Success of Senegal's first nationwide distribution of long-lasting insecticide-treated nets to children under five - contribution toward universal coverage

<p>Abstract</p> <p>Background</p> <p>In 2009, the first national long-lasting insecticide-treated net (LLIN) distribution campaign in Senegal resulted in the distribution of 2.2 million LLINs in two phases to children aged 6-59 months. Door-to-door teams visited all households to administer vitamin A and mebendazole, and to give a coupon to redeem later for an LLIN.</p> <p>Methods</p> <p>A nationwide community-based two-stage cluster survey was conducted, with clusters selected within regions by probability proportional to size sampling, followed by GPS-assisted mapping, simple random selection of households in each cluster, and administration of a questionnaire using personal digital assistants (PDAs). The questionnaire followed the Malaria Indicator Survey format, with rosters of household members and bed nets, and questions on campaign participation.</p> <p>Results</p> <p>There were 3,280 households in 112 clusters representing 33,993 people. Most (92.1%) guardians of eligible children had heard about the campaign, the primary sources being health workers (33.7%), neighbours (26.2%), and radio (22.0%). Of eligible children, 82.4% received mebendazole, 83.8% received vitamin A, and 75.4% received LLINs. Almost all (91.4%) LLINs received during the campaign remained in the household; of those not remaining, 74.4% had been given away and none were reported sold. At least one insecticide-treated net (ITN) was present in 82.3% of all households, 89.2% of households with a child < 5 years and 57.5% of households without a child < 5 years. Just over half (52.4%) of ITNs had been received during the campaign. Considering possible indicators of universal coverage, 39.8% of households owned at least one ITN per two people, 21.6% owned at least one ITN per sleeping space and 34.7% of the general population slept under an ITN the night before the survey. In addition, 45.6% of children < 5 years, and 49.2% of pregnant women had slept under an ITN.</p> <p>Conclusions</p> <p>The nationwide integrated LLIN distribution campaign allowed household ITN ownership of one or more ITNs to surpass the RBM target of 80% set for 2010, though additional distribution strategies are needed to reach populations missed by the targeted campaign and to reach the universal coverage targets of one ITN per sleeping space and 80% of the population using an ITN.</p

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease

Les sociétés médiévales, villes et campagnes, face à la question de la "soudure alimentaire" et au manque en général, dans les derniers siècles du Moyen Âge occidental et au début de l’époque moderne

In spite of the considerable progress made over the last few decades, in terms of quantity, quality and variety, in world agricultural production, the spectre, if not of famine, at least of lack of food, has not disappeared from the face of our earth: 820 million people are still threatened by hunger today, and the majority of them belong to the peasant world, particularly in South America and in several regions of Africa. The multiplication of regional conflicts (particularly in Africa and the Middle East) and recent climatic changes, which are increasing, threaten to undermine the progress made everywhere. During the lean season, between the privileged who are afraid of running out one day, the peasants and city dwellers who often run out, and the wanderers and outcasts who have nothing, all sorts of reactions are set up. These reactions, both private and public, of all societies, confronted with food shortages, constitute as many diversified responses to historical, structural and/or conjunctural situations evoked, and described especially in the European space.Malgré les progrès considérables accomplis au cours des dernières décennies, en quantité, qualité et variété, dans la production agricole mondiale, le spectre, si ce n’est de la famine, du moins du manque de nourriture, n’a pas disparu de la surface de notre terre : 820 millions de personnes sont aujourd’hui encore, menacées par la faim et la majorité d’entre elles appartiennent au monde paysan, notamment en Amérique du Sud et dans plusieurs régions de l’Afrique. Voici que la multiplication des conflits régionaux (particulièrement en Afrique et au Moyen-Orient) et les évolutions climatiques récentes, qui vont s’amplifiant, menacent de remettre partout en cause les progrès accomplis. En période de soudure, entre les privilégiés qui ont peur de manquer un jour, les paysans et citadins qui manquent souvent, les errants et exclus qui n’ont rien, se mettent en place toutes sortes de réactions. Ces dernières, tant privées que publiques, de toutes les sociétés, confrontées aux pénuries alimentaires, constituent autant de réponses diversifiées à des situations historiques, structurelles et/ou conjoncturelles évoquées, et décrites surtout dans l’espace européen

Les sociétés médiévales, villes et campagnes, face à la question de la "soudure alimentaire" et au manque en général, dans les derniers siècles du Moyen Âge occidental et au début de l’époque moderne

In spite of the considerable progress made over the last few decades, in terms of quantity, quality and variety, in world agricultural production, the spectre, if not of famine, at least of lack of food, has not disappeared from the face of our earth: 820 million people are still threatened by hunger today, and the majority of them belong to the peasant world, particularly in South America and in several regions of Africa. The multiplication of regional conflicts (particularly in Africa and the Middle East) and recent climatic changes, which are increasing, threaten to undermine the progress made everywhere. During the lean season, between the privileged who are afraid of running out one day, the peasants and city dwellers who often run out, and the wanderers and outcasts who have nothing, all sorts of reactions are set up. These reactions, both private and public, of all societies, confronted with food shortages, constitute as many diversified responses to historical, structural and/or conjunctural situations evoked, and described especially in the European space.Malgré les progrès considérables accomplis au cours des dernières décennies, en quantité, qualité et variété, dans la production agricole mondiale, le spectre, si ce n’est de la famine, du moins du manque de nourriture, n’a pas disparu de la surface de notre terre : 820 millions de personnes sont aujourd’hui encore, menacées par la faim et la majorité d’entre elles appartiennent au monde paysan, notamment en Amérique du Sud et dans plusieurs régions de l’Afrique. Voici que la multiplication des conflits régionaux (particulièrement en Afrique et au Moyen-Orient) et les évolutions climatiques récentes, qui vont s’amplifiant, menacent de remettre partout en cause les progrès accomplis. En période de soudure, entre les privilégiés qui ont peur de manquer un jour, les paysans et citadins qui manquent souvent, les errants et exclus qui n’ont rien, se mettent en place toutes sortes de réactions. Ces dernières, tant privées que publiques, de toutes les sociétés, confrontées aux pénuries alimentaires, constituent autant de réponses diversifiées à des situations historiques, structurelles et/ou conjoncturelles évoquées, et décrites surtout dans l’espace européen

Les sociétés médiévales, villes et campagnes, face à la question de la "soudure alimentaire" et au manque en général, dans les derniers siècles du Moyen Âge occidental et au début de l’époque moderne

In spite of the considerable progress made over the last few decades, in terms of quantity, quality and variety, in world agricultural production, the spectre, if not of famine, at least of lack of food, has not disappeared from the face of our earth: 820 million people are still threatened by hunger today, and the majority of them belong to the peasant world, particularly in South America and in several regions of Africa. The multiplication of regional conflicts (particularly in Africa and the Middle East) and recent climatic changes, which are increasing, threaten to undermine the progress made everywhere. During the lean season, between the privileged who are afraid of running out one day, the peasants and city dwellers who often run out, and the wanderers and outcasts who have nothing, all sorts of reactions are set up. These reactions, both private and public, of all societies, confronted with food shortages, constitute as many diversified responses to historical, structural and/or conjunctural situations evoked, and described especially in the European space.Malgré les progrès considérables accomplis au cours des dernières décennies, en quantité, qualité et variété, dans la production agricole mondiale, le spectre, si ce n’est de la famine, du moins du manque de nourriture, n’a pas disparu de la surface de notre terre : 820 millions de personnes sont aujourd’hui encore, menacées par la faim et la majorité d’entre elles appartiennent au monde paysan, notamment en Amérique du Sud et dans plusieurs régions de l’Afrique. Voici que la multiplication des conflits régionaux (particulièrement en Afrique et au Moyen-Orient) et les évolutions climatiques récentes, qui vont s’amplifiant, menacent de remettre partout en cause les progrès accomplis. En période de soudure, entre les privilégiés qui ont peur de manquer un jour, les paysans et citadins qui manquent souvent, les errants et exclus qui n’ont rien, se mettent en place toutes sortes de réactions. Ces dernières, tant privées que publiques, de toutes les sociétés, confrontées aux pénuries alimentaires, constituent autant de réponses diversifiées à des situations historiques, structurelles et/ou conjoncturelles évoquées, et décrites surtout dans l’espace européen

Medieval societies, cities and countryside, faced with the question of the "food gap" and scarcity in general, in the last centuries of the Western Middle Ages and at the beginning of the modern era

Malgré les progrès considérables accomplis au cours des dernières décennies, en quantité, qualité et variété, dans la production agricole mondiale, le spectre, si ce n’est de la famine, du moins du manque de nourriture, n’a pas disparu de la surface de notre terre : 820 millions de personnes sont aujourd’hui encore, menacées par la faim et la majorité d’entre elles appartiennent au monde paysan, notamment en Amérique du Sud et dans plusieurs régions de l’Afrique. Voici que la multiplication des conflits régionaux (particulièrement en Afrique et au Moyen-Orient) et les évolutions climatiques récentes, qui vont s’amplifiant, menacent de remettre partout en cause les progrès accomplis. En période de soudure, entre les privilégiés qui ont peur de manquer un jour, les paysans et citadins qui manquent souvent, les errants et exclus qui n’ont rien, se mettent en place toutes sortes de réactions. Ces dernières, tant privées que publiques, de toutes les sociétés, confrontées aux pénuries alimentaires, constituent autant de réponses diversifiées à des situations historiques, structurelles et/ou conjoncturelles évoquées, et décrites surtout dans l’espace européen.In spite of the considerable progress made over the last few decades, in terms of quantity, quality and variety, in world agricultural production, the spectre, if not of famine, at least of lack of food, has not disappeared from the face of our earth: 820 million people are still threatened by hunger today, and the majority of them belong to the peasant world, particularly in South America and in several regions of Africa. The multiplication of regional conflicts (particularly in Africa and the Middle East) and recent climatic changes, which are increasing, threaten to undermine the progress made everywhere. During the lean season, between the privileged who are afraid of running out one day, the peasants and city dwellers who often run out, and the wanderers and outcasts who have nothing, all sorts of reactions are set up. These reactions, both private and public, of all societies, confronted with food shortages, constitute as many diversified responses to historical, structural and/or conjunctural situations evoked, and described especially in the European space