Maria Regina Fernandes de Oliveira

Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

BackgroundIn areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective.MethodThe cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters.ResultsIn the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy.ConclusionMicroscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

Serological diagnosis of canine visceral leishmaniasis in Brazil: systematic review and meta‐analysis

BackgroundAlthough G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review.MethodsA systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent.ResultsThe Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent.ConclusionHaemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.

Estudo evolutivo da leishmaniose mucosa (7 a 17 anos de seguimento) causada por Leishmania (Viannia ) braziliensis em Três Braços, Bahia

To evaluate the quality and accuracy of serological diagnosis of canine visceral leishmaniasis in the Americas.

Severe forms of schistosomiasis mansoni: epidemiologic and economic impact in Brazil, 2010

Seventy seven (68%) patients with mucosal leishmaniasis recorded during the period 1976- 1986 in the region of Tres Bracos, Bahia were traced and re-evaluated clinically, diagnostically and therapeutically. Sixty-five patients were alive. The families of 12 dead patients were interviewed about probable cause of death. The 65 patients had a fresh clinical examination supplemented when necessary by a skilled ENT examination. All had a titre of circulating immunofluorescent antibodies estimated at the time. Eight patients with active mucosal lesions had triturated biopsies which were cultivated in NNN medium and inoculated in hamsters to attempt to recover Leishmania. The isolates were identified by monoclonal antibodies as Leishmania (Viannia) braziliensis. Fifty-six (86%) patients were judged clinically cured. Nine (13%) bad active lesions. Of the 12 patients who died 5 (41%) had no signs of activity at death. Mucosal leishmaniasis was thought to be the direct cause of death in 3 patients. The field treatment programme at Tres Bracos has managed to clinically cure 61 patients (79%) during 17 years. Follow-up periods were a mean of 10 years (range 7-17).

Validity and Reliability of Enzyme Immunoassays Using Leishmania major or L. infantum Antigens for the Diagnosis of Canine Visceral Leishmaniasis in Brazil

BACKGROUND Schistosoma mansoni infection is generally asymptomatic at the initial stage. However, patients left untreated can develop severe, potentially fatal clinical disease. In Brazil, S. mansoni transmission occurs in 19 states and, despite the contribution of infection to the cycle of poverty and disease, the economic impact of severe cases is unclear. Our objectives were to estimate the epidemiological burden and the costs of severe stages of S. mansoni in Brazil in 2010. METHODS We conducted an epidemiologic descriptive study and a partial economic evaluation of cost-of-illness. The study population was identified from records of notifications, hospitalizations and deaths related to S. mansoni in the respective information systems. RESULTS The mortality rate for S. mansoni was 0.3 deaths per 100 000 population, which represented 1.1% of the deaths in Brazil from infectious diseases listed in Chapter I of the International Statistical Classification of Disease and Related Health Problems, 10(th) revision (ICD 10), and almost 9.0% of deaths from infection diseases in the state of Pernambuco. We calculated 6419 potential years of life lost (PYLL) to S. mansoni. The costs estimated within the public health sector totaled R

QUADAS e STARD: avaliação da qualidade de estudos de acurácia de testes diagnósticos

889 049.58 (US

Validation of the rapid test Carestart(tm) G6PD among malaria vivax-infected subjects in the Brazilian Amazon.

495 016.47) and the costs of productivity losses reached R

Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

35 725 332.72 (US

G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: a cost study

19 891 590.86) in terms of salaries lost as a result of premature death or absence from work. The cost-of-illness related to S. mansoni in Brazil was R