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Abdelkader K, Gutiérrez D, Latka A, Boeckaerts D, Drulis-Kawa Z, Criel B, Gerstmans H, Safaan A, Khairalla AS, Gaber Y, Dishisha T, Briers Y. The Specific Capsule Depolymerase of Phage PMK34 Sensitizes Acinetobacter baumannii to Serum Killing. Antibiotics (Basel) 2022; 11:antibiotics11050677. [PMID: 35625321 PMCID: PMC9137491 DOI: 10.3390/antibiotics11050677] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/20/2022] Open
Abstract
The rising antimicrobial resistance is particularly alarming for Acinetobacter baumannii, calling for the discovery and evaluation of alternatives to treat A. baumannii infections. Some bacteriophages produce a structural protein that depolymerizes capsular exopolysaccharide. Such purified depolymerases are considered as novel antivirulence compounds. We identified and characterized a depolymerase (DpoMK34) from Acinetobacter phage vB_AbaP_PMK34 active against the clinical isolate A. baumannii MK34. In silico analysis reveals a modular protein displaying a conserved N-terminal domain for anchoring to the phage tail, and variable central and C-terminal domains for enzymatic activity and specificity. AlphaFold-Multimer predicts a trimeric protein adopting an elongated structure due to a long α-helix, an enzymatic β-helix domain and a hypervariable 4 amino acid hotspot in the most ultimate loop of the C-terminal domain. In contrast to the tail fiber of phage T3, this hypervariable hotspot appears unrelated with the primary receptor. The functional characterization of DpoMK34 revealed a mesophilic enzyme active up to 50 °C across a wide pH range (4 to 11) and specific for the capsule of A. baumannii MK34. Enzymatic degradation of the A. baumannii MK34 capsule causes a significant drop in phage adsorption from 95% to 9% after 5 min. Although lacking intrinsic antibacterial activity, DpoMK34 renders A. baumannii MK34 fully susceptible to serum killing in a serum concentration dependent manner. Unlike phage PMK34, DpoMK34 does not easily select for resistant mutants either against PMK34 or itself. In sum, DpoMK34 is a potential antivirulence compound that can be included in a depolymerase cocktail to control difficult to treat A. baumannii infections.
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Affiliation(s)
- Karim Abdelkader
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt; (A.S.K.); (Y.G.); (T.D.)
| | - Diana Gutiérrez
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
| | - Agnieszka Latka
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Department of Pathogen Biology and Immunology, Institute of Genetics and Microbiology, University of Wroclaw, Przybyszewskiego 63, 51-148 Wrocław, Poland;
| | - Dimitri Boeckaerts
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Department of Data Analysis and Mathematical Modelling, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Zuzanna Drulis-Kawa
- Department of Pathogen Biology and Immunology, Institute of Genetics and Microbiology, University of Wroclaw, Przybyszewskiego 63, 51-148 Wrocław, Poland;
| | - Bjorn Criel
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Department of Data Analysis and Mathematical Modelling, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Hans Gerstmans
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Laboratory of Gene Technology, Department of Biosystems, KU Leuven, Kasteelpark Arenberg 21, 3001 Leuven, Belgium
- Department of Biosystems, KU Leuven, Willem de Croylaan 42, 3001 Leuven, Belgium
| | - Amal Safaan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Menoufia University, Shebin El-Koum 51132, Egypt;
| | - Ahmed S. Khairalla
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt; (A.S.K.); (Y.G.); (T.D.)
- Department of Biology, University of Regina, Regina, SK S4S 0A2, Canada
| | - Yasser Gaber
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt; (A.S.K.); (Y.G.); (T.D.)
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Mutah University, Karak 61710, Jordan
| | - Tarek Dishisha
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt; (A.S.K.); (Y.G.); (T.D.)
| | - Yves Briers
- Department of Biotechnology, Ghent University, Valentin Vaerwyckweg 1, 9000 Gent, Belgium; (K.A.); (D.G.); (A.L.); (D.B.); (B.C.); (H.G.)
- Correspondence:
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Sow A, Smekens T, De Man J, De Spigelaere M, Vanlerberghe V, Van Dormael M, Criel B. [Quality of health worker-patient communication: What are the benefits of integrating mental health into front-line services in Guinea?]. Rev Epidemiol Sante Publique 2021; 69:287-295. [PMID: 34272084 DOI: 10.1016/j.respe.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Patient-centred care presupposes communication based on empathy, active listening and dialogue. Our study examines the effects of integrating mental health in multi-purpose health centres on health workers' communication with patients who consult for problems unrelated to mental health. The objective is to compare the quality of communication in health centres where staff have received specific training in the management of mental disorders (SM+) compared to those without such training (SM-). METHODS The study was conducted among 18 health workers in charge of primary curative consultations in 12 non-governmental health centers in Guinea: 7 health workers in 4 SM+ health centers and 11 health workers in 8 SM- health centres. The study is based on mixed methods: observation, semi-structured and group interviews. The Global Consultation Rating Scale (GCRS) was applied to assess patient-centered communication. RESULTS The SM+ GCRS scores obtained by SM+s during observations are generally higher than the SM- scores. The odds of having a "good quality" consultation are almost 3 times higher in SM+ than in SM- for some steps in the consultation process. The SM+ discourse is more patient-centered, and differs from the more biomedical discourse of SM-. SM- health workers do not consider all of the stages of a patient-centred consultation to be applicable and recommend "leapfrogging". On the contrary, SM+ health workers consider all stages to be important and are convinced that the integration of mental health has improved their communication through the training they have received and the practice of caring for persons with mental disorders. CONCLUSION The integration of mental health into primary care provision represents an opportunity to improve the quality of care in its "patient-centred care" dimension. That said, optimal development of patient-centred care presupposes favorable structural conditions.
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Affiliation(s)
- A Sow
- École de santé publique, Université Libre de Bruxelles, Route de Lennik 808 CP 594- B-1070, Bruxelles, Belgique; Faculté des sciences et techniques de la santé, Chaire de santé publique, Université Gamal Abdel Nasser, Commune de Dixinn-1017 Conakry, Guinée.
| | - T Smekens
- Institut de médecine tropicale, Nationalestraat155, 2000Anvers, Belgique
| | - J De Man
- Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
| | - M De Spigelaere
- École de santé publique, Université Libre de Bruxelles, Route de Lennik 808 CP 594- B-1070, Bruxelles, Belgique
| | - V Vanlerberghe
- Institut de médecine tropicale, Nationalestraat155, 2000Anvers, Belgique
| | - M Van Dormael
- Institut de médecine tropicale, Nationalestraat155, 2000Anvers, Belgique
| | - B Criel
- Institut de médecine tropicale, Nationalestraat155, 2000Anvers, Belgique
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Boeckaerts D, Stock M, Criel B, Gerstmans H, De Baets B, Briers Y. Predicting bacteriophage hosts based on sequences of annotated receptor-binding proteins. Sci Rep 2021; 11:1467. [PMID: 33446856 PMCID: PMC7809048 DOI: 10.1038/s41598-021-81063-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/30/2020] [Indexed: 12/04/2022] Open
Abstract
Nowadays, bacteriophages are increasingly considered as an alternative treatment for a variety of bacterial infections in cases where classical antibiotics have become ineffective. However, characterizing the host specificity of phages remains a labor- and time-intensive process. In order to alleviate this burden, we have developed a new machine-learning-based pipeline to predict bacteriophage hosts based on annotated receptor-binding protein (RBP) sequence data. We focus on predicting bacterial hosts from the ESKAPE group, Escherichia coli, Salmonella enterica and Clostridium difficile. We compare the performance of our predictive model with that of the widely used Basic Local Alignment Search Tool (BLAST). Our best-performing predictive model reaches Precision-Recall Area Under the Curve (PR-AUC) scores between 73.6 and 93.8% for different levels of sequence similarity in the collected data. Our model reaches a performance comparable to that of BLASTp when sequence similarity in the data is high and starts outperforming BLASTp when sequence similarity drops below 75%. Therefore, our machine learning methods can be especially useful in settings in which sequence similarity to other known sequences is low. Predicting the hosts of novel metagenomic RBP sequences could extend our toolbox to tune the host spectrum of phages or phage tail-like bacteriocins by swapping RBPs.
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Affiliation(s)
- Dimitri Boeckaerts
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Ghent, Belgium
- Laboratory of Applied Biotechnology, Department of Biotechnology, Ghent University, Ghent, Belgium
| | - Michiel Stock
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Ghent, Belgium
| | - Bjorn Criel
- Laboratory of Applied Biotechnology, Department of Biotechnology, Ghent University, Ghent, Belgium
| | - Hans Gerstmans
- Laboratory of Applied Biotechnology, Department of Biotechnology, Ghent University, Ghent, Belgium
- Laboratory of Gene Technology, Department of Biosystems, KU Leuven, Leuven, Belgium
- MeBioS-Biosensors group, Department of BioSystems, KU Leuven, Leuven, Belgium
| | - Bernard De Baets
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Ghent, Belgium
| | - Yves Briers
- Laboratory of Applied Biotechnology, Department of Biotechnology, Ghent University, Ghent, Belgium.
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Mwembo-Tambwe A, Chenge F, Criel B. Institutional strengthening for evidence-based health policies in the DR Congo (RIPSEC): Impact. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
In the DRC, the need to strengthen the health system for a more equitable charge of the health of the population in a perspective of universal health coverage proves to be relevant. Develop a culture that promotes decision-making based on scientific evidence, essential to improve the overall performance of the health system from this perspective
Description of the Problem
The RIPSEC program aims to (i) develop the capacity to manage health knowledge in the DRC through the creation of a Health Knowledge Center in the DRC, (CCSC- Asbl); to strengthen the scientific capacity of the Public Health Schools and the National Institute of Biomedical Research in health systems research and education and to strengthen the training capacity of the Public Health Schools by Development of Learning and Research Health Districts (LRHD). We assess the level of achievement of the results of this program.
Results
The majority of objectives have been reached.The CCSC-Asbl, created is an autonomous institution with legal personality. It produces scientific evidence and support for decision-making. The Ministry of Health has been strengthened and diversified. Institutional capacities and visibility have been strengthened through continuing education and the publication of scientific articles. But, no doctorals theses has been completed yet. Establishment of a consultation framework for health science training institutes: online training, short-term joint training on health system research. The third component concerns the development of LHRD; Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research.
Lessons
The RIPSEC program is increasingly becoming part of the Congolese health system as a strong partner.
Key messages
This experience can be used elsewhere in different contexts This program could be continued to perpetuate these fragile achievements. It corresponds to the felt needs and the priority of the health education system in the DRC or elsewhere.
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Affiliation(s)
- A Mwembo-Tambwe
- Santé Publique, RIPSEC/CCSC/ ESP UNILU, Lubumbashi, Democratic Republic of the Congo
| | - F Chenge
- Santé Publique, RIPSEC/CCSC/ ESP UNILU, Lubumbashi, Democratic Republic of the Congo
| | - B Criel
- Santé Publique, IMT Antwerp, Antwerp, Belgium
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Mwembo -Tambwekoy A, Chenge F, Criel B. Development of Learning and Research Health Districts (LRHD) in the DR Congo: results. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Issue
There is great need in DRCongo for adequate training sites where national public health managers and workers can discover what is means to manage complex district healthcare delivery systems in a perspective of PHC and UHC. The development of such LRHD is coherent with the national policy in DRC advocating for demonstration districts.
Description of the Problem
The RIPSEC has launched three sites called LRHD, two of which are rural and one urban. A specialist in the organization and management of health services, from each of the three schools of public health, supervised the development and monitoring of those LRHDs. The Provincial Supervisor was also involved. Three approaches to solving priority problems have been defined: strengthening leadership at the HD level; transform health services into a learning and research framework. We analyze the transformation process obtained in these HD.
Results
Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research. The results of those LRHD after 4 years were mixed: the leadership of the management teams has improved. A reflexive attitude developed which contributes to more appropriate decision-making,monitoring and evaluation.At least one hospital service and 2 health centers have been transformed according to specific problems,improving the interaction between health structures, in order to quality of care has improved, the results of action research have made it possible to resolve local health problems. RIPSEC support to Provincial Supervisor to develop their working tools to better address their functions and responsibilities. However, the documentation of these changes induced by RIPSEC was not yet systematized. No residential internship could be carried out due to operational constraints.
Lessons
Mentoring, through its intellectual inputs, has contributed to a dynamic of change in the HD.
Key messages
The basis of the strategy is the improvement of the leadership of the HD management team,reinforced by mentoring and systematic documentation of complex decisions. This program could be continued to perpetuate these fragile achievements. This experience can be used elsewhere in different contexts. But,the residential internship requires other resources.
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Affiliation(s)
- A Mwembo -Tambwekoy
- Santé Publique, RIPSEC ESP UNILU, Lubumbashi, Congo, Democratic Republic of the
| | - F Chenge
- Santé Publique, RIPSEC ESP UNILU, Lubumbashi, Congo, Democratic Republic of the
| | - B Criel
- Santé Publique, IMT Antwerp, Antwerp, Belgium
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Gerstmans H, Criel B, Briers Y. Synthetic biology of modular endolysins. Biotechnol Adv 2018; 36:624-640. [DOI: 10.1016/j.biotechadv.2017.12.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 01/15/2023]
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Olmen JV, Criel B, Bhojani U, Marchal B, Belle SV, Chenge MF, Hoerée T, Pirard M, Damme WV, Kegels G. The Health System Dynamics Framework: The introduction of an analytical model for health system analysis and its application to two case-studies. ACTA ACUST UNITED AC 2012. [DOI: 10.5195/hcs.2012.71] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening.
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Michielsen J, Criel B, Devadasan N, Soors W, Wouters E, Meulemans H. Can health insurance improve access to quality care for the Indian poor? Int J Qual Health Care 2011; 23:471-86. [DOI: 10.1093/intqhc/mzr025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Criel B, Hausman F, Oufir M, Swennen R, Panis B, Renaut J. Proteome and sugar analysis of abiotic stress underlying cryopreservation in potato. Commun Agric Appl Biol Sci 2006; 71:3-6. [PMID: 17191462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- B Criel
- Laboratory of Tropical Crop Improvement, Division of Crop Biotechnics, K.U.Leuven, Kasteelpark Arenberg 13, BE-3001 Heverlee, Belgium
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Abstract
The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no means exorbitant, albeit unfortunately not yet within reach of many sub-Saharan African countries today.
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Affiliation(s)
- B Vander Plaetse
- Department of Public Health, Institute of Tropical Medicine, 155 Nationalestraat, B-2000 Antwerp, Belgium
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Criel B, Panta A, Carpentier S, Renaut J, Swennen R, Panis B, Hausman JF. Cryopreservation and abiotic stress tolerance in potato: a proteomic approach. Commun Agric Appl Biol Sci 2005; 70:83-6. [PMID: 16366280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- B Criel
- Laboratory of Tropical Crop Improvement, Leuven, Belgium
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Boelaert M, Criel B, Leeuwenburg J, Van Damme W, Le Ray D, Van der Stuyft P. Visceral leishmaniasis control: a public health perspective. Trans R Soc Trop Med Hyg 2000; 94:465-71. [PMID: 11132368 DOI: 10.1016/s0035-9203(00)90055-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Visceral leishmaniasis (VL), also known as kala-azar, is a vector-borne disease caused by a protozoan of the Leishmania donovani complex. A phlebotomine sandfly transmits the parasite from person to person or via an animal reservoir. VL is a severe, debilitating disease, characterized by prolonged fever, splenomegaly, hypergammaglobulinaemia and pancytopenia. Patients become gradually ill over a period of a few months, and nearly always die if untreated. Case-fatality ratios are high even in treated patients. Worldwide an estimated 500,000 VL cases occur each year. This study reviews clinical, epidemiological and public health aspects of the disease and shows how critical adequate case detection is for the success of VL control. Examination of the issue of VL diagnosis with respect to the global challenges in VL control leads to the observation that a sound diagnostic-therapeutic algorithm for the health services in endemic areas is badly needed. Serological tests could be an alternative to parasitological diagnosis and the direct agglutination test (DAT) was found to fulfil many criteria for a 'field test', including cost effectiveness. Although research needs on vaccine and better drugs continue to be high on the agenda, a VL test-treatment strategy based on currently available highly sensitive serological tests, such as the DAT, should be introduced in the health services in endemic areas.
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Affiliation(s)
- M Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Criel B, Van der Stuyft P, Van Lerberghe W. The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns. Soc Sci Med 1999; 48:897-911. [PMID: 10192557 DOI: 10.1016/s0277-9536(98)00391-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few well-established and documented initiatives in the field of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is significantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the effect of the insurance scheme on hospital utilization patterns. More specifically, the distribution of this higher utilization over the different hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the effectiveness, equity and efficiency of hospital utilization are discussed. The relevance and possible implications of these findings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives.
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Affiliation(s)
- B Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Criel B, Van Dormael M. Mutual health organizations in Africa and social health insurance systems: will European history repeat itself? Trop Med Int Health 1999; 4:155-9. [PMID: 10223209 DOI: 10.1046/j.1365-3156.1999.43385.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Criel B, Van Dormael M, Lefèvre P, Menase U, Van Lerberghe W. Voluntary health insurance in Bwamanda, Democratic Republic of Congo. An exploration of its meanings to the community. Trop Med Int Health 1998; 3:640-53. [PMID: 9735934 DOI: 10.1046/j.1365-3156.1998.00286.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An insurance scheme covering hospital care in the rural district of Bwamanda in the North-west of the Democratic Republic of Congo, which locally is called the mutuelle, was conceived and developed in 1986 on the initiative of Belgian doctors working in the district under the arrangements for bilateral Belgian aid. After more than 10 years of operation the Bwamanda scheme has achieved a high rate of coverage, contributed to a significant improvement in access to hospital-based in-patient care, and constitutes a stable source of revenue for the operation of the hospital. We present an investigation conducted through focus groups in 1996 of the population's social perceptions of this risk-sharing scheme to identify ways to improve it. The findings pertain to the reasons for people to subscribe to the scheme; to the perception of its redistribution effects; to people's frustrations and questions; and finally to the relationships between the insurance scheme and traditional mutual aid arrangements. The difference between a hospital insurance scheme (a logic of contract) and the traditional systems of mutual aid (a logic of alliance) is highlighted, and the impact of the hospital insurance scheme on social inequalities is discussed. The implications of this study on the management of the Bwamanda health insurance scheme are reviewed, and this study may be useful to health managers working in similar contexts.
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Affiliation(s)
- B Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
In most settings, a 'public' health service refers to a service which belongs to the state. The term 'private' is used when health care is delivered by individuals and/or institutions not administered by the state. In this paper it is argued that such a distinction, which is based on the institutional or administrative identity of the health care provider, is not adequate because it takes for granted that the nature of this identity automatically determines the nature of the service delivered to the population. A different frame of classification between public and private health services is proposed: one which is based on the purpose the health service pursues and on the outputs it yields. A set of five operational criteria to distinguish between health services guided by a public or private purpose is presented. This alternative classification is discussed in relation to a variety of existing situations in sub-Saharan Africa (Mali, Uganda, Zimbabwe). It is hoped that it can be used as a tool in the hands of the health planner in order to bring more rationality in the current altercation between the public and the private health care sector.
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Affiliation(s)
- D Giusti
- Matany Hospital, Moroto District, Uganda
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17
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Abstract
A voluntary insurance scheme for hospital care was launched in 1986 in the Bwamanda District in northwest Zaire. The paper briefly reviews the rationale, design and implementation of the scheme and discusses its results and performance over time. The scheme succeeded in generating stable revenue for the hospital in a context where government intervention was virtually absent and external subsidies were most uncertain. Hospital data indicate that hospital services were used by a significantly higher proportion of insured patients than uninsured people. The features of the environment in which the insurance scheme thrived are discussed and the conditions that facilitated its development reviewed. These conditions comprise organizational-managerial, economic-financial, social and political factors. The Bwamanda case study illustrates the feasibility of health insurance-at least for hospital-based inpatient care-at rural district level in sub-Saharan Africa, but also exemplifies the managerial and social complexity of such financing mechanisms.
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Affiliation(s)
- B Criel
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
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18
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Abstract
Good access to health facilities providing good first-level health care remains problematic in many developing countries. It is a hindrance to effective and efficient functioning of the hospital, as outpatient departments become overcrowded with patients from areas without health centres. In many cases the quality of care delivered to these patients is poor because within the district health system the hospital is not the best place for the supply of comprehensive, integrated and continuous care. Eventually, high hospital involvement in first-level care can jeopardize the delivery of adequate referral care for those patients who desperately need the hospital's technology and expertise. This paper provides an account of the way this problem was investigated and managed by the district health management team in the Murewa district in north-east Zimbabwe. The design of a comprehensive 'master plan' or 'coverage plan' is presented as well as the problems and difficulties encountered. The Murewa experience highlights the relevance of a coverage plan for rational and coherent health infrastructure planning at district level. The approach followed by the Murewa team illustrates the use of action research as an integral part of the management of district health systems.
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Affiliation(s)
- B Criel
- District Health Services Management (DHSM) Project Team, Institute of Tropical Medicine, Antwerpen, Belgium
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De Brouwere V, Van Lerberghe W, Criel B, Van Dormael M. [Between scientific management and research-action: the problem of overconsumption of drugs in Kasongo (Zaire)]. Cah Sociol Demogr Med 1996; 36:141-70. [PMID: 8796103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A Primary Health Care (PHC) system may be effective and efficient to the extent that essential drugs are available in health services and financially accessible to the population. In developing countries, besides the difficulties related to supplying health services with adequate amounts of drugs, the control of drug consumption is one of the frequent problems encountered by health authorities. Literature is relatively abundant in the field of rationalization of the diagnosis and drug prescription processes, and also in the field of drug financing mechanisms; publications are however rather scarce when topics related to corruption or drug misappropriation are concerned. The case study submitted hereafter reports a drug overconsumption problem in the health centres (HC) of the Kasongo district (Zaire). Despite the existence of direct control mechanisms as well as indirect ones (monitoring of drug consumption by HC), the problem has been identified belatedly. The district staff then used a step-by-step analysis of the HC drug consumption profiles; this analysis allowed to demonstrate that misappropriation would be the most plausible hypothesis. In order to solve the misappropriation problem-the consequences of which jeopardized the functioning of the very health system-the district staff chose to involve the nurses, in charge of the HC, in the entire problem-solving process. This participative approach, involving different actors as partners, allowed to deepen the situation analysis and to elaborate solutions congruent with PHC principles and acceptable to all concerned.
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Affiliation(s)
- V De Brouwere
- Institut de Médecine Tropicale, Unité de Recherche et d'Enseignement en Santé Publique, Anvers, Belgique
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21
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Abstract
In most developing countries, government funding allocated to the health services is not sufficient to allow these services to provide appropriate health care accessible to all. Consequently, community financing has received much more attention in recent years and innovative schemes are being explored throughout the developing world. Risk-sharing schemes, like prepayment, are interesting because of their potential redistributive effects. At the end of the eighties, a prepayment scheme for hospital care was experimented with in the Masisi health district in Eastern Zaire. In the present paper, the experiment is described in a chronological way and the results are analyzed and discussed in detail. Although this particular case-study was not successful, it yields important lessons concerning the design, implementation and evaluation of prepayment schemes for hospital health care in developing countries. More specifically, phenomena like adverse selection and moral hazard are discussed. Finally, conditions for success of similar experiments are discussed. These conditions relate mainly to the organization pattern of the district health services system. The Masisi experiment is a nice illustration of the fact that prepayment is not a 'magic bullet': the lessons drawn from it may be of relevancy to health planners intending to implement hospital prepayment schemes in similar settings.
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Affiliation(s)
- J P Noterman
- Public Health Research and Training Unit, Institute of Tropical Medicine, Antwerp, Belgium
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22
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Abstract
This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited.
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Affiliation(s)
- J P Unger
- Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium
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23
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Abstract
The main goal of antenatal care in developing countries is to identify women whose pregnancy or delivery is likely to raise problems and to refer them at the appropriate time to a hospital facility where the necessary medical equipment and expertise (vacuum extractors, cesarian sections, human skill, etc.) is available. This approach, which is known as the Risk Approach (RA) strategy, is expected to significantly reduce maternal morbidity and mortality. However, the RA will function properly only if the women identified at risk agree to give birth in a hospital on the one hand, and if they can indeed reach this hospital on the other hand. In this article the authors assess to what extent women with a risk of difficult labor (nulliparous or primiparous women under 150 cm, history of previous difficult delivery or stillbirth, women with transverse lie) agreed to give birth in a hospital. This descriptive survey, which covered 5060 pregnancies monitored in the Kasongo District, Maniema, in eastern Zaire, showed that the referral success rate in this socioeconomically very disadvantaged region was only 33%, despite some favorable conditions, such as a strong emphasis on community participation, a complementarity of health centers and hospital, and the absence of financial barriers within the health services system. Of the various hypotheses tested, the geographic accessibility of the hospital and the parturient's perception of the risk status were the two most important factors determining the compliance rate. A stratified analysis shows that the intensity of the parturient's perception has a different impact on compliance whether rural or urban situations are considered.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Dujardin
- Public Health Unit, Institute of Tropical Medicine, Antwerpen, Belgium
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Kegels G, Criel B, van Lerberghe W, Mentens H, Magnus E, Van Balen H. Screening for Trypanosoma brucei gambiense antibodies with the Indirect Fluorescent Antibody Test (IFAT). Effect of age and previous treatment. Ann Soc Belg Med Trop 1992; 72:271-81. [PMID: 1292423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper reports on some of the findings of a longitudinal multi-round investigation into the predictive power of early signs and symptoms of human African trypanosomiasis caused by T.b. gambiense, in the Rural Health Zone of Kasongo (Maniema, Zaire). It assesses the importance of the effect of age and a history of previously treated sleeping sickness on serological positivity as measured by the Indirect Fluorescent Antibody Test (IFAT), used as a screening test. The impact of including age and a history of previous sleeping sickness as part of the screening process is discussed in terms of sensitivity and positive predictive value. Including weak serological positivity among the screening criteria does not appear to improve the sensitivity of the IFAT test in this setting.
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Affiliation(s)
- G Kegels
- Public Health Research and Training Unit, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium
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Criel B. [The integration of tuberculosis in primary health care: where do we stand?]. Ann Soc Belg Med Trop 1992; 72:1-3. [PMID: 1567263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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