Role of Trust in Self-Organizing Pharmaceutical Supply Chain Model with Variable Good Quality and Imperfect Information

We present an Agent-Based Model (hereafter ABM) for a pharmaceutical supply chain operating under conditions of weak regulation and imperfect information, exploring the possibility of poor quality medicines and their detection. Our interest is to demonstrate how buyers can learn about the quality of sellers (and their medicines) based on previous successful and unsuccessful transactions, thereby establishing trust over time. Furthermore, this network of trust allows the system itself to evolve to positive outcomes (under some but not all circumstances) by eliminating sellers with low quality products. The ABM we develop assumes that rational and non-corrupt agents (wholesalers, retailers and consumers) learn from experience and adjust their behaviour accordingly. The system itself evolves over time: under some — but not all — circumstances, sellers with low-quality products are progressively eliminated. Three distinct states of the supply chain are observed depending on the importance of trust built up from past experience. The “dynamic” state is characterised by a low level of trust leading to a continually changing system with new drugs introduced and rejected with little regard to quality. The “frozen” state arises from high levels of reliance on past experience and locks the supply chain into a suboptimal state. The “optimising” state has moderate reliance on past experience and leads to the persistence of suppliers with good quality; however, the system is still “invadable” by better quality drugs. Simulation results show that the state reached by the system depends strongly on the precise way that trust is established: Excessive levels of trust make it impossible for new, improved treatments to be adopted. This highlights the critical need to understand better how personal experience influences consumer behaviour, especially where regulation is weak and for products like medicines whose quality is not readily observable

Sero-prevalence and risk factors for hepatitis E virus infection among pregnant women in the Cape Coast Metropolis, Ghana

<div><p>Background</p><p>Hepatitis E virus is an emerging infection in Africa with poor maternal and foetal outcomes. There is scanty data on the sero-prevalence of HEV infection among pregnant women in Ghana. This study highlighted the prevalence and risk factors associated with HEV infection among pregnant women in Cape Coast Metropolis, Central Region of Ghana.</p><p>Methods</p><p>A multicenter (3 selected sites) analytical cross sectional study involving 398 pregnant women in the Cape Coast metropolis was conducted. HEV (Anti-HEV IgG and Anti-HEV IgM) ELISA was performed. Sero-positive women had liver chemistries done and data collected on maternal and neonatal outcomes. Data analyses were performed using Stata version 13 software (STATA Corp, Texas USA).</p><p>Results</p><p>Mean age was 28.01 (± 5.93) years. HEV sero-prevalence was 12.2% (n = 48) for IgG and 0.2% (n = 1) for IgM with overall of 12.3%. The odds of being HEV sero-positive for women aged 26–35 years was 3.1 (95% CI: 1.1–8.1), p = 0.02 and ≥36 years it was 10.7 (95% CI; 3.4–33.5), p = 0.0001. Living in urban settlement was associated with lowest odds of HEV infection {OR 0.4 (95% CI; 0.2–0.8), p = 0.01}. Factors with no statistical evidence of association include main source of drinking water and history of blood transfusion. The sero-prevalence of HEV IgG increased progressively across trimesters with the highest among women in their third trimester (55.3%). None of the 49 HEV sero-positive women had elevated ALT level. Ten (N = 41) of the neonates born to sero-positive women developed jaundice in the neonatal period. The mean birth weight was 3.1kg (SD 0.4).</p><p>Conclusion</p><p>HEV sero-prevalence among pregnant women in the Cape Coast Metropolis is high enough to deserve more attention than it has received so far. It is therefore important to conduct further research on the potential impact on maternal and neonatal mortality and morbidity in Ghana.</p></div

Liver function results of 49 pregnant women who were positive for HEV IgG and/or IgM.

<p>Liver function results of 49 pregnant women who were positive for HEV IgG and/or IgM.</p

Socio-demographic characteristics of study participants (N = 398).

<p>Socio-demographic characteristics of study participants (N = 398).</p

Pregnancy and neonatal outcome among HEV positive women (N = 42).

<p>Pregnancy and neonatal outcome among HEV positive women (N = 42).</p

Factors associated with HEV IgG positivity among study participants.

<p>Factors associated with HEV IgG positivity among study participants.</p

Obstetric and other relevant parameters of study participants.

<p>Obstetric and other relevant parameters of study participants.</p

Additional file 1: of Epidemiology of cervical human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among a cohort of HIV-infected and uninfected Ghanaian women

Questionnaire for collecting data from study participants. This is the questionnaire which was administered to all recruited women before sample collection towards this epidemiology study. (DOCX 51 kb

Logistic regression data for association of sICAM-1 and anti-VSA antibodies with CM.

<p>UM is the reference patient category.</p

Patient characteristics and laboratory data at baseline.

<p>Values reported as median (minimum-maximum) and comparisons made using Wilcoxon sign rank test. Antibody levels are expressed as mean fluorescence intensity (MFI). #ICAM-1 levels were statistically significantly higher in CM than in UM (p = 0.0037).</p><p>Anti-VSA (CD36-binding) levels were statistically significantly higher in CM than in UM (p = 0.048).</p