Does Price Reveal Poor-Quality Drugs? Evidence from 17 Countries

Focusing on 8 drug types on the WHO-approved medicine list, we constructed an original dataset of 899 drug samples from 17 low- and median-income countries and tested them for visual appearance, disintegration, and analyzed their ingredients by chromatography and spectrometry. Fifteen percent of the samples fail at least one test and can be considered substandard. After controlling for local factors, we find that failing drugs are priced 13.6-18.7% lower than non-failing drugs but the signaling effect of price is far from complete, especially for non-innovator brands. The look of the pharmacy, as assessed by our covert shoppers, is weakly correlated with the results of quality tests. These findings suggest that consumers are likely to suspect low quality from market price, non-innovator brand and the look of the pharmacy, but none of these signals can perfectly identify substandard and counterfeit drugs. Indeed, many cheaper non-innovator products pass all quality tests, and are genuine generic drugs.

Big data analytics for preventive medicine

© 2019, Springer-Verlag London Ltd., part of Springer Nature. Medical data is one of the most rewarding and yet most complicated data to analyze. How can healthcare providers use modern data analytics tools and technologies to analyze and create value from complex data? Data analytics, with its promise to efficiently discover valuable pattern by analyzing large amount of unstructured, heterogeneous, non-standard and incomplete healthcare data. It does not only forecast but also helps in decision making and is increasingly noticed as breakthrough in ongoing advancement with the goal is to improve the quality of patient care and reduces the healthcare cost. The aim of this study is to provide a comprehensive and structured overview of extensive research on the advancement of data analytics methods for disease prevention. This review first introduces disease prevention and its challenges followed by traditional prevention methodologies. We summarize state-of-the-art data analytics algorithms used for classification of disease, clustering (unusually high incidence of a particular disease), anomalies detection (detection of disease) and association as well as their respective advantages, drawbacks and guidelines for selection of specific model followed by discussion on recent development and successful application of disease prevention methods. The article concludes with open research challenges and recommendations

Influence of household behaviour and perception on Malaria control and prevention in Zamfara State North West Nigeria

Household behaviour has been established as a fundamental element in health preventive practices. Malaria control paradigm focuses mostly on the medical and health approach. Household behaviour has been to a large extent do not take into account. Household behaviour, not only plays a critical role in the influence of malaria prevalence, but these behaviours and attitudes can also play a role in its control and management. The objective of this study is to investigate the influence of household behaviour and perception on malaria control and prevalence in Zamfara state North West Nigeria. The study used a mixed methodology of quantitative and qualitative research. For the quantitative, a total of 409 respondents participated in the study. Statistical Package for Social Science (SPSS) and smart PLS 2.0 is use for the quantitative analysis. For the qualitative, 20 people participated as respondents. Thematic analysis was used for qualitative analysis. Result from the PLS analysis supported the entire three hypothesis. Specifically, the finding from hypothesis one shows that there is a significant relationship between behaviour on fumigation and malaria control. Furthermore, results from hypothesis two indicate that there is a connection between household behaviour on waste disposal and malaria control. The result from the hypothesis three reveals that there is a relationship between household malaria perception and malaria control. A finding from the qualitative study reveals that household behaviour has the influence to available and effective malaria control measures in Nigeria. Part of the result also shows that available and effective control measures influence household behaviour. The findings of the study were supported by the literature and theories. In general the study provides further proofs on the influence of household behaviour on malaria control and prevention with particular reference to Zamfara state in North West Nigeria. Household behaviour should be considered as an important concept for malaria control and prevention

Exploring the Plasmodium falciparum Transcriptome Using Hypergeometric Analysis of Time Series (HATS)

Malaria poses a significant public health and economic threat in many regions of the world, disproportionately affecting children in sub-Saharan Africa under the age of five. Though success has been celebrated in lowering infection rates, it remains a serious challenge, causing at least 200 million infections and 655,000 deaths per year, with deleterious effects on economic growth and development. Investigation of the malaria parasite Plasmodium falciparum has entered the post-genomics age, with several strains sequenced and many microarray gene expression studies performed. Gene expression studies allow a full sampling of the genomic repertoire of a parasite, and their detailed analysis will prove invaluable in deciphering novel parasite biology as well as the modes of action of antimalarial drug resistance. We have developed a computational pipeline that converts a series of fluorescence readings from a DNA microarray into a meaningful set of biological hypotheses based on the comparison of two lines, generally one that is drug sensitive and one that is drug resistant. Each step of the computational pipeline is described in detail in this thesis, beginning with data normalization and alignment, followed by visualization through dimensionality reduction, and finally a direct analysis of the differences and similarities between the two lines. Comparisons and analyses were performed at both the individual gene and gene set level. An important component of the analytical methods we have developed is a suite of visualization tools that help to easily identify outliers and experimental flaws, measure the significance of predictions, show how lines relate and how well they can be aligned, and demonstrate the results of an analysis. These visualization tools should be used as a starting point for further biological study to test the resulting hypotheses. We also developed a software tool, Gene Attribute and Set Enrichment Ranking (GASER), which combines a wealth of genomic data from the TDR Targets web site along with expression data from a variety of sources, and allows researchers to create sophisticated weighted queries to undercover potential drug targets. Queries in our system can be updated in real time, along with their accompanying gene and gene set lists. We analyzed all possible pair-wise combinations of 11 parasite lines to create baseline distributions for gene and gene set enrichment. Using the baseline as a comparison, we identified and discarded spurious results and recognized stochastic genes and gene sets. We analyzed three major sets of parasite lines: those involving manipulation of the multidrug resistance-1 (PfMDR1) transporter, a key resistance determinant; those involving manipulation of the P. falciparum chloroquine resistance transporter (PfCRT), another important resistance determinant; and finally a set of parasites that had varying sensitivity to artemisinins. This analysis resulted in a rich library of high scoring genes that may merit further exploration as potential modes of action of resistance. More specifically, we found that manipulation of pfcrt expression resulted in an up-regulation of tRNA synthetases, which might serve to increase protein production in response to reduced amino acid availability from degraded hemoglobin. We observed that a copy number increase in pfmdr1 resulted in increases in glycerophospholipid metabolism and up-regulation of a number of ABC transporters. Finally, when comparing artemisinin sensitive to artemisinin tolerant lines, we found an increased abundance of redox metabolites and the transcripts involved in redox regulation, and significant reduction in transcription and altered expression of transcripts encoding for core histone proteins. These alterations could help confer an increased tolerance to drug induced redox perturbation by lowering endogenous redox stress. We also offer a robust computational tool, Hypergeometric Analysis of Time Series (HATS), to handle challenging biological questions related to comparison of time series experiments. Our pipeline provides a rigorous method for aligning expression experiments and then determining which genes and gene sets differ most between them. The changes in gene expression level between drug-sensitive and drug-resistant lines offer important clues in our quest for understanding mechanisms of resistance and identifying new drug targets. Our pipeline allows for comparison of future lines with our base set and holds potential for other organisms, especially those similar to Plasmodium with a strong time-dependent component. The full excel files of all the analyses performed in this thesis can be found at: (http://www.fidock.org/dan)

Clinical and pathophysiological aspects of severe falciparum malaria

Malaria is a major global public health problem. One-fifth of the world's population is at risk of malaria and drug resistance is spreading. Nearly five times as many cases of malaria were reported in 2000 as tuberculosis, AIDS, measles and leprosy cases combined. In the time it takes to say the word "malaria," ten children will contract the disease and begin fighting for their lives. Since the cinchona alkaloids were introduced as a specific treatment for agues 350 years ago, the treatment of severe malaria has changed little and therapy remains largely empirical. Quinine and quinidine remain the drugs of choice for severe chloroquine-resistant malaria due to Plasmodium falciparum, and with the spread of these resistant parasites, the usage of these drugs is increasing. In 1972 scientists in China discovered the antimalarial properties of a group of sesquiterpene lactone peroxides derived from the qinghao plant (Artemisia annua). The principal component, qinghaosu (artemisinin), and two derivatives - the water-soluble hemisuccinate artesunate and the oil-soluble artemether - are the most rapidly acting and potent of all antimalarial drugs. Although much research effort has been invested in optimizing antimalarial drug regimes, severe malaria remains a major cause of adult mortality in the Asiatic tropics. Despite many clinical trials reducing the mortality from severe malaria has proved difficult. Artemether has been shown to be as good as quinine but not better. This thesis set out to determine whether Artemether or Artesunate was the the better drug, how to manage acute renal failure in severe malaria, to design a severity score for malaria and assess whether there had been any change in the parasite clearance times in Viet Nam over a 18 year period. The results from a series of clinical trials and research from one hospital in Viet Nam are presented. This thesis undertook the following studies: 1. A randomised clinical trial of artesunate vs artemether in the treatment of severe malaria in adults in Viet Nam. 2. A randomized comparison of pumped venovenous haemofiltration and peritoneal dialysis in acute renal failure associated with severe infection. 3. Fluid management in severe malaria. 4. The stage of the development of the falciparum parasites at the time of clinical presentation with severe malaria is important in predicting outcome. 5. Development of a predictive score of outcome in adults with severe falciparum malaria. 6. Assessment of the efficacy of the artemisinin derivatives in the treatment of severe falciparum malaria in Viet Nam 1991-2008