Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.

BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People\u27s Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was \u3e75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies

Supramolecular architecture from nucleoside derivatives

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Guanosine self-association spreadsheets to calculate association constants and p-values

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem. 2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p>Excel spreadsheets allowing the calculation of self-association constant and p-values for guanosine (G).</p

C=C Excel spreadsheets to calculate binding constants and associated p-values for 2:1 binding alkynyl cytosine receptor

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem.  2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p> </p> <p>Excel spreadsheets allowing the calculation of binding constanst and p-values for guanosine (G) binding to cytosine (C) and ditopic cytosine receptors.  Determination of cooperativity.</p> <p> </p> <p> </p

C==C Excel spreadsheets to calculate self-association and p-values of dialkynyl receptor

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem. 2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p>Excel spreadsheets allowing the calculation of binding constanst and p-values for guanosine (G) binding to cytosine (C) and ditopic cytosine receptors. Determination of cooperativity.</p

C=C Excel spreadsheet to calculate binding constant for alkynyl cytosine receptor.

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem. 2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p>Excel spreadsheets allowing the calculation of binding constanst and p-values for guanosine (G) binding to cytosine (C) and ditopic cytosine receptors. Determination of cooperativity.</p

光エネルギー利用のためのホウ化物および酸化物を基軸とした高伝導性セラミック膜の研究 [論文内容及び審査の要旨]

Additional file 2. Catalogue of anti-malarials found in the private sector that were not indicated in the national treatment guidelines

C==C guanosine 2:1 Excel spreadsheets to calculate binding constant and p-values of 2:1 binding to dialkynylcytosine receptor

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem. 2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p>Excel spreadsheets allowing the calculation of binding constanst and p-values for guanosine (G) binding to cytosine (C) and ditopic cytosine receptors. Determination of cooperativity.</p

Apparent non-statistical binding in a ditopic receptor for guanosine

Analysis of stepwise association constants for guests binding to more than one site in a receptor is expected to give a ratio of the first association constant to the second of about 4 : 1 on statistical grounds (since a second guest should have an equal chance of binding to a different site on the same, or a new molecule). Taking account of self-association in our analysis of a system in which the binding sites are close together, we observe a ratio closer to 1 : 1, indicative of non-statistical, or cooperative binding. The longer homologue built around two alkynes displays a very different ratio of stepwise association constants of about 7 : 1. We discuss the origins of this unusual behaviour in terms of steric interactions within the receptors and their corresponding complexes with guanosine derivatives