IMPACT World+: a globally regionalized life cycle impact assessment method

The International Journal of Life Cycle Assessment - This paper addresses the need for a globally regionalized method for life cycle impact assessment (LCIA), integrating multiple state-of-the-art...     

Overview and recommendations for regionalized life cycle impact assessment

The International Journal of Life Cycle Assessment - Regionalized life cycle impact assessment (LCIA) has rapidly developed in the past decade, though its widespread application, robustness, and...     

Cost Effectiveness of Seasonal Intermittent Preventive Treatment Using Amodiaquine & Artesunate or Sulphadoxine-Pyrimethamine in Ghanaian Children

Background

Intermittent preventive treatment for malaria in children (IPTc) involves the administration of a full course of an anti-malarial treatment to children under 5 years old at specified time points regardless of whether or not they are known to be infected, in areas where malaria transmission is seasonal. It is important to determine the costs associated with IPTc delivery via community based volunteers and also the potential savings to health care providers and caretakers due to malaria episodes averted as a consequence of IPTc.

Methods

Two thousand four hundred and fifty-one children aged 3–59 months were randomly allocated to four groups to receive: three days of artesunate plus amodiaquine (AS+AQ) monthly, three days of AS+AQ bimonthly, one dose of sulphadoxine-pyrimethamine (SP) bi-monthly or placebo. This paper focuses on incremental cost effectiveness ratios (ICERs) of the three IPTc drug regimens as delivered by community based volunteers (CBV) in Hohoe, Ghana compared to current practice, i.e. case management in the absence of IPTc. Financial and economic costs from the publicly funded health system perspective are presented. Treatment costs borne by patients and their caretakers are also estimated to present societal costs. The costs and effects of IPTc during the intervention period were considered with and without a one year follow up. Probabilistic sensitivity analysis was undertaken to account for uncertainty.

Results

Economic costs per child receiving at least the first dose of each course of IPTc show SP bimonthly, at US$8.19, is the cheapest to deliver, followed by AS+AQ bimonthly at US$10.67 and then by AS+AQ monthly at US$14.79. Training, drug delivery and supervision accounted for approximately 20–30% each of total unit costs. During the intervention period AS & AQ monthly was the most cost effective IPTc drug regimen at US$67.77 (61.71–74.75, CI 95%) per malaria case averted based on intervention costs only, US$64.93 (58.92–71.92, CI 95%) per malaria case averted once the provider cost savings are included and US$61.00 (54.98, 67.99, CI 95%) when direct household cost savings are also taken into account. SP bimonthly was US$105.35 (75.01–157.31, CI 95%) and AS & AQ bimonthly US$211.80 (127.05–399.14, CI 95%) per malaria case averted based on intervention costs only. The incidence of malaria in the post intervention period was higher in children who were <1 year old when they received AS+AQ monthly compared to the placebo group leading to higher cost effectiveness ratios when one year follow up is included. The cost per child enrolled fell considerably when modelled to district level as compared to those encountered under trial conditions.

Conclusions

We demonstrate how cost-effective IPTc is using three different drug regimens and the possibilities for reducing costs further if the intervention was to be scaled up to the district level. The need for effective training, drug delivery channels and supervision to support a strong network of community based volunteers is emphasised.     

Life cycle assessment applying planetary and regional boundaries to the process level: a model case study

The International Journal of Life Cycle Assessment - The planetary boundaries framework contains regional boundaries in addition to global boundaries. Geographically resolved methods to assess...     

Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries

Background

Private for-profit outlets are important treatment sources for malaria in most endemic countries. However, these outlets constitute only the last link in a chain of businesses that includes manufacturers, importers and wholesalers, all of which influence the availability, price and quality of antimalarials patients can access. We present evidence on the composition, characteristics and operation of these distribution chains and of the businesses that comprise them in six endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia).

Methods and Findings

We conducted nationally representative surveys of antimalarial wholesalers during 2009–2010 using an innovative sampling approach that captured registered and unregistered distribution channels, complemented by in-depth interviews with a range of stakeholders. Antimalarial distribution chains were pyramidal in shape, with antimalarials passing through a maximum of 4–6 steps between manufacturer and retailer; however, most likely pass through 2–3 steps. Less efficacious non-artemisinin therapies (e.g. chloroquine) dominated weekly sales volumes among African wholesalers, while volumes for more efficacious artemisinin-based combination therapies (ACTs) were many times smaller. ACT sales predominated only in Cambodia. In all countries, consumer demand was the principal consideration when selecting products to stock. Selling prices and reputation were key considerations regarding supplier choice. Business practices varied across countries, with large differences in the proportions of wholesalers offering credit and delivery services to customers, and the types of distribution models adopted by businesses. Regulatory compliance also varied across countries, particularly with respect to licensing. The proportion of wholesalers possessing any up-to-date licence from national regulators was lowest in Benin and Nigeria, where vendors in traditional markets are important antimalarial supply sources.

Conclusions

The structure and characteristics of antimalarial distribution chains vary across countries; therefore, understanding the wholesalers that comprise them should inform efforts aiming to improve access to quality treatment through the private sector.     

Including metal atmospheric fate and speciation in soils for terrestrial ecotoxicity in life cycle impact assessment

Purpose

The aim of the study is to calculate regionalized characterization factors for the atmospheric emissions of metals transferred to soil for zinc, copper, and nickel taking into account the atmospheric fate and speciation.

Methods

In order to calculate characterization factors for all possible atmospheric emission locations around the world, the link between atmospheric deposition with regionalized soil fate factors and bioavailability factors accounting for the metal’s speciation was established. The methodology to develop the regionalized fate factors and characterization factors is threefold. First, the emitted metal fraction that is deposited on soils is calculated from atmospheric source-receptor matrices providing for each emission location the fraction of an emission that is deposited on each worldwide receiving cell (2°?×?2.5° resolution). Second, the fraction of metal deposited in different soil types is determined by overlapping the deposition map with a soil map, based on the 4513 different soil types from the Harmonized World Soil Database. Third, bioavailability factors are calculated for each soil type, which allows determining the bioavailable fraction of the deposited metal depending on the soil properties. Combining these steps with the effect factors results in a series of terrestrial ecotoxicological characterization factors. These characterization factors are then applied in an illustrative example and compared to results obtained with generic characterization factors. The case study focuses on the electricity production process in Québec, whose ecosystem impacts are currently dominated by metal ecotoxicity impacts. The uncertainty due to the spatial variability of the impact is quantified.

Results and discussion

Our results show that regionalized characterization factors are over three orders of magnitude lower than generic characterization factors. They are presented on maps and their spatial variability was evaluated at different regional scales (region, country, world). The use of regionalized characterization factors with their spatial variability at different geographic resolution scales in the case study gives a result more or less precise depending on the level of resolution of the characterization factor applied (country or global-default). The impact scores of the three metals in the case study are three orders of magnitude lower when compared to the scores obtained with generic characterization factors.

Conclusions

The development of those regionalized characterization factors improves the terrestrial ecotoxicity assessment in life cycle impact assessment by taking into account the atmospheric fate and the speciation of the metal for new 3 metals for the different soil types in the world and by documenting their spatial variability.

     

Prioritizing regionalization efforts in life cycle assessment through global sensitivity analysis: a sector meta-analysis based on ecoinvent v3

The International Journal of Life Cycle Assessment - Regionalization in life cycle assessment (LCA) aims to increase the representativeness of LCA results and reduce the uncertainty due to spatial...     

Effect of Paying for Performance on Utilisation,Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study

Background

Despite widespread implementation across Africa, there is limited evidence of the effect of payment for performance (P4P) schemes in low income countries on the coverage of quality services and affordability, consistent with universal health coverage objectives. We examined the effect of a government P4P scheme on utilisation, quality, and user costs of health services in Tanzania.

Methods

We evaluated the effects of a P4P scheme on utilisation of all maternal and child immunization services targeted by the scheme, and non-targeted general outpatient service use. We also evaluated effects on patient satisfaction with care and clinical content of antenatal care, and user costs. The evaluation was done in 150 facilities across all 7 intervention districts and 4 comparison districts with two rounds of data collection over 13-months in January 2012 and February 2013. We sampled 3000 households of women who had delivered in the 12 months prior to interview; 1500 patients attending health facilities for targeted and non-targeted services at each round of data collection. Difference-in-difference regression analysis was employed.

Findings

We estimated a significant positive effect on two out of eight targeted indicators. There was an 8.2% (95% CI: 3.6% to 12.8%) increase in coverage of institutional deliveries among women in the intervention area, and a 10.3% (95% CI: 4.4% to 16.1%) increase in the provision of anti-malarials during pregnancy. Use of non-targeted services reduced at dispensaries by 57.5 visits per month among children under five (95% CI: -110.2 to -4.9) and by 90.8 visits per month for those aged over five (95% CI: -156.5 to -25.2). There was no evidence of an effect of P4P on patient experience of care for targeted services. There was a 0.05 (95% CI: 0.01 to 0.10) increase in the patient satisfaction score for non-targeted services. P4P was associated with a 5.0% reduction in those paying out of pocket for deliveries (95% CI: -9.3% to -0.7%) but there was no evidence of an effect on the average amount paid.

Conclusion

This study adds to the very limited evidence on the effects of P4P at scale and highlights the potential risks of such schemes in relation to non-targeted service use. Further consideration of the design of P4P schemes is required to enhance progress towards universal health coverage, and close monitoring of effects on non-targeted services and user costs should be encouraged.     

Measurement of changes in amino acids related to total collagen in fibrotic human liver

In the liver, total collagen accumulation during the fibrotic or cirrhotic process was measured using a methodology based on the determination of collagen amino acids in liver biopsies from adults with alcoholic liver diseases or children with biliary atresia. The results obtained with this methodology were compared to histopathological findings. Thus, it was shown that generally the severity of hepatic injury was dependent on collagen accumulation. In biliary atresia, collagen accumulation increased with the children's age despite reconstructive surgery and restoration of biliary flow.