Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania

BACKGROUND: WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. METHODS/PRINCIPAL FINDINGS: Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). CONCLUSIONS: A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39125414

Prenatal exposures and exposomics of asthma

This review examines the causal investigation of preclinical development of childhood asthma using exposomic tools. We examine the current state of knowledge regarding early-life exposure to non-biogenic indoor air pollution and the developmental modulation of the immune system. We examine how metabolomics technologies could aid not only in the biomarker identification of a particular asthma phenotype, but also the mechanisms underlying the immunopathologic process. Within such a framework, we propose alternate components of exposomic investigation of asthma in which, the exposome represents a reiterative investigative process of targeted biomarker identification, validation through computational systems biology and physical sampling of environmental medi

Preliminary wind analysis regarding different speed ranges in the city of La Plata, Argentina

La Plata city (approximately 800 000 inhabitants) has intense traffic and industrial activity; nevertheless, the city has no governmental air monitoring network for air pollutants and winds have been scarcely studied. Wind observations provided here (covering 1998- 2007) belong to a weather station that was contrasted against the unique governmental site in the city area (the Airport). The present preliminary study analyses wind direction frequencies according to wind speeds and emphasizes wind patters within the first hour after calm occurrences. Results show that independently of the wind speed, wind direction frequency roses are in general similar to each other. Low wind speeds may occur most of the time (on average 58.2 %) and together with calm occurrences (on average 17.1% ) constitute an important factor for the accumulation of air pollutants. The proposed "outgoing of calm" wind direction frequency roses were found to be appropriate to gain knowledge in the structure of winds that transport pollutants towards exposed population after calm occurrences. Long term systematic meteorological fieldworks should be encouraged in the future so as to provide better tools for environmental modeling.A cidade de La Plata (aproximadamente 800.000 habitantes) tem tráfego e atividade industrial intensos. Contudo, não tem uma rede oficial de monitoramento para os contaminantes do ar e os ventos têm sido pouco estudados. As observações dos ventos aqui apresentadas (desde 1998 até 2007) correspondem a uma estação meteorológica que foi comparada com o único sitio oficial de registros de ventos na área urbana (o Aeroporto). O presente estudo preliminar analisa as frequências das direções do vento, segundo as suas velocidades, e coloca ênfase nos padrões de vento na primeira hora após as ocorrências calmarias. Os resultados mostram que as rosas de frequências de direções de ventos são em geral similares entre elas independentemente das velocidades. Velocidades baixas de ventos são factíveis de acontecer na maior parte do tempo (na média 58,2%), e, junto com as ocorrências de calmarias (na média 17,1%), constitui um fator importante para acumulação dos contaminantes. As rosas de frequência de direções de ventos propostas, nomeadas "saída de calmarias", resultaram ser apropriadas para o conhecimento da estrutura dos ventos que transportam os contaminantes acumulados em direção à população exposta, após períodos de calmaria. Na meteorologia deveriam se incentivados os trabalhos de campo sistemáticos, de longo prazo, de forma a prover melhores ferramentas para a modelagem de meio ambiente