Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study.

In malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case-control study of children aged 2-59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age-matched controls (PCV > or = 25%). Most cases [55.6% (n = 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health-seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9-6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3-3.9), P = 0.005], malnutrition [OR 2.4 (95%CI 1.3-4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9-4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7-9.1), P < 0.001] and P. falciparum parasitaemia [OR 9.5 (95% CI 4.3-21.3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control

Matter–Form (Hylomorphism) in Early Modern Alchemy

info:eu-repo/semantics/publishe

A global evaluation of coral reef management performance: are MPAs producing conservation and socio-economic improvements?

There is a consensus that Marine Protected Area (MPA) performance needs regular evaluation against clear criteria, incorporating counterfactual comparisons of ecological and socio-economic performance. However, these evaluations are scarce at the global level. We compiled self-reports from managers and researchers of 78 coral reef-based MPAs world-wide, on the conservation and welfare improvements that their MPAs provide. We developed a suite of performance measures including fulfilment of design and management criteria, achievement of aims, the cessation of banned or destructive activities, change in threats, and measurable ecological and socio-economic changes in outcomes, which we evaluated with respect to the MPA's age, geographical location and main aims. The sample was found to be broadly representative of MPAs generally, and suggests that many MPAs do not achieve certain fundamental aims including improvements in coral cover over time (in 25% of MPAs), and conflict reduction (in 25%). However, the large majority demonstrated improvements in terms of slowing coral loss, reducing destructive uses and increasing tourism and local employment, despite many being small, underfunded and facing multiple large scale threats beyond the control of managers. However spatial comparisons suggest that in some regions MPAs are simply mirroring outside changes, with demonstrates the importance of testing for additionality. MPA benefits do not appear to increase linearly over time. In combination with other management efforts and regulations, especially those relating to large scale threat reduction and targeted fisheries and conflict resolution instruments, MPAs are an important tool to achieve coral reef conservation globally. Given greater resources and changes which incorporate best available science, such as larger MPAs and no-take areas, networks and reduced user pressure, it is likely that performance could further be enhanced. Performance evaluation should test for the generation of additional ecological and socio-economic improvements over time and compared to unmanaged areas as part of an adaptive management regime