Who is responsible for global road safety? A cross-cultural comparison of Actor Maps

The traditional three ‘E’s approach to road safety (engineering, education, enforcement) has had, and will continue to have, a significant impact on road traffic casualty rates worldwide. Nevertheless, with rising motorisation in many countries, global fatality numbers have changed little over the past decade. Following calls for the application of sociotechnical systems thinking to the problem, we widen the road safety discussion with an additional four ‘E’s; economics, emergency response, enablement, and, the umbrella term for the approach taken, ergonomics. The research presents an application of Rasmussen’s Risk Management Framework to the road safety systems of five distinct nations; Bangladesh, China, Kenya, the UK, and Vietnam. Following site visits, reviews of literature, and interviews with subject matter experts in each of the countries, a series of Actor Map models of the countries’ road safety systems were developed. These are compared and discussed in terms of the wide variety of interconnecting organisations involved, their influences on road safety outcomes, the differences between nations, and the need to look beyond road users when designing road safety interventions

Response to diazepam in children with malaria induced seizures

Malaria infection reduces the binding capacity of benzodiazepine receptors in mice. We studied the efficacy of diazepam terminating seizures in children with falciparum malaria. Diazepam stopped seizures in fewer patients with malaria parasitaemia (χ2 = 3.93, P = 0.047) and those with clinical diagnosis of malaria (χ2 = 9.84, P = 0.002) compared to those without. However malaria was not identified as an independent risk factor for diazepam's failure to stop seizures in children

NON-TYPHI SALMONELLA IN CHILDREN WITH SEVERE MALARIA

Objective: To determine the association between Plasmodium falciparum malaria andnon-typhi Salmonella in children.Design: Cross-sectional hospital based study.Setting: Kilifi District Hospital (KDH) between January 1997 and June 2001.Subjects: Children aged between three months to 123 months (mean age 28.28 months)and who had been admitted to the paediatric or High Dependency Research Ward(HDRW) of the KDH.Methods: A total of 19, 118 blood cultures routinely obtained for all admissions and1,820 clinically indicated stools samples were obtained from 9,147 children admittedwith malaria. The specimens were cultured and antibiotic sensitivity done using standardlaboratory procedures with stringent internal and external quality control in place.Results: The total bacterial pathogens isolated from blood and stool were 1,395/19,118(7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395(18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out ofwhich a total of 101 NTS occurred in children with severe malaria. Out of the 9,147malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS withsevere malaria as a proportion of all malaria admissions for the period varied between0.8% and 1.5%. There was a significant association (p-value=0.032) between clinicaloutcome of death and female sex of the patient. The NTS isolates which occurred withsevere malaria showed various levels of antibiotic resistance. They were resistant toampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%),sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%),amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR)was seen in 34 (33.6%) of the isolates.Conclusions: NTS and severe malaria occurring together are a problem in this areaand that a large number of the isolates are MDR. An elaborate case-controlled studyis required to elucidate the chain of events of both NTS and malaria parasite co-existence