Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance

Malaria elimination requires a variety of approaches individually optimized for different transmission settings. A recent field study in an area of low seasonal transmission in South West Cambodia demonstrated dramatic reductions in malaria parasite prevalence following both mass drug administration (MDA) and high treatment coverage of symptomatic patients with artemisinin-piperaquine plus primaquine. This study employed multiple combined strategies and it was unclear what contribution each made to the reductions in malaria.A mathematical model fitted to the trial results was used to assess the effects of the various components of these interventions, design optimal elimination strategies, and explore their interactions with artemisinin resistance, which has recently been discovered in Western Cambodia. The modelling indicated that most of the initial reduction of P. falciparum malaria resulted from MDA with artemisinin-piperaquine. The subsequent continued decline and near elimination resulted mainly from high coverage with artemisinin-piperaquine treatment. Both these strategies were more effective with the addition of primaquine. MDA with artemisinin combination therapy (ACT) increased the proportion of artemisinin resistant infections, although much less than treatment of symptomatic cases with ACT, and this increase was slowed by adding primaquine. Artemisinin resistance reduced the effectiveness of interventions using ACT when the prevalence of resistance was very high. The main results were robust to assumptions about primaquine action, and immunity.The key messages of these modelling results for policy makers were: high coverage with ACT treatment can produce a long-term reduction in malaria whereas the impact of MDA is generally only short-term; primaquine enhances the effect of ACT in eliminating malaria and reduces the increase in proportion of artemisinin resistant infections; parasite prevalence is a better surveillance measure for elimination programmes than numbers of symptomatic cases; combinations of interventions are most effective and sustained efforts are crucial for successful elimination

‘Fire Burn and Cauldron Bubble’: Iron Age and Early Roman Cauldrons of Britain and Ireland

‘A man can live to 50 but a cauldron will live to 100’ – Old Kazakh sayingThis paper presents a re-examination of Iron Age and early Roman cauldrons, a little studied but important artefact class that have not been considered as a group since the unpublished study of Loughran of 1989. Cauldrons are categorised into two broad types (projecting-bellied and globular) and four groups. New dating evidence is presented, pushing the dating of these cauldrons back to the 4th centurybc. A long held belief that cauldrons are largely absent from Britain and Ireland between 600 and 200bcis also challenged through this re-dating and the identification of cauldrons dating from 600–400bc. Detailed examination of the technology of manufacture and physical evidence of use and repair indicates that cauldrons are technically accomplished objects requiring great skill to make. Many have been extensively repaired, showing they were in use for some time. It is argued that owing to their large capacity cauldrons were not used every day but were instead used at large social gatherings, specifically at feasts. The social role of feasting is explored and it is argued that cauldrons derive much of their significance from their use at feasts, making them socially powerful objects, likely to be selected for special deposition.This is the author's accepted manuscript. The final version is published by CUP in Proceedings of the Prehistoric Society: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9392057&fileId=S0079497X14000073

Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study

<p>Abstract</p> <p>Background</p> <p><it>Zuo yuezi </it>is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of <it>zuo yuezi </it>from social, cultural and western medical perspectives.</p> <p>Methods</p> <p>We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards.</p> <p>Results</p> <p>Respondents reported that <it>zuo yuezi </it>was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. <it>Zuo yuezi </it>included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several <it>zuo yuezi </it>practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although <it>zuo yuezi </it>emphasises breast feeding.</p> <p>Conclusion</p> <p><it>Zuo yuezi </it>is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed.</p

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

BACKGROUND: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. METHODS: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15–19 years. RESULTS: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15–19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. CONCLUSION: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives

Domestic water use in the New Guinea Highlands: the case of the Raiapu Enga. May 1973.

Study of traditional patterns of water use. Data reported for the Raiapu Enga clan in the Saka Valley near Wapenamanda in the Western Highlands. Regional and environment and culture briefly described. Attitudes to water, including fear of poison,, female contamination. Sources are natural streams, rivers and springs. Rainwater also in the wet season. Pollution status varies from relatively clean to human and porcine faecal material. Water is collected in late afternoons in gourds, bamboos, tins and cooking pots, for which the average return journey takes 12.5 minutes. Each domestic group collects 2.46 liters a day of which 79% is drunk. The rest is used for cooking food (for humans and pigs), drinking for dogs, pigs and chickens, washing utensils, and discarded. Total per capita use is 0.68 litres per day. On average 0.54 litres are drunk daily and, including the water both contained in food and caused by food oxidation. 2.4 litres per day are available to the body. Per capita use decreases with increasing size of domestic group: travel time to source has no association with water use patterns. Major non-domestic uses of water include coffee washing and growing the reed-like plant Kuta from which women's aprons are made