require a subsidy.

Antimalarials↗

PubMed2002

Cost of distributing oral raccoon-variant rabies vaccine in Ohio: 1997-2000.

OBJECTIVE: Analysis of the cost of 8 distributions of oral rabies vaccine (ORV) with strains known to infect raccoons in Ohio between 1997 and 2000. DESIGN: Original study. PROCEDURE: Fishmeal bait containing ORV was distributed on foot, by vehicle, and by helicopter and fixed-wing aircraft. The cost of personnel, vehicles, and helicopter and aircraft use and other associated expenses were obtained from field records and interviews with personnel and agencies involved in the ORV program. RESULTS: Each bait distribution lasted approximately 1 week. Areas baited ranged from 1,701 km2 to 6,497 km2. Density varied for each distribution, with means of 79 baits/km2 for ground baiting and 93 baits/km2 for aerial baiting. Typically, 72 people participated in the ground portion of each distribution and 32 in the aerial portion. The cost of ground baiting (mean +/- SD, 19.24 dollars/km2 +/- 6.35 dollars/km2) was consistently less than that for air baiting (mean +/- SD, 24.71 dollars/km2 +/- 4.65 dollars/kml) for each distribution. The total cost of distribution varied from 30,568 dollars to 145,842 dollars (mean, 96,791 dollars), and bait cost varied from 150,714 dollars to 1,029,423 dollars (mean, 543,839 dollars). The total cost of ORV distributions ranged from 102 dollars/km2 to 261 dollars/km2 (mean, 153 dollars/km2). CONCLUSIONS: In the United States, rabies strains that infect raccoons have been responsible for the largest increase in rabies in animals in the past 3 decades. Use of ORV is a promising new tool that can be used to control rabies in raccoons. Documenting the estimated cost of implementing an ORV program may lead to more efficient use of resources to control and limit the spread of rabies. In addition, accurately measured distribution costs can be used to perform an economic cost-benefit analysis for an ORV program.

Administration, Oral↗

PubMed2002

Vaccinating first-year college students living in dormitories for Meningococcal disease: an economic analysis.

BACKGROUND: Surveillance of meningococcal disease among U.S. college students found an elevated rate of this disease among first-year students living in dormitories. OBJECTIVE: This study examines the economics of routinely vaccinating a cohort of 591,587 incoming first-year students who will live in dormitories for > or =1 years. METHODS: A cost-benefit model (societal perspective) was constructed to measure the net present value (NPV) of various vaccination scenarios, as well as the cost/case and cost/death averted. Input values included hospitalization costs from $10,924 to $24,030 per hospitalization; immunization costs (vaccine plus administration costs) from $54 to $88 per vaccine; 30 nonfatal, vaccine-preventable cases over a 4-year period (includes 3 with sequelae); 3 premature deaths; value of human life from $1.2 million to $4.8 million; and long-run sequelae costs from $1298 to $14,600. Sensitivity analyses were also conducted on vaccine efficacy (80% to 90%); discount rate (0% to 5%); and coverage (60% to 100%). RESULTS: The costs of vaccination outweighed the benefits gained with NPVs ranging from -$11 million to -$49 million. The net cost per case averted ranged from $0.6 million to $1.9 million. The net cost per death averted ranged from $7 million to $20 million. The break-even costs of vaccination (when NPV=$0) at 60% coverage ranged from $23 (90% vaccine efficacy) to $5 (80% efficacy). CONCLUSIONS: The model showed that the vaccination program is not cost-saving. Key variables influencing the results were the low number of vaccine-preventable cases and the high cost of vaccination. However, from the perspective of students and parents, the cost of vaccination might be worth the real or perceived benefit of reducing the risk to an individual student of developing meningococcal disease.

Adolescent↗

PubMedDate not supplied

Maxi-Vac: planning mass smallpox vaccination clinics.

To help emergency response planners prepare for conducting mass smallpox vaccination clinics, the Centers for Disease Control and Prevention researchers developed the Maxi-Vac software (available free from http://www.bt.cdc.gov/agent/smallpox/vaccination/maxi-vac/index.asp); it assists in designing a mass vaccination clinic with up to 9 separate stations. Users select clinic characteristics that best represent their intended setup, and the software displays the optimal placement of staff to vaccinate the maximum number of people possible. For example, for a clinic that will have 3 physicians, 30 nurses, and 10 other staff members available per 12-hour shift, Maxi-Vac shows how these staff members can best be deployed, and it projects the maximum number of persons who can be vaccinated at 8,245 per 24-hour period. Users can alter the number of available staff, which will probably be the greatest limiting factor, to determine the impact on the number of persons vaccinated per 24-hour period.

Bioterrorism↗

PubMedDate not supplied

FluSurge--a tool to estimate demand for hospital services during the next pandemic influenza.

PURPOSE: To assess the impact of pandemic influenza on hospital services. METHODS: Based on census data and estimates of hospital resources (non-ICU [intensive care unit] beds, ICU beds, and mechanical ventilators) in a given area, FluSurge software estimates the number of hospital admissions and deaths due to pandemic influenza under variable duration and virulence scenarios and compares hospital resources needed during a pandemic with existing hospital resources. RESULTS: Sample results from Metropolitan Atlanta illustrate how the next influenza pandemic may overwhelm existing hospital resources, given that hospitals increasingly operate at nearly full capacity. CONCLUSIONS: Hospitals need to consider and plan for a surge in demand for hospital services during the next influenza pandemic.

Adolescent↗