Abstract:
Background:Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life-saving critical care interventions in low-resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource-poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective:To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods:The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings:523 patients (median age 25 years, IQR 21-30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 - resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion:With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.
journal_name
Ann Glob Healthjournal_title
Annals of global healthauthors
Marotta C,Di Gennaro F,Pisani L,Pisani V,Senesie J,Bah S,Koroma MM,Caracciolo C,Putoto G,Amatucci F,Borgonovi Edoi
10.5334/aogh.2907subject
Has Abstractpub_date
2020-07-20 00:00:00pages
82issue
1issn
2214-9996journal_volume
86pub_type
杂志文章abstract::Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest global public health challenges. Additionally, secondhand smoke, which was decl...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.5334/aogh.2417
更新日期:2019-01-22 00:00:00
abstract::The article highlights the importance of critically examining medical missions to low-resourced countries in light of a bioethical focus on social justice and the promotion of the common good. ...
journal_title:Annals of global health
pub_type: 评论,社论
doi:10.5334/aogh.2519
更新日期:2019-06-17 00:00:00
abstract::Evidence has accumulated that exposure to widespread environmental toxicants, such as heavy metals, persistent organic pollutants, and tobacco smoke adversely affect fetal development and organ maturation, even after birth. The developing immune and respiratory systems are more sensitive to environmental toxicants due...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.1016/j.aogh.2016.01.023
更新日期:2016-01-01 00:00:00
abstract:Background:As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay. Objectives:We aim to describe th...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2629
更新日期:2019-12-17 00:00:00
abstract:Background:Researchers across the world are emphasising the importance of hand-washing and limited touching of face to curb the spread of COVID-19. However, access to safe water and hygiene is inadequate in many places around the globe; hence T-zone touching restriction is considered more worthwhile compared to other p...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2956
更新日期:2020-07-06 00:00:00
abstract:BACKGROUND:Sub-Saharan Africa (SSA) has one of the highest levels of perinatal mortality globally. However, there are sub-regional and country-specific disparities in its distribution. OBJECTIVE:The aim of this study was to undertake a meta-analysis of demographic and health surveys to quantify perinatal mortality rat...
journal_title:Annals of global health
pub_type: 杂志文章,meta分析
doi:10.5334/aogh.2348
更新日期:2019-07-12 00:00:00
abstract:Background:There is consensus among many medical school deans that exposure to human rights is a necessary component of physician training [78], however little is known about the impact of engagement in human rights programs on students' personal and professional development [1516171819202122232425262728]. Objective:T...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2940
更新日期:2020-10-08 00:00:00
abstract:BACKGROUND:Waste from end-of-life electrical and electronic equipment, known as e-waste, is a rapidly growing global problem. E-waste contains valuable materials that have an economic value when recycled. Unfortunately, the majority of e-waste is recycled in the unregulated informal sector and results in significant ri...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.1016/j.aogh.2014.10.001
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Exposure to contaminant mixtures in developing countries is an important public health issue. Children are identified as the most susceptible group to adverse health effects due to the exposure. OBJECTIVE:The aim of this study was to conduct a screening for mixture pollutants in Mexican children in urban ma...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.29024/aogh.912
更新日期:2018-07-27 00:00:00
abstract:Background:UC San Diego Health System (UCSDHS) is an academic medical center and integrated care network in the US-Mexico border area of California contiguous to the Mexican Northern Baja region. The COVID-19 pandemic deeply influenced UCSDHS activities as new public health challenges increasingly related to high popul...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.3108
更新日期:2021-01-04 00:00:00
abstract:BACKGROUND:In 1977 the World Health Organization created its first Model List of Essential Medicines-a list designed to aid countries in determining which medicines to prioritize on their National Essential Medicines Lists. In classifying drugs as "essential," the World Health Organization has historically stressed dru...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.1016/j.aogh.2017.05.005
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Ethiopia has one of the lowest rates of facility delivery and is promoting birth preparedness among pregnant women through its community health services to increase the rate of institutional delivery and reduce maternal mortality. Observational studies of birth preparedness in Ethiopia have thus far only rep...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.920
更新日期:2019-03-21 00:00:00
abstract:Background:Although the incidence of cervical cancer has declined in developed countries, cervical cancer remains a major problem in those that are developing. Past studies suggest that Indian women, who account for at least one-fourth of the global disease burden, are not routinely screened. Objectives:Among the wome...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2735
更新日期:2020-03-16 00:00:00
abstract:BACKGROUND:Health professionals must be academically and experientially prepared regarding the social determinants of health to reduce health disparities at the global level. The emerging literature reflects a trend for incorporating global health competencies for health care. Specifically, recommendations from the Con...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2456
更新日期:2019-03-19 00:00:00
abstract:BACKGROUND:European asbestos manufacturers and their expert witnesses have advanced the claim that recent exposures to asbestos are not of significance in the causation of malignant mesothelioma. They argue that in cases of prolonged exposure to asbestos only the earliest exposures contribute to mesothelioma induction....
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.1016/j.aogh.2016.01.017
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:In 2012, the Rio+20 meeting initiated the concept of the Sustainable Development Goals (SDGs) as a continuation of the Millennium Development Goals. The resulting document "The Future We Want" is best conceived as a roadmap toward poverty eradication and sustainable development. Although the SDGs were develo...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.1016/j.aogh.2016.10.014
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with d...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2435
更新日期:2019-04-05 00:00:00
abstract:BACKGROUND:Evidence from the developed world associates higher prevalence of hypertension with lower socioeconomic status (SES). However, patterns of association are not as clear in Africa and other developing countries, with varying levels of socioeconomic development and epidemiological transition. Using wealth and e...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2404
更新日期:2019-03-05 00:00:00
abstract:Background:Communication about climate change is critical in addressing the greatest public health challenge of our time. Public health professionals must convey the human implications of climate change and educating populations regarding climate change as a threat to the health and wellbeing of people globally. Effect...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2900
更新日期:2020-05-22 00:00:00
abstract::The research literature discusses two opposite hypotheses regarding the possible effects of healthcare quality on the willingness to pay more taxes to improve public healthcare. One hypothesis theorizes that a lower quality of public healthcare may weaken the willingness to pay more taxes towards improving it. Another...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2462
更新日期:2019-11-07 00:00:00
abstract:BACKGROUND:The Lancet Commission on Global Surgery includes obstetrics and gynecology as an area needing international strengthening in low- and middle-income countries. Despite interest, a majority of participants in US residency programs graduate with little exposure to global health or preparation to work abroad. O...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.1016/j.aogh.2016.09.004
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and insufficient human resource capacity is among the contributing factors. Thus, a critical component of hypertension management is to develop novel and effective solutions to the human ...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.1016/j.aogh.2013.12.002
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world. OBJECTIVE:The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of heal...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.1016/j.aogh.2016.01.002
更新日期:2015-11-01 00:00:00
abstract:Background:Healthcare equipment funded by international partners is often not properly utilized in many developing countries due to low levels of awareness and a lack of expertise. A long-term on-site training program for laparoscopic surgery was established at a regional hospital in Ghana upon request of the Ghana Hea...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2957
更新日期:2020-07-30 00:00:00
abstract:BACKGROUND:Viral hepatitis B is a disease condition of the liver caused by the hepatitis B virus, and it leads to complications such as cancer and cirrhosis. This poses an occupational hazard because about 66,000 health care workers get infected with the virus annually. Adequate knowledge and right attitude of health w...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.750
更新日期:2019-02-28 00:00:00
abstract:BACKGROUND:Chile has recently been reclassified by the World Bank from an upper-middle-income country to a high-income country. There has been great progress in the last 20 to 30 years in relation to air and water pollution in Chile. Yet after 25 years of unrestrained growth, there remain clear challenges posed by air ...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.1016/j.aogh.2015.06.008
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Western Asia comprises a large proportion of the world population with different ethnicities and religions inhabiting areas of diverse geographic features. The countries of this region have experienced rapid economic growth over the latter half of the 20th century, which continues to this day, resulting in m...
journal_title:Annals of global health
pub_type: 杂志文章,评审
doi:10.1016/j.aogh.2014.09.012
更新日期:2014-09-01 00:00:00
abstract:Background:Until recently, Colombia has been a country actively using asbestos. A major factory in Bogota manufactures friction products. Objective:To determine if the use of chrysotile asbestos in a friction products facility leads to workers developing disease. Methods:One hundred forty-eight factory workers, forme...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2634
更新日期:2020-01-03 00:00:00
abstract:Background:Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives:This systematic review, con...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.2592
更新日期:2019-10-23 00:00:00
abstract::The proposed viewpoint seems important at this time of the COVID-19 pandemic. Indeed, the COVID-19 prevention strategies implemented in the population are based on medical paradigms that generate extremely deleterious social and environmental impacts. Using the occupational health and safety perspective - taking care ...
journal_title:Annals of global health
pub_type: 杂志文章
doi:10.5334/aogh.3104
更新日期:2020-11-02 00:00:00