Wheeze is a common symptom in patients with

Wheeze is a common symptom in patients with KN-93 hydrochloride Supplier and an uncommon symptom in COPD caused by tobacco smoke. The high prevalence of wheeze in this study suggests that COPD caused by biomass smoke might be a different phenotype than COPD caused by tobacco smoke. Biomass COPD mainly affects airways, whereas tobacco smoke affects both airways and lung parenchyma. What do these observations mean for countries in sub-Saharan Africa? van Gemert and colleagues have shown that high quality studies of COPD prevalence can be done with locally trained paramedical field workers. COPD seems to be highly prevalent in Africa, yet remains almost unknown. It seems to affect mainly people aged 30–40 years and the major risk factors are tobacco smoking and biomass smoke exposure, although other risk factors, such as poverty, poor nutrition, history of lung tuberculosis, or HIV infection, might also be as important. More studies are needed to understand the true burden of COPD in Africa and the risk factors for the disease. However, improved surveillance is merely the first step in addressing COPD in sub-Saharan Africa. African health-care providers, including doctors, should be taught how to address COPD effectively; at present, diagnosis and treatment are grossly inadequate. Health-care policy makers in sub-Saharan Africa need to take notice of the silently growing epidemic of COPD and start taking measures to both prevent and treat COPD effectively, before it gets out of hand.
In , Stephen Resch and colleagues\' study benchmarks 12 countries\' government expenditure on HIV/AIDS. This important research emphasises that many governments are not meeting spending goals, and in many countries the financing gaps are so great that, even if they met the spending goals, expenditure would still fall short of what is needed (expenditure would cover only 64% of estimated future funding requirements, leaving a gap of around a third of the total US$7·9 billion needed). Quantification of the gaps in domestic spending encourages us to consider whether the amount of funding is appropriate and how much more could and should be done to fight HIV/AIDS. The important question of how governments make allocation choices also comes to the forefront. The aim of this Comment is to draw attention to the many dimensions that contribute to the complexity of these decisions on health resource allocation. The allocation of governmental resources is a multifaceted balance between competing tradeoffs. In the 12 low-income and middle-income countries focused on by Resch and colleagues, government resources are sparse. Taking this into consideration, Resch and colleagues\' benchmarking exercise uses internationally set targets, economic forecasts, and burden of disease estimates to establish the appropriateness of spending patterns. In addition to these factors, governments face several competing considerations when allocating health resources. We believe that this complexity boils down to five key factors: disease burden, cost-effectiveness, external parties\' ability and willingness to pay, intertemporal tradeoffs, and health equity. The disease burden, as noted by Resch and colleagues, should affect how resources are allocated in the health sector. In general, a larger avertable health burden necessitates more resources. Ongoing improvements and timeliness of global burden of disease data can be an informative diagnostic approach for policymakers and researchers alike for this purpose. Cost-effectiveness is the mechanism that transforms financial resources into health gains. Inherently, attainment of the greatest health effect possible with the finite resources available is of the utmost importance to policy makers. A push to prioritise the most cost-effective interventions can lead to substantive health gains. However, more work is needed to develop comparable, comprehensive, and context-specific cost-effectiveness estimates, since continuous variation are not available for some causes and many interventions, especially in low-income and middle-income countries.