Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

2015 ASEE Southeast Section Conference Anaerobic Digestion from the Laboratory to the Field: An Experimental Study into the Scalability of Anaerobic Digestion

Abstract Bench-scale laboratory experimentation is an essential component of anaerobic digestion (AD) research and development, as the ability to simultaneously test multiple variables on a smallscale to see their impact on AD efficiency helps in reducing the costs associated with optimization. To be of use there must be a strong correlation between results obtained in the lab, and the actual performance of large-scale anaerobic digesters. In this study, three differently sized bench-scale digesters (100 mL, 1 L, and 10 L) treating horse manure were tested side-byside to determine the accuracy of scaling between digester sizes. Cumulative and daily biogas production, methane content, VS-destruction, and pH of the digestate were compared. A strong correlation was found between the three digester sizes, indicating the scalability of AD is tenable. However, some statistically significant differences in biogas production showed that there is a scaling effect that must be taken into account