Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali.

Malaria is the most common cause of morbidity and mortality in children under 5 in Mali. Health centres provide primary care, including malaria treatment, under a system of cost recovery. In 2005, Médecins sans Frontieres (MSF) started supporting health centres in Kangaba with the provision of rapid malaria diagnostic tests and artemisinin-based combination therapy. Initially MSF subsidized malaria tests and drugs to reduce the overall cost for patients. In a second phase, MSF abolished fees for all children under 5 irrespective of their illness and for pregnant women with fever. This second phase was associated with a trebling of both primary health care utilization and malaria treatment coverage for these groups. MSF's experience in Mali suggests that removing user fees for vulnerable groups significantly improves utilization and coverage of essential health services, including for malaria interventions. This effect is far more marked than simply subsidizing or providing malaria drugs and diagnostic tests free of charge. Following the free care strategy, utilization of services increased significantly and under-5 mortality was reduced. Fee removal also allowed for more efficient use of existing resources, reducing average cost per patient treated. These results are particularly relevant for the context of Mali and other countries with ambitious malaria treatment coverage objectives, in accordance with the United Nations Millennium Development Goals. This article questions the effectiveness of the current national policy, and the effectiveness of reducing the cost of drugs only (i.e. partial subsidies) or providing malaria tests and drugs free for under-5s, without abolishing other related fees. National and international budgets, in particular those that target health systems strengthening, could be used to complement existing subsidies and be directed towards effective abolition of user fees. This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid

Déterminants de la demande de soins en milieu péri-urbain dans un contexte de subvention à Pikine, Sénégal

Depuis les années 2000, le Sénégal a adopté des politiques nationales visant la suppression progressive du paiement direct au point de services pour rendre les soins de santé plus accessibles. La mise en place de ces politiques de subvention et de gratuité dans un espace dense hétérogène voire hétéroclite, présente une situation particulière. Pour comprendre ces interactions et étudier le comportement des ménages en matière de demande de soins, 5520 individus ont étés enquêtés à quatre reprises sur la période 2010-2011 dans la banlieue de Dakar (Pikine), un probit multinomial est estimé pour étudier la demande de soins de la population face à un épisode de maladie. Les résultats montrent que l'effet négatif du prix est en moyenne assez faible, mais qu'il varie en fonction du niveau de revenu et de la sévérité de la maladie. La qualité perçue des soins a un effet positif sur le recours aux services de santé privés pour lesquels on observe une compensation de l'effet négatif du prix par la qualité. L'effet de l'âge n'est pas linéaire et les enfants, plus touchés par la maladie, bénéficient de peu d'exemption ou du moins d'exemption partielle contrairement aux personnes âgées qui bénéficient d'exemption totale (plan SESAME)

Spectral Sparsification and Regret Minimization Beyond Matrix Multiplicative Updates

In this paper, we provide a novel construction of the linear-sized spectral sparsifiers of Batson, Spielman and Srivastava [BSS14]. While previous constructions required $\Omega(n^4)$ running time [BSS14, Zou12], our sparsification routine can be implemented in almost-quadratic running time $O(n^{2+\varepsilon})$. The fundamental conceptual novelty of our work is the leveraging of a strong connection between sparsification and a regret minimization problem over density matrices. This connection was known to provide an interpretation of the randomized sparsifiers of Spielman and Srivastava [SS11] via the application of matrix multiplicative weight updates (MWU) [CHS11, Vis14]. In this paper, we explain how matrix MWU naturally arises as an instance of the Follow-the-Regularized-Leader framework and generalize this approach to yield a larger class of updates. This new class allows us to accelerate the construction of linear-sized spectral sparsifiers, and give novel insights on the motivation behind Batson, Spielman and Srivastava [BSS14]

Malaria, Production and Income of the Producers of Coffee and Cocoa: an Analysis from Survey Data in Côte d'Ivoire. Malaria, coffee and cocoa production and income

The sectors of coffee and cocoa represented in Côte d'Ivoire, before the political crisis, approximately 15% of the GDP and 40% of exports. The zones of production of these two cultures are in the forest area which is infected with malaria. The culture of these products is less constraining than that of the food crops such as rice or yam (one does not need to replant each year for example). However, the maintenance of the ground and of the trees and pest management contribute to obtain high yields. In addition, these products allow the producers to obtain monetary income. However, output is not the sole determinant of the level of income: precocity and speed of gathering, by permitting early sale, contribute to get higher income. In addition, food crops such as rice growing, are produced in the area. The objective of this paper is twofold, first, to evaluate the role of malaria on coffee and cocoa productions, second, to assess if the behaviour of rural households facing a liberalisation of the coffee and cocoa chains has an impact on their income. Three functions are thus estimated: production of coffee, production of cocoa and income. Data are taken from a survey carried out on 800 households (21 villages) in 1999 in the forest area of Danané. The main results are the absence of malaria impact on productions and the dominance of individual over collective sale strategies

Gain properties of dye-doped polymer thin films

Hybrid pumping appears as a promising compromise in order to reach the much coveted goal of an electrically pumped organic laser. In such configuration the organic material is optically pumped by an electrically pumped inorganic device on chip. This engineering solution requires therefore an optimization of the organic gain medium under optical pumping. Here, we report a detailed study of the gain features of dye-doped polymer thin films. In particular we introduce the gain efficiency $K$, in order to facilitate comparison between different materials and experimental conditions. The gain efficiency was measured with various setups (pump-probe amplification, variable stripe length method, laser thresholds) in order to study several factors which modify the actual gain of a layer, namely the confinement factor, the pump polarization, the molecular anisotropy, and the re-absorption. For instance, for a 600 nm thick 5 wt\% DCM doped PMMA layer, the different experimental approaches give a consistent value $K\simeq$ 80 cm.MW$^{-1}$. On the contrary, the usual model predicting the gain from the characteristics of the material leads to an overestimation by two orders of magnitude, which raises a serious problem in the design of actual devices. In this context, we demonstrate the feasibility to infer the gain efficiency from the laser threshold of well-calibrated devices. Besides, temporal measurements at the picosecond scale were carried out to support the analysis.Comment: 15 pages, 17 figure

An insight into polarization states of solid-state organic lasers

The polarization states of lasers are crucial issues both for practical applications and fundamental research. In general, they depend in a combined manner on the properties of the gain material and on the structure of the electromagnetic modes. In this paper, we address this issue in the case of solid-state organic lasers, a technology which enables to vary independently gain and mode properties. Different kinds of resonators are investigated: in-plane micro-resonators with Fabry-Perot, square, pentagon, stadium, disk, and kite shapes, and external vertical resonators. The degree of polarization P is measured in each case. It is shown that although TE modes prevail generally (P>0), kite-shaped micro-laser generates negative values for P, i.e. a flip of the dominant polarization which becomes mostly TM polarized. We at last investigated two degrees of freedom that are available to tailor the polarization of organic lasers, in addition to the pump polarization and the resonator geometry: upon using resonant energy transfer (RET) or upon pumping the laser dye to an higher excited state. We then demonstrate that significantly lower P factors can be obtained.Comment: 12 pages, 12 figure

Master Equation Study of Hydrogen Relaxation Using Complete Sets of State-to-state Transition Rates

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97096/1/AIAA2012-362.pd