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- Ahmed, S., et al.
(author)
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The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh
- 2021
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In: Vaccine. - : Elsevier BV. - 0264-410X .- 1873-2518. ; 39:48, s. 7082-7090
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Journal article (peer-reviewed)abstract
- Background: Rotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. Methods: We estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. Results: The total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116-136) and total household costs were 161 USD (95% CI: 145-177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. Conclusions: A substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh. (c) 2021 Elsevier Ltd. All rights reserved.
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- Jahangir, Hadi, et al.
(author)
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Biostratigraphy of the Cambrian–Ordovician boundary beds at Kopet-Dagh, Iran
- 2015
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In: Stratigraphy. - 1547-139X .- 2331-656X. ; 2:12, s. 40-47
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Journal article (peer-reviewed)abstract
- A continuous succession comprising upper Cambrian (Furongian) to Lower Ordovician (Tremadocian) conodont biozones is reported for the first time from the Kopet-Dagh Region of northeastern Iran. Seven biostratigraphical units are recognized, including the Proconodontus tenuiserratus and Proconodontus posterocostatus zones; these two lowermost biostratigraphical units are defined by euconodont species which have not been previously reported from Iran and temperate latitude peri-Gondwana. The conodont diversity and abundance decreased significantly above the Eoconodontus notchpeakensis Zone; the conodont faunas of the succeeding Cordylodus proavus, Cordylodus lindstromi (sensu lato) and Cordylodus angulatus zones are characterised by oligotaxic to monotaxic associations dominated by species of Cordylodus. In the absence of diagnostic conodont species, the position of the lower boundary of the Ordovician System in the Kalat Valley Section can be placed somewhat below the first occurrence of the early planktonic graptolite Rhabdinopora flabelliformis, which approximately coincides with the onset of black shale deposition.
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- Jahangir, Hadi, et al.
(author)
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The siphonotretide brachiopod Schizambon from the Early Ordovician of South China : ontogeny and affinity
- 2023
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In: Papers in Palaeontology. - : John Wiley & Sons. - 2056-2799 .- 2056-2802. ; 9:4
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Journal article (peer-reviewed)abstract
- Schizambon is one of the earliest and most distinctive genera in the Order Siphonotretida. However, current knowledge of siphonotretide phylogeny and early evolution requires understanding of their earliest ontogeny. In this study, the new species Schizambon tongziensis from the Tungtzu Formation at Honghuayuan section in Guizhou Province, South China is described; it is also the first record of Schizambon in South China. The new well-preserved specimens shed light on the ontogeny, palaeobiogeographical distribution, phylogeny and early evolution of siphonotretide brachiopods. Characters of metamorphic shells on both valves, outlined by distinct halos, show that Schizambon had a planktotrophic ‘paterinide-type’ larva, typical of many early Palaeozoic brachiopods. Based on the newly obtained data it is inferred that the free-swimming larva of Schizambon settled directly on the ventral side of the body, and this type of ontogeny is probably true for other siphonotretides. The divergence of Schizambon from the main siphonotretide lineage probably happened prior to the Guzhangian Age, well before the occurrence of major biodiversification within the order.
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- Ahmed, S., et al.
(author)
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Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach
- 2021
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:11
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Journal article (peer-reviewed)abstract
- Background National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. Methods HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Results Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was (sic)32 in HVS and (sic)15 in MHI scheme. Conclusion HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider's costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.
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- Ghobadi Pour, M., et al.
(author)
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Early Ordovician (Tremadocian) faunas and biostratigraphy of the Gerd-Kuh section, eastern Alborz, Iran
- 2015
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In: Stratigraphy. - 1547-139X .- 2331-656X. ; 12:2, s. 55-61
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Journal article (peer-reviewed)abstract
- The Tremadocian of the East Alborz Region is dominated by condensed fine clasticsediments. These beds have yielded low to medium diversity trilobite associations, which belong to theolenid, nileid and raphiophorid biofacies, characteristic of an outer shelf environment. Five successivetrilobite biozones can be recognised in the Tremadocian succession of Alborz. The lower TremadocianAsaphellus inflatus–Dactylocephalus and Psilocephalina lubrica zones are characterised by mediumdiversity trilobite associations with strong links to contemporaneous faunas of South China. Three upperzones are documented in the section at Gerd-Kuh, the successive Vachikaspis insueta and Kayseraspiszones represent a low diversity interval during a time of rapid changes in the sea level changes; themedium diversity fauna of the Asaphellus fecundus–Taihungshania miqueli zone shows strong links tothe faunas of Mediterranean segment of Gondwana. Brachiopods in Gerd-Kuh are represented by themonotaxic Tarfaya Association and the low diversity Paralenorthis–Xinanorthis Association. Therecurrent oligotaxic Protambonites Association invaded the area in the late Tremadocian during shortterm regressive episodes.
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- Hasan, M. Z., et al.
(author)
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Factors affecting the healthcare utilization from Shasthyo Suroksha Karmasuchi scheme among the below-poverty-line population in one subdistrict in Bangladesh: a cross sectional study
- 2022
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background Financing healthcare through out-of-pocket (OOP) payment is a major barrier in accessing healthcare for the poor people. The Health Economics Unit (HEU) of the Ministry of Health and Family Welfare of the government of Bangladesh has developed Shasthyo Suroksha Karmasuchi (SSK), a health protection scheme, with the aim of reducing OOP expenditure and improving access of the below-poverty-line (BPL) population to healthcare. The scheme started piloting in 2016 at Kalihati sub-district of Tangail District. Our objective was to assess healthcare utilization by the enrolled BPL population and to identify the factors those influencing their utilization of the scheme. Method A cross-sectional household survey was conducted from July to September 2018 in the piloting sub-district. A total of 806 households were surveyed using a semi-structured questionnaire. Information on illness and sources of healthcare service were captured for the last 90 days before the survey. Multiple logistic regression models were applied to determine the factors related to utilization of healthcare from the SSK scheme and other medically trained providers (MTPs) by the SSK members for both inpatient and outpatient care. Result A total of 781 (24.6%) people reported of suffering from illness of which 639 (81.8%) sought healthcare from any sources. About 8.0% (51 out of 639) of them sought healthcare from SSK scheme and 28.2% from other MTPs within 90 days preceding the survey. Households with knowledge about SSK scheme were more likely to utilize healthcare from the scheme and less likely to utilize healthcare from other MTPs. Non-BPL status and suffering from an accident/injury were significantly positively associated with utilization of healthcare from SSK scheme. Conclusion Among the BPL population, healthcare utilization from the SSK scheme was very low compared to that of other MTPs. Effective strategies should be in place for improving knowledge of BPL population on SSK scheme and the benefits package of the scheme should be updated as per the need of the target population. Such initiative can be instrumental in increasing utilization of the scheme and ultimately will reduce the barriers of OOP payment among BPL population for accessing healthcare.
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| 11. |
- Iem, V., et al.
(author)
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Pooled testing of sputum with Xpert MTB/RIF and Xpert Ultra during tuberculosis active case finding campaigns in Lao People's Democratic Republic
- 2022
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In: Bmj Global Health. - : BMJ. - 2059-7908. ; 7:2
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Journal article (peer-reviewed)abstract
- Introduction Active case finding (ACF) of individuals with tuberculosis (TB) is a key intervention to find the 30% of people missed every year. However, ACF requires screening large numbers of individuals who have a low probability of positive results, typically <5%, which makes using the recommended molecular tests expensive. Methods We conducted two ACF surveys (in 2020 and 2021) in high TB burden areas of Lao PDR. Participants were screened for TB symptoms and received a chest X-ray. Sputum samples of four consecutive individuals were pooled and tested with Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) (Xpert-MTB/RIF) (2020) or Xpert-Ultra (2021). The agreement of the individual and pooled samples was compared and the reasons for discrepant results and potential cartridge savings were assessed. Results Each survey included 436 participants, which were tested in 109 pools. In the Xpert-MTB/RIF survey, 25 (sensitivity 89%, 95% CI 72.8% to 96.3%) of 28 pools containing MTB-positive samples tested positive and 81 pools containing only MTB-negative samples tested negative (specificity 100%, 95% CI 95.5% to 100%). In the Xpert-Ultra survey, all 32 (sensitivity 100%, 95% CI 89.3% to 100%) pools containing MTB-positive samples tested positive and all 77 (specificity 100%, 95% CI 95.3% to 100%) containing only MTB-negative samples tested negative. Pooling with Xpert-MTB/RIF and Xpert-Ultra saved 52% and 46% (227/436 and 199/436, respectively) of cartridge costs alone. Conclusion Testing single and pooled specimens had a high level of agreement, with complete concordance when using Xpert-Ultra. Pooling samples could generate significant cartridge savings during ACF campaigns.
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| 12. |
- Iem, V., et al.
(author)
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Pooling samples to increase testing capacity with Xpert Xpress SARS-CoV-2 during the Covid-19 pandemic in Lao People's Democratic Republic
- 2022
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9 September
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Journal article (peer-reviewed)abstract
- The COVID-19 pandemic created the need for large-scale testing of populations. However, most laboratories do not have sufficient testing capacity for mass screening. We evaluated pooled testing of samples, as a strategy to increase testing capacity in Lao PDR. Samples of consecutive patients were tested in pools of four using the Xpert Xpress SARS CoV-2 assay. Positive pools were confirmed by individual testing, and we describe the performance of the test and savings achieved. We also diluted selected positive samples to describe its effect on the assays CT values. 1,568 patients were tested in 392 pools of four. 361 (92.1%) pools were negative and 31 (7.9%) positive. 29/31 (93.5% (95%CI 77-99%) positive pools were confirmed by individual testing of the samples but, in 2/31 (6.5%) the four individual samples were negative, suggesting contamination. Pools with only one positive sample had higher CT values (lower RNA concentrations) than the respective individual samples, indicating a dilution effect, which suggested an increased risk of false negative results with dilutions >1:10. However, this risk may be low if the prevalence of infection is high, when pools are more likely to contain more than one positive sample. Pooling saved 67% of cartridges and substantially increased testing capacity. Pooling samples increased SARS-CoV-2 testing capacity and resulted in considerable cartridge savings. Given the need for high-volume testing, countries may consider implementation of pooling for SARS-CoV-2 screening. © 2022 Iem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 13. |
- Jahangir, Sana, et al.
(author)
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Sensitivity of simulated knee joint mechanics to selected human and bovine fibril-reinforced poroelastic material properties
- 2023
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In: Journal of Biomechanics. - 0021-9290. ; 160
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Journal article (peer-reviewed)abstract
- Fibril-reinforced poroviscoelastic material models are considered state-of-the-art in modeling articular cartilage biomechanics. Yet, cartilage material parameters are often based on bovine tissue properties in computational knee joint models, although bovine properties are distinctly different from those of humans. Thus, we aimed to investigate how cartilage mechanical responses are affected in the knee joint model during walking when fibril-reinforced poroviscoelastic properties of cartilage are based on human data instead of bovine. We constructed a finite element knee joint model in which tibial and femoral cartilages were modeled as fibril-reinforced poroviscoelastic material using either human or bovine data. Joint loading was based on subject-specific gait data. The resulting mechanical responses of knee cartilage were compared between the knee joint models with human or bovine fibril-reinforced poroviscoelastic cartilage properties. Furthermore, we conducted a sensitivity analysis to determine which fibril-reinforced poroviscoelastic material parameters have the greatest impact on cartilage mechanical responses in the knee joint during walking. In general, bovine cartilage properties yielded greater maximum principal stresses and fluid pressures (both up to 30%) when compared to the human cartilage properties during the loading response in both femoral and tibial cartilage sites. Cartilage mechanical responses were very sensitive to the collagen fibril-related material parameter variations during walking while they were unresponsive to proteoglycan matrix or fluid flow-related material parameter variations. Taken together, human cartilage material properties should be accounted for when the goal is to compare absolute mechanical responses of knee joint cartilage as bovine material parameters lead to substantially different cartilage mechanical responses.
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| 15. |
- Smith, Stuart W., et al.
(author)
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Tree species that 'live slow, die older' enhance tropical peat swamp restoration : Evidence from a systematic review
- 2022
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In: Journal of Applied Ecology. - : Wiley. - 0021-8901 .- 1365-2664. ; 59:8, s. 1950-1966
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Research review (peer-reviewed)abstract
- 1. Degraded tropical peatlands lack tree cover and are often subject to seasonal flooding and repeated burning. These harsh environments for tree seedlings to survive and grow are therefore challenging to revegetate. Knowledge on species performance from previous plantings represents an important evidence base to help guide future tropical peat swamp forest (TPSF) restoration efforts.2. We conducted a systematic review of the survival and growth of tree species planted in degraded peatlands across Southeast Asia to examine (1) species differences, (2) the impact of seedling and site treatments on survival and growth and (3) the potential use of plant functional traits to predict seedling survival and growth rates.3. Planted seedling monitoring data were compiled through a systematic review of journal articles, conference proceedings, reports, theses and unpublished datasets. In total, 94 study-sites were included, spanning three decades from 1988 to 2019, and including 141 indigenous peatland tree and palm species. Accounting for variable planting numbers and monitoring durations, we analysed three measures of survival and growth: (1) final survival weighted by the number of seedlings planted, (2) half-life, that is, duration until 50% mortality and (3) relative growth rates (RGR) corrected for initial planting height of seedlings.4. Average final survival was 62% and half-life was 33 months across all species, sites and treatments. Species differed significantly in survival and half-life. Seedling and site treatments had small effects with the strongest being higher survival of mycorrhizal fungi inoculated seedlings; lower survival, half-life and RGR when shading seedlings; and lower RGR and higher survival when fertilising seedlings. Leaf nutrient and wood density traits predicted TPSF species survival, but not half-life and RGR. RGR and half-life were negatively correlated, meaning that slower growing species survived for longer.5. Synthesis and applications. To advance tropical peat swamp reforestation requires expanding the number and replication of species planted and testing treatments by adopting control vs. treatment experimental designs. Species selection should involve slower growing species (e.g. Lophopetalum rigidum, Alstonia spatulata, Madhuca motleyana) that survive for longer and explore screening species based on functional traits associated with nutrient acquisition, flooding tolerance and recovery from fire.
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