Do Malaria Vector control Measures Impact Disease-Related Behaviour and Knowledge? Evidence from a Large-scale Larviciding Intervention in Tanzania.

Recent efforts of accelerated malaria control towards the long-term goal of elimination had significant impacts in reducing malaria transmission. While these efforts need to be sustained over time, a scenario of low transmission could bring about changes in individual disease risk perception, hindering adherence to protective measures, and affecting disease-related knowledge. The goal of this study was to investigate the potential impact of a successful malaria vector control intervention on bed net usage and malaria-related knowledge. Dar es Salaam's Urban Malaria Control Program was launched in 2004 with the aim of developing a sustainable larviciding intervention. Larviciding was scaled-up using a stepped-wedge design. Cross-sectional and longitudinal data were collected using a randomized cluster sampling design (2004--2008). Prevalence ratios (PR) for the effect of the larviciding intervention on bed net usage (N = 64,537) and household heads' knowledge of malaria symptoms and transmission (N = 11,254) were obtained from random effects regression models.\ud The probability that individuals targeted by larviciding had used a bed net was reduced by 5% as compared to those in non-intervention areas (PR = 0.95; 95% credible intervals (CrI): 0.94-0.97) and the magnitude of this effect increased with time. Larviciding also led to a decline in household heads' knowledge of malaria symptoms (PR = 0.88; 95% CrI: 0.83-0.92) but no evidence of effect on knowledge of malaria transmission was found. Successful control interventions could bring about further challenges to sustaining gains in reducing malaria transmission if not accompanied by strategies to avoid changes in individual knowledge and behaviour. This study points to two major research gaps. First, there is an urgent need to gather more evidence on the extent to which countries that have achieved significant decline in malaria transmission are also observing changes in individual behaviour and knowledge. Second, multidisciplinary assessments that combine quantitative and qualitative data, utilizing theories of health behaviour and theories of knowledge, are needed to optimize efforts of national malaria control programmes, and ultimately contribute to sustained reduction in malaria transmission

Cost-effectiveness of larviciding for urban malaria control in Tanzania

Background: Larviciding for malaria control can contribute to an Integrated Vector Management (IVM) approach. This intervention is currently supported in settings where breeding habitats are ‘few, fixed, and findable’, such as urban areas of sub-Saharan Africa, but the knowledge base regarding the cost-effectiveness of larviciding is non-existent. Methods: Programme costs and effectiveness data were collected from the Dar es Salaam Urban Malaria Control Programme in Tanzania. Cost-effectiveness ratios (CER) were estimated from the provider and societal perspectives for standard indicators using different malaria transmission scenarios. Results: CER for microbial larviciding were highly dependent on the assumed baseline malaria incidence rates. Using the societal perspective, net CER were estimated (in 2012 US dollars) at $43 (95$15-181) per disability-adjusted life year averted (DALY) when malaria incidence was 902 infections per 1,000 individuals, increasing to $545 (95$337-1,558) per DALY at an incidence of 122 per 1,000. Larviciding was shown to be cost-effective in Tanzania for incidences as low as 40 infections per 1,000 people per year. Conclusion: This is believed to be the first study to estimate the cost-effectiveness of larviciding for urban malaria control in sub-Saharan Africa. The results support the use of larviciding as a cost-effective intervention in urban areas and managers of national malaria control programme should consider this intervention as part of an IVM approach. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-477) contains supplementary material, which is available to authorized users

Highly Ionized High-Velocity Clouds toward PKS 2155-304 and Markarian 509

To gain insight into four highly ionized high-velocity clouds (HVCs) discovered by Sembach et al. (1999), we have analyzed data from the Hubble Space Telescope (HST) and Far Ultraviolet Spectroscopic Explorer (FUSE) for the PKS 2155-304 and Mrk 509 sight lines. We measure strong absorption in OVI and column densities of multiple ionization stages of silicon (SiII/III/IV) and carbon (CII/III/IV). We interpret this ionization pattern as a multiphase medium that contains both collisionally ionized and photoionized gas. Toward PKS 2155-304, for HVCs at -140 and -270 km/s, respectively, we measure logN(OVI)=13.80+/-0.03 and log N(OVI)=13.56+/-0.06; from Lyman series absorption, we find log N(HI)=16.37^(+0.22)_(-0.14) and 15.23^(+0.38)_(-0.22). The presence of high-velocity OVI spread over a broad (100 km/s) profile, together with large amounts of low-ionization species, is difficult to reconcile with the low densities, n=5x10^(-6) cm^(-3), in the collisional/photoionization models of Nicastro et al. (2002), although the HVCs show a similar relation in N(SiIV)/N(CIV) versus N(CII)/N(CIV) as high-z intergalactic clouds. Our results suggest that the high-velocity OVI in these absorbers do not necessarily trace the WHIM, but instead may trace HVCs with low total hydrogen column density. We propose that the broad high-velocity OVI absorption arises from shock ionization, at bowshock interfaces produced from infalling clumps of gas with velocity shear. The similar ratios of high ions for HVC Complex C and these highly ionized HVCs suggest a common production mechanism in the Galactic halo.Comment: 38 pages, including 10 figures. ApJ, 10 April, 2004. Replaced with accepted versio

Factors affecting providers’ delivery of intermittent preventive treatment for malaria in pregnancy: a five-country analysis of national service provision assessment surveys

Background: Intermittent preventive treatment in pregnancy (IPTp) delivered during antenatal care (ANC) visits has been shown to be a highly efficacious and cost-effective intervention. Given the high rates of ANC attendance in sub-Saharan Africa, the current low IPTp coverage represents considerable missed opportunities. The objective of this study was to explore factors affecting provider’s delivery of IPTp during ANC consultations. Methods: Data from five nationally representative service provision assessment surveys informed the statistical analyses (Kenya, Namibia, Rwanda, Tanzania, and Uganda; 2006-2010). Poisson regression models with robust/clustered standard errors were used to estimate the effect of different determinants on IPTp delivery from 4,971 observed ANC consultations. Results: The five major modifiable determinants of IPTp delivery were: 1) user-fees for ANC medicines (relative risk (RR) = 0.76; 95% confidence intervals (95% CI): 0.62-0.93); 2) facilities having IPTp guidelines (RR = 1.12; 95% CI: 1.01-1.24); 3) facilities having implemented IPTp as part of their routine ANC services offering (RR = 4.18; 95% CI: 1.75-10.01); 4) stock-outs of sulphadoxine-pyrimethamine (RR = 0.40; 95% CI: 0.27-0.60); and, 5) providers having received IPTp training (RR = 1.21; 95% CI: 1.09-1.35). Using the population-attributable fraction, it was estimated that addressing these barriers jointly could lead to a 31% increase in delivery of this intervention during ANC consultations. Of these four potentially modifiable determinants, training of providers for IPTp had the largest potential impact. Conclusions: If proved to be cost-effective, dispensing IPTp training to ANC providers should be prioritized. Multifaceted approaches targeted in areas of low coverage and/or type of facilities least likely to provide this intervention should be implemented if the Roll Back Malaria target of 100% IPTp coverage by 2015 is to be attained. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-440) contains supplementary material, which is available to authorized users

Reliability of Quality Assessments in Research Synthesis: Securing the Highest Quality Bioinformation for HIT.

Current trends in bio-medicine include research synthesis and dissemination of bioinformation by means of health (bio) information technology (H[b] IT). Research must secure the validity and reliability of assessment tools to quantify research quality in the pursuit of the best available evidence. Our concerted work in this domain led to the revision of three instruments for that purpose, including the stringent characterization of inter-rater reliability and coefficient of agreement. It is timely and critical to advance the methodological development of the science of research synthesis by strengthening the reliability of existing measure of research quality in order to ensure H[b] IT efficacy and effectiveness

Sex and the Cinema: What American Pie Teaches the Young

This paper focuses upon the wildly successful blockbuster American Pie teenpics, especially American Pie 3 – the Wedding. I argue that these films, which are sited so securely within the visual and pedagogical machinery of Hollywood culture, are specifically designed to appeal to teenage male audiences, and to provide lessons in sex and romance. Movies like this are especially important as they are experienced by far more teenagers than, for example, instructional films or other classroom materials; indeed, as Henry Giroux has observed, "teens and youth learn how to define themselves outside of the traditional sites of instruction, such as the home and the school… Learning in the postmodern age is located elsewhere – in popular spheres that shape their identities, through forms of knowledge and desires that appear absent from what is taught in schools" (Giroux, 1997, p.49). In this paper I discuss whether the American Pie series is actually a "new age" effort which, via insubordinate performances of gender, contests the hegemonic field of signification which regulates the production of sex, gender and desire, or whether it is more accurately described as a retrogressive hetero-conservative opus with a veneer of sexual radicalism. In short, I intend to probe whether this filmic vector for sex education is all about the shaping of responsible, caring, vulnerable men, or is it guiding them to become just like their heterosexual, middle-class fathers? And whether, despite its riotous and raunchy advertising, American Pie really dishes up something spicy or something terribly wholesome instead

Public geographies II: being organic

This second report on ‘public geographies' considers the diverse, emergent and shifting spaces of engaging with and in public/s. Taking as its focus the more ‘organic’ rather than ‘traditional’ approach to doing public geography, as discussed in the first report, it explores the multiple and unorthodox ways in which engagements across academic-public spheres play out, and what such engagements may mean for geography/ers. The report first explores the role of the internet in ‘enabling conversations', generating a range of opportunities for public geography through websites, wikis, blogs, file-sharing sites, discussion forums and more, thinking critically about how technologies may enable/disable certain kinds of publically engaged activities. It then considers issues of process and praxis: how collaborations with groups/communities/organizations beyond academia are often unplanned, serendipitous encounters that evolve organically into research/learning/teaching endeavours; but also that personal politics/positionality bring an agency to bear upon whether we, as academics, follow the leads we may stumble upon. The report concludes with a provocative question – given that many non-academics appear to be doing some amazing and inspiring projects and activities, thoughtful, critical and (arguably) examples of organic public geographies, what then is academia’s role