David Reeve

Cost-effectiveness of respiratory syncytial virus prophylaxis with palivizumab

Background:  A monoclonal antibody, palivizumab, directed against respiratory syncytial virus (RSV) has been shown to decrease hospitalisation rates. Because of its expense, the cost‐effectiveness of this agent should be determined for high‐risk groups.

Predicting respiratory syncytial virus hospitalisation in Australian children.

Background:  There is limited information on respiratory syncytial virus infections among Australians, particularly those of Indigenous descent.

Lymphatic filariasis in Papua New Guinea: distribution at district level and impact of mass drug administration, 1980 to 2011

BackgroundLymphatic filariasis (LF) caused by Wuchereria bancrofti is present at high prevalence in some parts of Papua New Guinea. However, there has been no rigorous data-based representative assessment of nationwide prevalence of LF. The LF programme has been daunted by the scope of the problem, and progress on mass drug administration (MDA) has been slow and lacking in resources.MethodsA systematic literature review identified LF surveys in Papua New Guinea between 1980 and 2011. Results were extracted by location, time period and test used (blood slide, immunochromatographic test (ICT) or Og4C3 ELISA) and combined by district. Three criteria schemes based on the Global Programme to Eliminate Lymphatic Filariasis guidelines, with modifications, were developed to classify and prioritize districts by prevalence level. Results of repeated surveys in the same sites were used to investigate the impact of MDA on LF prevalence over the time period.ResultsThere were 312 distinct survey sites identified in 80 of the 89 districts over the 31-year period. The overall LF prevalence in the sites tested was estimated at 18.5 to 27.5% by blood slide for microfilariae (Mf), 10.1% to 12.9% by ICT and 45.4% to 48.8% by Og4C3. Biases in site selection towards areas with LF, and change in type of assay used, affected the prevalence estimates, but overall decline in prevalence over the time period was observed. Depending on the criteria used, 34 to 36 districts (population 2.7 to 2.9 million) were classed as high endemic (≥5% prevalence), 15 to 25 districts (1.7 to 1.9 million) as low endemic (<5%) and 20 to 31 (1.3 to 2.2 million) as non-endemic. Nine districts (0.7 million) had no information. The strong impact of MDA, especially on microfilaria (Mf) prevalence, was noted in sites with repeat surveys.ConclusionsThis analytical review of past surveys of LF in Papua New Guinea enables better estimation of the national burden, identifies gaps in knowledge, quantifies and locates the population at risk, and can be used to predict the likely impact of MDA and/or vector control. Better targeting of districts by level of prevalence will strengthen the control programme, facilitate monitoring of the disease trend and increase the likelihood of reaching the target of LF elimination by 2020.

Strengthening primary health care: achieving health gains in a remote region of Australia.

Objective: To evaluate the impact of a comprehensive primary health care service model on key health performance indicators in a remote region of Australia.

Evaluation of an ear health pathway in remote communities: Improvements in ear health access

OBJECTIVE Reduce long waiting lists for ear, nose and throat (ENT) specialist review and improve primary ear health care. DESIGN A retrospective evaluation of ear health care after the implementation of an ear health program (EHP). SETTING AND PARTICIPANTS School children in Aboriginal communities in the Fitzroy Valley of Western Australia. KEY MEASURES FOR IMPROVEMENT Access number of children screened for ear disease, effectiveness-referral letter completeness (history, otoscopy, tympanometry, audiometry), patient management and waiting time until first ENT contact. INTERVENTIONS EHP--an electronic referral template, ear health nurse, ear health educator and telehealth ENT specialist review. MAIN OUTCOME MEASURES Screening rates, timely ENT review and improved primary care management. RESULTS Number of children screened increased from 148 per 18 months to 710. Nearly twofold increase in numbers of patients referred to ENT (32, 66). A reduction in median waiting time from 141 days to 22 days for ENT review using telehealth. Content of referral letters showed an increase in essential information--otoscopy, audiometry and tympanometry. Primary care management in accordance with guidelines improved. CONCLUSIONS The addition of an ear health team increased access to appropriate primary care management and the time to contact with ENT was reduced by using an electronic template and telehealth sessions.

Short Communication: A Simple Method for Performing Worm-Egg Counts on Sodium Acetate Formaldehyde-Preserved Samples

The Kato Katz method is the most common way of performing worm-egg counts on human faecal samples, but it must be done in the field using freshly collected samples. This makes it difficult to use in remote, poorly accessible situations. This paper describes a simple method for egg counts on preserved samples collected in the field and sent to a central location for further processing.

Community outreach midwifery‐led model improves antenatal access in a disadvantaged population

OBJECTIVE This study aimed to assess the impact of a new model of antenatal care for women living in a very remote area. DESIGN This is a retrospective 2-year evaluation of antenatal care. SETTING AND PARTICIPANTS Two hundred thirteen pregnant women in Aboriginal communities in the Fitzroy Valley of Western Australia participated in this study. INTERVENTION The implementation of a midwifery-led interdisciplinary model of antenatal outreach care. MAIN OUTCOME MEASURES The indicators measured were numbers of antenatal visits, their location and quality care indicators (presentation in first trimester, alcohol and smoking, ultrasound and blood-borne virus screening) and outcome indicators (birth weight, prematurity, in utero deaths and mode of delivery). RESULTS There was an increase in access to antenatal care and improvements in quality-of-care indicators. The proportion of visits provided in local Aboriginal communities increased from 10% to 24%. There were statistically significant increases in women presenting in the first trimester (40-58%), screening for alcohol and smoking (48-93%) and having an ultrasound in pregnancy (59-94%). There were no significant improvements in neonatal outcome indicators. CONCLUSION There is a large disparity in maternal and child health outcomes between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous Australians thought to be due to decreased access to antenatal care, poorer socioeconomic status and the associated risk factors. The change in model of care resulted in earlier presentation for antenatal care, increased numbers of antenatal visits and increased screening for risk factors. Regular auditing of services enables the identification of opportunity for improvement with the goal of improving health outcomes.Objective This study aimed to assess the impact of a new model of antenatal care for women living in a very remote area. Design This is a retrospective 2-year evaluation of antenatal care. Setting and participants Two hundred thirteen pregnant women in Aboriginal communities in the Fitzroy Valley of Western Australia participated in this study. Intervention The implementation of a midwifery-led interdisciplinary model of antenatal outreach care. Main outcome measures The indicators measured were numbers of antenatal visits, their location and quality care indicators (presentation in first trimester, alcohol and smoking, ultrasound and blood-borne virus screening) and outcome indicators (birth weight, prematurity, in utero deaths and mode of delivery). Results There was an increase in access to antenatal care and improvements in quality-of-care indicators. The proportion of visits provided in local Aboriginal communities increased from 10% to 24%. There were statistically significant increases in women presenting in the first trimester (40–58%), screening for alcohol and smoking (48–93%) and having an ultrasound in pregnancy (59–94%). There were no significant improvements in neonatal outcome indicators. Conclusion There is a large disparity in maternal and child health outcomes between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous Australians thought to be due to decreased access to antenatal care, poorer socioeconomic status and the associated risk factors. The change in model of care resulted in earlier presentation for antenatal care, increased numbers of antenatal visits and increased screening for risk factors. Regular auditing of services enables the identification of opportunity for improvement with the goal of improving health outcomes.