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  • br Control of visceral leishmaniasis requires access

    2019-05-20


    Control of visceral leishmaniasis requires access to low-cost, safe, and effective treatment. Amphotericin causes infusion-related fever, rigor, and nephrotoxicity, limiting its use. Ambisome—a liposomal amphotericin manufactured by Gilead—is better tolerated and is effective as a single dose. However, its limited production is inadequate for all cases of visceral leishmaniasis, and its cost needs further reduction. The liposomal or lipid-associated amphotericin products Amphotec, Abelcet, and Ambisome have different lipids, shapes, sizes, toxic effects, pharmacokinetics, manufacturing processes, and formulations, yet similar efficacies. Ambisome and Anfogen (a liposomal amphotericin by Genpharma, Argentina, withdrawn for further development) have the same composition but are manufactured differently and have different particle sizes, toxic effects, and efficacy in the aspergillosis mouse model. The liposomal amphotericin Fungisome, developed by academic institutions and marketed in India, is indeed not a generic of Ambisome: it contains different meclizine hcl (soy phosphadidylcholine and cholesterol), and has a different vesicle size, formulation, and pharmacokinetics in preclinical and clinical phase 1 studies. It is safe and effective in animal models of mouse aspergillosis and visceral leishmaniasis; in phases 2, 3, and 4 of systemic mycosis; in a phase 2 dose-finding study of visceral leishmaniasis; and in a single-dose study in visceral leishmaniasis (personal communication, Lifecare).
    A recent letter to drew attention to Chinese achievements with regard to Millennium Development Goals (MDGs) 4 and 5. The wide wealth and health disparities, including in maternal survival, in China, linked both to the urban–rural divide and to the east–west divide, have been noted many times. Here we draw attention to the closing gap between urban and rural maternal mortality ratio (MMR), both in terms of the drivers behind the dramatic drop in rural maternal mortality and the surprising lack of improvement in urban maternal mortality. The drop in rural maternal mortality coincides with the launch of the New Cooperative Medical Scheme (NCMS) in 2003. The scheme operates on a voluntary basis and pools funds from central and local governments, with individual contributions. The maternity package offered under NCMS varies across counties, but cambium typically offers subsidies of expenses for facility-based delivery including antenatal and postnatal services, either as a prepayment or a retrospective reimbursement. In 2011, 97·5% of rural villages were enrolled in the NCMS. Since launch, the officially reported MMR in rural China decreased from 65·4 per 100 000 in 2003 to 26·5 per 100 000 in 2011, reaching almost the same level as the urban MMR (25·2 per 100 000 in 2011; ).