Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania

BACKGROUND\ud \ud Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions.\ud \ud METHODS\ud \ud We conducted community-based treatment-seeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources.\ud \ud RESULTS\ud \ud After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2-93.8) of the fever cases in children and 80.7% (68.1-90.0) in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine). However, only 22.5% (13.9-33.2) of the children and 10.5% (4.0-21.5) of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR = 7.7) but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers.\ud \ud CONCLUSION\ud \ud A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health services in delivering antimalarial treatment. Health system factors like these need to be tackled urgently in order to translate the high efficacy of newly introduced artemisinin-based combination therapy (ACT) into equitable community-effectiveness and health-impact

Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night.</p> <p>Methods</p> <p>PermaNet 2.0^®and Olyset^®were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year.</p> <p>Results</p> <p>The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use.</p> <p>Conclusion</p> <p>In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.</p

Deployment of ACT antimalarials for treatment of malaria: challenges and opportunities

Following a long period when the effectiveness of existing mono-therapies for antimalarials was steadily declining with no clear alternative, most malaria-endemic countries in Africa and Asia have adopted artemisinin combination therapy (ACT) as antimalarial drug policy. Several ACT drugs exist and others are in the pipeline. If properly targeted, they have the potential to reduce mortality from malaria substantially. The major challenge now is to get the drugs to the right people. Current evidence suggests that most of those who need the drugs do not get them. Simultaneously, a high proportion of those who are given antimalarials do not in fact have malaria. Financial and other barriers mean that, in many settings, the majority of those with malaria, particularly the poorest, do not access formal healthcare, so the provision of free antimalarials via this route has only limited impact. The higher cost of ACT creates a market for fake drugs. Addressing these problems is now a priority. This review outlines current evidence, possible solutions and research priorities

Malaria in the United Republic of Tanzania: cultural considerations and health-seeking behaviour.

Malaria is one of the biggest health problems in sub-Saharan Africa. Large amounts of resources have been invested to control and treat it. Few studies have recognized that local explanations for the symptoms of malaria may lead to the attribution of different causes for the disease and thus to the seeking of different treatments. This article illustrates the local nosology of Bondei society in the north-eastern part of the United Republic of Tanzania and shows how sociocultural context affects health-seeking behaviour. It shows how in this context therapy is best viewed as a process in which beliefs and actions are continuously debated and evaluated throughout the course of treatment

Online-Intensivtraining im Rahmen der ambulanten CI-Rehabilitation

Hintergrund: Für ein bestmögliches Sprachverstehen nach einer Cochlea Implantation ist eine intensive postoperative Hör- und Sprachtherapie unerlässlich. Meistens findet diese im Rahmen der Initial REHA aus Zeit- und Kostengründen nur 1mal pro Woche statt. Gerade für Patienten mit einem geringeren Sprachoutcome ist jedoch ein intensiveres Training anzustreben. Ziel der Studie war daher, ein online Intensivtraining additiv zur Standardtherapie vor Ort bei erwachsenen CI-Trägern zu evaluieren.Material und Methoden: Bei 13 CI-Trägern im Alter von Ø 63,83 (±10,87) Jahren mit einer CI-Erfahrung von 16,67 Monaten (±16,18) und einem Einsilberverstehen von 33,85 (±22,97) bei 65 dB und von 44,23 (±24,33) bei 80 dB gemessen am Freiburger Einsilbertest (FET) wurden insgesamt 15 Intensivtrainings (8x zur Phonologie, 7x zur Kognition, 4x zum schnellen Benennen) über einen Zeitraum von 3 Wochen (15 Termine à 30 min) additiv zur Standardtherapie vor Ort über die Plattform Sprechstunde online dargeboten. Vor und nach dem Training wurde das Sprachverstehen (FET, HSM-Test), die Phonologie (BAKO in der Adaption für Hörgeschädigte, LEMO, Lexical Decision Test), die Kognition (M3 und OSPAN der ALACog) und das schnelle Benennen (RAN-Test) überprüft.Ergebnisse: Nach dem Phonologietraining zeigte sich eine Verbesserung im HSM auf 60,57 (±35,55) (p=.22). 90,8% der Patienten gaben an, das Training sei gut in den Alltag integrierbar, 73,7%, das Hören habe sich subjektiv durch das Training verbessert. Der zeitliche Umfang wurde von 92% als angemessen beurteilt; 73,7% würden gerne ein solches wiederholen. Auch die Einschätzung der Therapeuten war durchweg positiv. Diese gaben in 100% an, ein Online-Training sei ein sinnvoller Baustein im Rahmen der CI-REHA und in 75%, ein solches könne eine ambulante vor Ort REHA für einen bestimmten Zeitraum ersetzen.Diskussion: Die vorliegende Studie bietet erste Hinweise dazu, dass ein online Intensivtraining ein geeignetes Instrument ist, um eine ambulante Rehabilitation vor Ort bei erwachsenen CI-Trägern zu ergänzen

P3.11 - Experimental and numerical evaluation of interdigitated electrode array for monitoring gaseous sterilization processes

A sensor to evaluate sterilization processes with hydrogen peroxide vapor has been introduced. Experimental, analytical and numerical methods have been applied to evaluate and study the sensor behavior. The sensor set-up is based on a planar interdigitated electrode array of a total sensing area of 20 mm2. Sensor measurements with and without microbiological spores have been conducted. Further measurements have been performed after chemical sterilization using vaporized hydrogen peroxide. The measurements were verified using a predefined published equation used to describe periodic planar interdigitated structures. Additionally, a two-dimensional periodic finite element method model was designed and simulated to validate the experimental findings