Deworming delusions in the search for scientific certainty

Duncan Green and Mohga Kamal-Yanni analyse the latest developments in Worm Wars

Options for Scaling up Community-Based Health Insurance for Rural Communities in Armenia

This paper summarises the results of a study which examined international experience with regard to community-based health financing (CBHF) schemes, scaling up CBHF schemes, and the feasibility of scaling up community-based health insurance (CBHI) in Armenia. It was based on a literature review of international experience and qualitative research in Armenia. The recommendations derived from this study have relevance both for Armenia and for the use of CBHI schemes as a tool for promoting pro-poor health system reform in low-resource settings more generally

2-(2-Hy­droxy­phen­yl)-3,4-dihydro­iso­quinolin-1(2H)-one

There are two independent mol­ecules in the asymmetric unit of the title compound, C15H13NO2, in both the six-membered dihydro­pyridine rings adopt a half-chair conformation. The two benzene rings make dihedral angles of 43.66 (10) and 62.22 (10)° in the two mol­ecules. In the crystal, the two independent mol­ecules are linked alternately by inter­molecular O—H⋯O hydrogen bonds, forming a zigzag chain along the c axis. Furthermore, inter­molecular C—H⋯π inter­actions link the chains into a three-dimensional network

2-(2-Iodo­phen­yl)-1,2,3,4-tetra­hydro­isoquinoline-1-carbonitrile

In the title compound, C16H13IN2, the two benzene rings make a dihedral angle of 67.26 (5)°. The six-membered heterocycle of the tetra­hydro­isoquinoline unit adopts a half-chair conformation. In the crystal, adjacent mol­ecules are linked by pairs of weak inter­molecular C—H⋯N hydrogen bonds, forming inversion dimers. An intra­molecular C—H⋯I close contact is also observed

Improved basic life support skills and patient transportation at ambulance drivers in Medan Tuntung and Medan Sunggal area to improve patient safety

The technique of providing basic and quick life support (BHD) and transportation to patients with cardiac and pulmonary arrest can save a patient's life. An ambulance driver as one of the ambulance personnel should be equipped with the two forms of skills above. The aim of community service is to increase the capacity of ambulance drivers in terms of providing basic life support skills and patient transportation to improve patient safety. This training was held in September 2019, at the H. Adam Malik General Hospital Training Center Installation Medan, with 24 participants. The training is carried out with 2 methods, namely exposure to BHD theory and BHD skills training. The knowledge and skills of participants before and after the training were assessed. Pre and post assessment results were analyzed using paired t-test with a significance level of p <0.05 Ambulance drivers in the Medan Tuntung and Medan Sunggal area are mostly over 30 years old, with most working as ambulance drivers for more than 5 years. The most recent level of education is high school graduation or equivalent. The results of statistical analysis using paired t-test, obtained a significant difference in the knowledge of ambulance drivers about basic life support theory before and after training (p = 0.000). Likewise, ambulance driver skills in providing basic life support for adult patients, infants and children were significantly different before and after training (p = 0.000). Training in basic life support skills and patient transportation can increase the capacity of ambulance drivers in providing basic life support.

A pandemic treaty for equitable global access to medical countermeasures:seven recommendations for sharing intellectual property, know-how and technology Comment

The COVID-19 pandemic highlighted how current international laws and practices fail to ensure medical countermeasures (ie, vaccines, therapeutics, diagnostics and personal protective equipment) are equitably distributed in a global health crisis. In 2021, the 194 Member States of the World Health Organization agreed to begin negotiations towards an international instrument that would better position the world to prevent, respond and prepare for future pandemics (often called a ‘pandemic treaty’.) A pandemic treaty presents an opportunity to address these challenges in international law, and craft a better system, based on solidarity, for the global development and distribution of medical countermeasures. We recommend that a pandemic treaty ensures sufficient financing for biomedical research and development (R&D), creates conditions for licensing government-funded R&D, mandates technology transfer, shares intellectual property, data and knowledge needed for the production and supply of products, and streamlines regulatory standards and procedures to market medical countermeasures. We also recommend that a pandemic treaty ensures greater transparency and inclusive governance of these systems. The aim of these components in a pandemic treaty should be to craft a better collective response to global health threats, consistent with existing international law, political commitments and sound public health practice

Quality of care for the treatment for uncomplicated malaria in South-East Nigeria: how important is socioeconomic status?

Introduction: Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups. Methods: A total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey. Results: Among the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups. Conclusions: The quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind

Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies.

Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4).\ud Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops

Retail sector distribution chains for malaria treatment in the developing world: a review of the literature

BACKGROUND: In many low-income countries, the retail sector plays an important role in the treatment of malaria and is increasingly being considered as a channel for improving medicine availability. Retailers are the last link in a distribution chain and their supply sources are likely to have an important influence on the availability, quality and price of malaria treatment. This article presents the findings of a systematic literature review on the retail sector distribution chain for malaria treatment in low and middle-income countries. METHODS: Publication databases were searched using key terms relevant to the distribution chain serving all types of anti-malarial retailers. Organizations involved in malaria treatment and distribution chain related activities were contacted to identify unpublished studies. RESULTS: A total of 32 references distributed across 12 developing countries were identified. The distribution chain had a pyramid shape with numerous suppliers at the bottom and fewer at the top. The chain supplying rural and less-formal outlets was made of more levels than that serving urban and more formal outlets. Wholesale markets tended to be relatively concentrated, especially at the top of the chain where few importers accounted for most of the anti-malarial volumes sold. Wholesale price mark-ups varied across chain levels, ranging from 27% to 99% at the top of the chain, 8% at intermediate level (one study only) and 2% to 67% at the level supplying retailers directly. Retail mark-ups tended to be higher, and varied across outlet types, ranging from 3% to 566% in pharmacies, 29% to 669% in drug shops and 100% to 233% in general shops. Information on pricing determinants was very limited. CONCLUSIONS: Evidence on the distribution chain for retail sector malaria treatment was mainly descriptive and lacked representative data on a national scale. These are important limitations in the advent of the Affordable Medicine Facility for Malaria, which aims to increase consumer access to artemisinin-based combination therapy (ACT), through a subsidy introduced at the top of the distribution chain. This review calls for rigorous distribution chain analysis, notably on the factors that influence ACT availability and prices in order to contribute to efforts towards improved access to effective malaria treatment