Hasil untuk "Arctic medicine. Tropical medicine"

P. Hotez, S. Brooker, J. Bethony et al.

G. Tawfik, K. A. S. Dila, M. Mohamed et al.

BackgroundThe massive abundance of studies relating to tropical medicine and health has increased strikingly over the last few decades. In the field of tropical medicine and health, a well-conducted systematic review and meta-analysis (SR/MA) is considered a feasible solution for keeping clinicians abreast of current evidence-based medicine. Understanding of SR/MA steps is of paramount importance for its conduction. It is not easy to be done as there are obstacles that could face the researcher. To solve those hindrances, this methodology study aimed to provide a step-by-step approach mainly for beginners and junior researchers, in the field of tropical medicine and other health care fields, on how to properly conduct a SR/MA, in which all the steps here depicts our experience and expertise combined with the already well-known and accepted international guidance.We suggest that all steps of SR/MA should be done independently by 2–3 reviewers’ discussion, to ensure data quality and accuracy.ConclusionSR/MA steps include the development of research question, forming criteria, search strategy, searching databases, protocol registration, title, abstract, full-text screening, manual searching, extracting data, quality assessment, data checking, statistical analysis, double data checking, and manuscript writing.

Frank J. Bia

The very first edition of this classic text in tropical diseases appeared in 1898 under the authorship of the legendary "father of tropical medicine," Sir Patrick Manson, who nurtured this book through six editions until his death in 1922. For over eighty years students of tropical diseases have turned to its previous editions to familiarize themselves with these important disease entities. The eighteenth edition promises once again to serve that purpose admirably. As the editors indicate in their preface, the 1982 edition contains substantially new or rewritten sections on haemoglobinopathies, animal poisons, ophthalmology in the tropics, drugs, and medical entomology. They are timely and welcome additions. The book itself is compact, readily transportable to remote areas, and thoroughly readable. Many excellent diagrams, charts, and photographs are retained from the previous editions and bear historical witness to the advances of twentieth-century tropical medicine. I can think of no more enjoyable way to foray into this wealth of material. However, in reviewing this latest edition of Manson's Tropical Diseases I found myself increasingly concerned about the ability of this edition to transmit the advances made in the immunology, diagnosis, and treatment of these diseases. This task demands updating and revisions for nearly every chapter in a text whose last edition appeared ten years ago. In chapter 31, on lymphogranuloma venereum, I was surprised to find it still referred to as a "generalized viral infection" when it is now known to be associated with distinct strains of Chlamydia, which are not viruses. The discussion of hepatitis barely covers three pages, with hepatitis B receiving a few cursory paragraphs in which there is no mention of its relation to hepatocellular carcinoma, a topic of particular relevance to workers in developing tropical countries. Non-A, non-B hepatitis receives ten lines, and the reader is referred to a 1978 editorial in the British Medical Journal for review. The reader is often referred to primary sources for additional material but this could place the text in an awkward position. Whereas Man-son's Tropical Diseases is an excellent historical introduction and reference work, it is in danger of losing practical relevance for workers in the tropics who require the presentation of fairly current material without the need to refer to primary sources which are often expensive and unavailable. Manson's Tropical Diseases should not be allowed to go that route. It is a priceless resource, having been there at the beginning, …

Shinjini Bandopadhyay, Sujata Mandal, Mimosa Ghorai et al.

Centella asiatica is an ethnomedicinal herbaceous species that grows abundantly in tropical and sub‐tropical regions of China, India, South‐Eastern Asia and Africa. It is a popular nutraceutical that is employed in various forms of clinical and cosmetic treatments. C. asiatica extracts are reported widely in Ayurvedic and Chinese traditional medicine to boost memory, prevent cognitive deficits and improve brain functions. The major bioactive constituents of C. asiatica are the pentacyclic triterpenoid glycosides, asiaticoside and madecassoside, and their corresponding aglycones, asiatic acid and madecassic acid. Asiaticoside and madecassoside have been identified as the marker compounds of C. asiatica in the Chinese Pharmacopoeia and these triterpene compounds offer a wide range of pharmacological properties, including neuroprotective, cardioprotective, hepatoprotective, wound healing, anti‐inflammatory, anti‐oxidant, anti‐allergic, anti‐depressant, anxiolytic, antifibrotic, antibacterial, anti‐arthritic, anti‐tumour and immunomodulatory activities. Asiaticoside and madecassoside are also used extensively in treating skin abnormalities, burn injuries, ischaemia, ulcers, asthma, lupus, psoriasis and scleroderma. Besides medicinal applications, these phytocompounds are considered cosmetically beneficial for their role in anti‐ageing, skin hydration, collagen synthesis, UV protection and curing scars. Existing reports and experimental studies on these compounds between 2005 and 2022 have been selectively reviewed in this article to provide a comprehensive overview of the numerous therapeutic advantages of asiaticoside and madecassoside and their potential roles in the medical future.

Katherine Snyman, Walter Ochieng, Sam Gonahasa et al.

Abstract Background Innovative, equitable, and sustainable multisectoral solutions are required to address persistently high global malaria deaths, widespread insecticide and antimalarial resistance, and falling funding for malaria control. Housing modification presents a promising option. Alongside a cluster-randomized control trial in Eastern Region, Uganda, we analysed the costs and households’ willingness to pay (WTP) for two housing modification interventions, screening and eave tubes, focusing on equity and scale-up potential. Methods Taking a disaggregated societal perspective, we assessed financial and economic costs of installing two housing modification interventions in approximately 4000 homes (20000 people). We collected WTP data through three cross-sectional household surveys (n = 1500 households each) using modified structured haggling and calculated price elasticity of demand. We used multivariable regressions and concentration indices to analyse how costs and WTP varied by household characteristics. To identify potential financing gaps, we compared WTP to costs and examined variation by household wealth quintiles. Results Screening cost a mean of $116 (societal economic costs; 95%CI $112–120) United States Dollars (2022 USD) per house; eave tubes cost $50 (95%CI $48–52). When annualized over 5 years, screening cost $4.22 per person protected per year and eave tubes cost $3.03. Installation cost more in the wealthiest versus poorest quintiles for both screening ($151 vs $69) and eave tubes ($95 vs $31). Over 75% of respondents were willing to pay something for the interventions, but these values represented only a small fraction of the costs, with a higher fraction in the wealthiest vs poorest quintiles (screening: 12% vs 7%; eave tubes: 18% vs 14%). Conclusions While housing modification has relatively high upfront costs, its annual cost per person protected is comparable to other malaria interventions. Households, especially the poorest, are unwilling or unable to pay the full cost of housing modifications. Equitable scale-up would require additional financing and/or demand-boosting interventions. Trial Registration: NCT04622241 (clinicaltrials.gov).

Norman L. Beatty, Catalina Arango-Ferreira, Lídia Gual-González et al.

Chagas disease (CD) remains endemic throughout many regions of Colombia despite implementing decades of vector control strategies in several departments. Some regions have had a significant decrease in vectorial transmission, but the oral ingestion of Trypanosoma cruzi through consumption of contaminated food and drink products is increasingly described. This form of transmission has important public health relevance in Colombia due to an increase in reported acute CD cases and clinical manifestations that often lead to significant morbidity and mortality. Oral CD in Colombia has been associated with the consumption of contaminated fruit juices, such as palm wine, sugar cane, or tangerine juice and water for consumption, or contaminated surfaces where food has been prepared. Another interesting route of oral transmission includes ingestion of unbeknownst infected armadillos’ blood, which is related to a traditional medicine practice in Colombia. Some earlier reports have also implemented consumption of infected bush meat as a source, but this is still being debated. Within the Amazon Basin, oral transmission is now considered the principal cause of acute CD in these regions. Furthermore, new cases of acute CD are now being seen in departments where CD has not been documented, and triatomine vectors are not naturally found, thus raising suspicion for oral transmission. The oral CD could also be considered a food-borne zoonosis, and odoriferous didelphid secretions have been implemented in contaminating the human dwelling environment, increasing the risk of consumption of infectious metacyclic trypomastigotes. In this article, we will discuss the complex transmission dynamics of oral CD in Colombia and further examine the unique clinical manifestations of this route of infection. New insights into the oral transmission of Trypanosoma cruzi are being discovered in Colombia, which can help bring increased awareness and a better understanding of this neglected tropical disease to reduce the burden of CD throughout Latin America.

N. Astman, Chen Arbel, Oren Katz et al.

Miltefosine, an orally administered drug, is an important component of the therapeutic arsenal against visceral and mucosal forms of leishmaniasis. However, data regarding the safety and tolerability of miltefosine treatment for cutaneous leishmaniasis (CL) are relatively limited. The aim of this study was to evaluate the tolerability, safety, and adverse events (AEs) of miltefosine treatment in patients with CL. In this cohort study, we reviewed the medical records of all miltefosine-treated patients between 1 January 2016 and 31 December 2022, at Israel Defense Forces military dermatology clinics and the dermatology and Tropical Medicine Clinics at Chaim Sheba Medical Center, Ramat-Gan, Israel. A total of 68 patients (54 males, 79%) with a median age of 30.3 ± 15.6 years (range: 18–88) were included in this study. Leishmania species were identified as L. major (n = 37, 54.4%), L. tropica (n = 12, 17.6%), L. braziliensis (n = 18, 26.5%), and L. infantum (n = 1, 1.5%) using polymerase chain reaction (PCR). Miltefosine tablets were administered orally at a dose of 50 mg, three times daily, for 28 days. Overall, 44 patients (65%) completed the 28-day treatment, and the remaining patients required dose reduction or early discontinuation of treatment. AEs (of any degree) were common, reported in 91% of patients. Both previously reported and previously unreported AEs were documented. Gastrointestinal symptoms (66.1%) and malaise (23.5%) typically occurred during the first two weeks of treatment and tended to subside. Other AEs, including acute renal failure (20.6%), sudden and severe pleuritic chest pain (7.6%), acne exacerbation (11.8%), suppuration of CL lesions (17.8%), and AEs related to the male genitourinary system (39.6% of males), typically occurred towards the end of treatment. The latter included testicular pain, epididymitis, diminution or complete absence of ejaculate, inability to orgasm, and impotence. Severe AEs necessitated treatment discontinuation (29.4%) or hospitalization (10.3%). URTI-like symptoms, arthritis, cutaneous eruption, pruritus, and laboratory abnormalities were also observed. Overall, the cure rate (for all patients combined) evaluated 3 months after the completion of treatment was 60%. The tolerability of miltefosine treatment for CL is low. Close clinical and laboratory monitoring is required during treatment, as severe AEs are not uncommon. As new insights regarding its toxicities emerge, further studies are required to define the role of miltefosine in the treatment of CL.

Amy Caughey, Pitsiula Kilabuk, Theresa Koonoo et al.

Indigenous knowledge is central to understanding environment and health sciences in the Arctic, yet limited research in these fields has explored the human–animal–environment interface from the unique perspectives of Inuit women. Using a community-led, Inuit-centred research approach, we characterized the use and meaning of country food in the context of community well-being for Inuit women in Nunavut, Canada. In-depth conversational interviews and focus groups ( n = 16) were held with Inuit women ( n = 10) who are knowledge holders in the Qikiqtani region that hold decades of country food knowledge. Data were analyzed using thematic analysis and constant comparative methods. Inuit women described country food in the context of (1) well-being, connection, and identity, (2) hunger, craving, and healing, (3) food security and nourishment, and (4) change and adaptation. Inuit women described a wide range of country food as central to physical and mental health, food security, identity, culture, healing and medicine. Adaptive strategies were discussed, such as eating more fish when caribou were scarce. This research highlights the critical role of country food for health and well-being for Inuit women and shares knowledgeand perspective that is relevant to wildlfe and environment researchers, public health practitioners, policy makers, and others interested in advancing health, well-being, and food sovereignty in Inuit communities.

Nattachai Srisawat, Duane J. Gubler, T. Pangestu et al.

The 6th Asia Dengue Summit (ADS) themed “Road Map to Zero Dengue Death” was held in Thailand from 15th–16th June 2023. The summit was hosted by Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand in conjunction with Queen Saovabha Memorial Institute, The Thai Red Cross Society; Faculty of Tropical Medicine, Mahidol University; and the Ministry of Public Health. The 6th ADS was convened by Asia Dengue Voice and Action (ADVA); Global Dengue and Aedes Transmitted Diseases Consortium (GDAC); Southeast Asian Ministers of Education Tropical Medicine and Public Health Network (SEAMEO TROPMED); Fondation Mérieux (FMx) and the International Society for Neglected Tropical Diseases (ISNTD). Dengue experts from academia and research, and representatives from the Ministries of Health, Regional and Global World Health Organization (WHO) and International Vaccine Institute (IVI) participated in the three-day summit. With more than 51 speakers and 451 delegates from over 24 countries, 10 symposiums, and 2 full days, the 6th ADS highlighted the growing threat of dengue and its antigenic evolution, flagged the urgent need to overcome vaccine hesitancy and misinformation crisis, and focused on dengue control policies, newer diagnostics, therapeutics and vaccines, travel-associated dengue, and strategies to improve community involvement.

Santiago Manrique-Castaño, Luis Armando Velásquez-Trujillo, Mariana Ángel Correa et al.

La mucormicosis es una infección fúngica poco frecuente causada por hongos del orden Mucorales, la cual se presenta en individuos inmunocomprometidos o con pérdida de la integridad de la barrera de piel o mucosas. Se reportan cuatro casos de mucormicosis rinocerebral atendidos en un hospital de tercer nivel de Cali (Colombia) durante un periodo de tres años. Los cuatro pacientes presentaron diferentes cuadros clínicos y tiempos de evolución. Todos tenían diagnóstico de diabetes mellitus de tipo 2, de novo o previo, con una hemoglobina glucosilada de ingreso mayor del 10 % y en todos se descartaron otras enfermedades que explicaran su compromiso inmunitario. La mucormicosis se diagnosticó por la visualización directa de hifas hialinas sincitiales (coenocytic) en las biopsias tomadas. El pilar del tratamiento fue la anfotericina B liposómica junto con el desbridamiento quirúrgico. Dos pacientes presentaron coinfección bacteriana. De los cuatro, uno firmó su egreso voluntario sin completar el tratamiento y otro falleció. Los dos pacientes restantes han asistido a los controles y han mostrado una adecuada evolución.

Claudia Colomba, Chiara Albano, Giovanni Boncori et al.

Tibeso Gemechu, Teferi Eshetu, Tesfaye Kassa et al.

Background. Food-borne infections are common public health problems worldwide. A street food handler with poor personal hygiene contributes to the transmission of intestinal parasites and enteric bacteria to the public via contaminated foods. In Ethiopia, health risks associated with street food are common. Previous studies in this area are scanty. Hence, the aim of this study was to determine the prevalence of intestinal parasites, enteric bacterial infections, and antimicrobial susceptibility among street food handlers in Jimma town. Methods. A cross-sectional study was conducted from October to December 2020 among 260 street food handlers in Jimma town. A semi-structured questionnaire was used to collect data through face-to-face interviews. About 3 grams of the fecal specimen were collected from each food handler for bacterial culture and concentration techniques. The data were entered into Epi-Data 3.1 and analyzed by SPSS version 20. Associated factors were identified by using binary logistic regression analysis. A statistically significant association was determined at a p-value less than 0.05. Results. The overall prevalence of intestinal parasites and enteric bacterial pathogens was 39.2% (33.3%–45.2%) and 8.85% (5.4%–12.3%), respectively. Ascaris lumbricoides (18.5%) and Salmonella (8.1%) were the most predominant parasite and enteric bacterial isolates, respectively. Not trimming fingernails (AOR = 2.884; 95% CI: 1.682–4.945) and not washing hands with soap after toilet (AOR = 3.342; 95% CI: 1.939–5.761) were factors associated with increased risk of infection by intestinal parasites or enteric bacterial pathogens. All Salmonella and Shigella isolates were 100% resistant to ampicillin. Conclusion. The infection with intestinal parasites and enteric bacterial pathogens detected in this study indicated that street food handlers may serve as sources of pathogens/parasites for transmission and experience morbidities due to the infections. Therefore, periodic medical checkups and creating awareness of personal hygiene are mandatory to reduce the risk of infections.

J. Gutiérrez, J. Chippaux, G. Isbister

Envenomings from animal bites and stings are particularly frequent in developing countries where they dramatically affect the most deprived populations. A wide variety of animals from different taxa synthesize and inject venoms either as a trophic mechanism to subdue and digest prey or as a defense against predators and other enemies. These toxic secretions can also be injected into humans or domestic animals and significantly impact human and veterinary health. Bites by venomous snakes cause 1.8 to 2.7 million cases of envenomings every year, with 81,000 to 138,000 fatalities, and, possibly, leaving more people with permanent physical and psychological sequelae [1]. This burden of illness largely occurs in impoverished rural populations in sub-Saharan Africa, Asia, and Latin America. In addition, snakebite has a heavy socioeconomic impact, because it predominantly affects the young working population in lowand middle-income countries [2]. For these reasons, snakebite envenoming is included in the list of neglected tropical diseases of the World Health Organization. As one of the foremost journals in tropical medicine and neglected tropical diseases, PLOS Neglected Tropical Diseases has regularly published contributions on various aspects of snakebite and snake envenoming for over a decade. However, envenoming by animal bites and stings goes beyond snakebite and includes scorpions and spiders, insects, jellyfish, and other marine creatures. Scorpion stings cause severe and potentially fatal envenoming that mainly affects children in regions of Africa, Asia, and Latin America [3]. Scorpion sting envenoming shares many of the features that characterize neglected tropical diseases, because it disproportionately affects families in resource-poor regions of the world, which usually lack access to medical facilities. Spider bite is also a significant problem in many parts of the world, with bites from widow spiders causing a painful neurotoxic envenoming syndrome (latrodectism) that occurs worldwide and cutaneous and systemic loxoscelism that can result in necrotic ulcers and haemolytic and renal complications [4]. Other arthropods can also inflict systemic envenoming, ranging from caterpillar envenoming in South America, massive bee attacks associated with potentially fatal multi-organ injury, and tick envenoming that can result in paralysis. Marine envenoming is rarely fatal, but jellyfish stings cause thousands of cases each year in many parts of the world. To broaden the coverage of a variety of conditions that share the features of currently recognized neglected tropical diseases, PLOS Neglected Tropical Diseases will accept manuscripts dealing with scorpion sting envenoming, in addition to snakebite envenoming. Moreover, it will consider manuscripts on envenomings by other animals, especially if the studies deal with epidemiological, clinical, therapeutic, social science, and/or public policy aspects. Studies on

Ana Villegas-Mendez, Nicholas Stafford, Michael J. Haley et al.

Abstract Background Recent genome wide analysis studies have identified a strong association between single nucleotide variations within the human ATP2B4 gene and susceptibility to severe malaria. The ATP2B4 gene encodes the plasma membrane calcium ATPase 4 (PMCA4), which is responsible for controlling the physiological level of intracellular calcium in many cell types, including red blood cells (RBCs). It is, therefore, postulated that genetic differences in the activity or expression level of PMCA4 alters intracellular Ca2+ levels and affects RBC hydration, modulating the invasion and growth of the Plasmodium parasite within its target host cell. Methods In this study the course of three different Plasmodium spp. infections were examined in mice with systemic knockout of Pmca4 expression. Results Ablation of PMCA4 reduced the size of RBCs and their haemoglobin content but did not affect RBC maturation and reticulocyte count. Surprisingly, knockout of PMCA4 did not significantly alter peripheral parasite burdens or the dynamics of blood stage Plasmodium chabaudi infection or reticulocyte-restricted Plasmodium yoelii infection. Interestingly, although ablation of PMCA4 did not affect peripheral parasite levels during Plasmodium berghei infection, it did promote slight protection against experimental cerebral malaria, associated with a minor reduction in antigen-experienced T cell accumulation in the brain. Conclusions The finding suggests that PMCA4 may play a minor role in the development of severe malarial complications, but that this appears independent of direct effects on parasite invasion, growth or survival within RBCs.

Silvia D’Andretta Iglezias, Patrícia Antonia Estima Abreu, Cristina Kanamura et al.

ABSTRACT Leptospirosis is an acute infection caused by pathogenic species of the genus Leptospira, which affects humans and animals in all world. In severe forms of the disease, kidneys, liver and lungs are the main affected organs, resulting in acute kidney injury, jaundice and pulmonary hemorrhage. Previous post-mortem studies have shown that lesions are not limited to these organs. Cardiac and striated muscle injuries have already been reported, but the pathophysiology of cardiac and skeletal lesions in leptospirosis is not fully understood. It has been suggested that the tissue damage observed in leptospirosis could be directly mediated by leptospires or by their toxic cellular components. LipL32 and Lp25 are leptospira membrane proteins with unknown functions, that are present only in pathogenic strains of Leptospira spp. Both proteins induce skeletal muscle lesions similar to those observed when normal guinea pigs are inoculated with leptospires. Through immunohistochemistry, this study showed the presence of LipL32 and Lp25 proteins on muscle cell membranes and in the underlying cytoplasm of skeletal muscles, as well as focal lesions in cardiac tissues of fatal cases of leptospirosis. Altogether, these results reinforce that both proteins can be important factors in the pathogenesis of leptospirosis.

Hari Mohan Saxena, Sugandha Raj

Brucellosis is an important zoonotic disease causing huge economic losses worldwide. Currently no effective immunotherapy for Brucellosis or any biomarker to monitor the efficacy of therapy is available. Treatment is ineffective and animals remain carrier lifelong. S19 and RB51 are live attenuated vaccine strains of Brucella abortus. However, S19 induces only antibody, ineffective for intracellular pathogen. RB51 induces cell mediated immunity (CMI) but it is Rifampicin resistant. Both organisms are secreted in milk and can infect humans and cause abortions in animals. Phage lysed bacteria (lysates) retain maximum immunogenicity as opposed to killing by heat or chemicals. We report here the successful immunotherapy of bovine Brucellosis by phage lysates of RB51 (RL) and S19 (SL). The SL induced strong antibody response and RL stimulated CMI. In vitro restimulation of leukocytes from RL immunized cattle induced interferon gamma production. A single subcutaneous dose of 2 ml of cocktail lysate (both RL and SL), eliminated live virulent Brucella from Brucellosis affected cattle with plasma level of Brucella specific 223 bp amplicon undetectable by RT-PCR and blood negative for live Brucella by culture in 3 months post-immunization. This is the first report on minimally invasive monitoring of the efficacy of antibacterial therapy employing plasma RNA specific for live bacteria as a biomarker as well as on the use of RB51 phage lysate for successful immunotherapy of Brucellosis in cattle.

P. Smit, I. Elliott, R. Peeling et al.

Tropical infectious diseases diagnosis and surveillance are often hampered by difficulties of sample collection and transportation. Filter paper potentially provides a useful medium to help overcome such problems. We reviewed the literature on the use of filter paper, focusing on the evaluation of nucleic acid and serological assays for diagnosis of infectious diseases using dried blood spots (DBS) compared with recognized gold standards. We reviewed 296 eligible studies and included 101 studies evaluating DBS and 192 studies on other aspects of filter paper use. We also discuss the use of filter paper with other body fluids and for tropical veterinary medicine. In general, DBS perform with sensitivities and specificities similar or only slightly inferior to gold standard sample types. However, important problems were revealed with the uncritical use of DBS, inappropriate statistical analysis, and lack of standardized methodology. DBS have great potential to empower healthcare workers by making laboratory-based diagnostic tests more readily accessible, but additional and more rigorous research is needed.

C. Fitzpatrick, F. Fleming, M. Madin-Warburton et al.

Background Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked. Methods We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks. Results We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher. Discussion The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.

E. Puca, A. Pilaca, T. Kalo et al.

A. Farnham, Ulf Blanke, Emily Stone et al.