A Feminist Political Economy Analysis of Medical Broker and Fertility Clinic Websites

This dissertation studies the ways in which market-based reproductive health services are advertised and virtually represented on a global scale. I detail the implicit values and assumptions found in the content of reproductive tourism websites. In doing so, I show how medical broker and fertility clinic websites reproduce dominant ideologies and how these websites portray reproductive tourists, egg providers and surrogates. Using a feminist political economy approach, I situate the practice of reproductive tourism within particular historical, economic and political contexts, including both domestic and global neoliberal healthcare reforms. The findings of this thesis reveal that the websites portray neoliberal policies that emphasize consumerism, individual responsibility for ones healthcare and that position reproductive tourists as empowered consumers capable of making informed choices in purchasing new reproductive technologies (NRTs). The marketing of reproductive tourism on these websites also ignore the physical and affective labour of women who are egg providers and surrogates and minimizes the unequal power relationships that exist between reproductive tourists and egg providers and surrogates. Their experiences are erased from view and their bodies objectified and fragmented for market consumption

Modelling the Requirements and Benefits of Mosquito Control Interventions in the Presence of Mosquito Dispersal

Vector control methods are widely used as a means to control malaria, however, the role of spatial arrangement when deploying these interventions is not well known. Understanding the effects of spatial distribution and clustering of interventions on mosquito populations can provide a guide to strategically deploying interventions to effectively maximize benefits. A recently developed discrete-space continuous-time mathematical model of mosquito population dynamics and dispersal was extended to incorporate vector control interventions of insecticide residual spraying (IRS), larviciding and insecticide treated bednets (ITNs). Model simulations were used to determine intervention deployment strategies, for certain coverage levels, which maximize the benefits of interventions. Assuming homogeneous distribution of water resources and humans, then clustering of IRS and larviciding interventions, when only low coverage is possible, is more beneficial than random deployment. However, with moderate coverage of these interventions, there is no added benefit with clustering compared to random deployment. For low coverage of ITNs, clustering their distribution lowers the\ud benefits. Surprisingly, with moderate coverage of ITNs then random deployment of ITNs to humans is more beneficial than clustering. There is evidence that the effectiveness of an intervention is highly dependent on its spatial distribution. Although the results presented here are based on model\ud assumptions, the findings are useful to consider when designing modes of deployment of interventions to offer maximal benefits.\u

Creative Activism – learning everywhere with children and young people

Creative activism is an approach to education that asks, ‘What can happen when we take learning outside the classroom and think of it happening everywhere?’. Two charities - House of Imagination and Cambridge Curiosity and Imagination - have been asking this question in their creative place-making programmes working with socially engaged artists and communities linked to primary schools in Bath and Cambridge. Young children and adults co-create and speculate about the future of their communities and environments in these different geographical locations. This article draws together our shared understanding of creative pedagogies and the value to everyone of working in this way

State of inequality in malaria intervention coverage in sub-Saharan African countries

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries.; Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015.; There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions.; Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity

A Study to Characterize and Source Hydrocarbon Contamination of Sediments and Scallops in the Port au Port Bay, NL

The local fish harvesters of the Port au Port area noticed an increase in the number of dead/empty scallops (also known as ‘clappers’) in the Fall of 2012. By 2013 almost all of the scallops in the area were clappers. For example, in one catch, 160 of 176 scallops were clappers (Gale, 2014). This problem has been limited to the Port au Port area including Fox Island, Shag Island, and Long Point and Shoal Point areas (Hillier, 2014). However, clappers are not a problem in nearby St. George (Fig. 1a). Scallops have been tested and determined to be free of disease. However, testing has not been performed to determine if organic or inorganic contamination could have been the cause in the collapse of the scallops’ fishery in the Port-au-Port area in 2013. In the Port au Port area alone there are typically 12 to 15 scallop draggers from July to December, and it is estimated that the lost of the scallops in this area will cost these individuals 25% of their income (Hillier, 2014). The Port au Port Fishery Committee asked for help to identify the cause and potential remediation of loss of their scallop fishery. The Port au Port Fishery Committee identified a number of potential causes including seismic testing, environmental contamination due to dumping and drilling, and climate change

Simulation of the cost-effectiveness of malaria vaccines

<p>Abstract</p> <p>Background</p> <p>A wide range of possible malaria vaccines is being considered and there is a need to identify which vaccines should be prioritized for clinical development. An important element of the information needed for this prioritization is a prediction of the cost-effectiveness of potential vaccines in the transmission settings in which they are likely to be deployed. This analysis needs to consider a range of delivery modalities to ensure that clinical development plans can be aligned with the most appropriate deployment strategies.</p> <p>Methods</p> <p>The simulations are based on a previously published individual-based stochastic model for the natural history and epidemiology of <it>Plasmodium falciparum </it>malaria. Three different vaccine types: pre-erythrocytic vaccines (PEV), blood stage vaccines (BSV), mosquito-stage transmission-blocking vaccines (MSTBV), and combinations of these, are considered each delivered via a range of delivery modalities (Expanded Programme of Immunization – EPI-, EPI with booster, and mass vaccination combined with EPI). The cost-effectiveness ratios presented are calculated for four health outcomes, for assumed vaccine prices of US$2 or US$ 10 per dose, projected over a 10-year period.</p> <p>Results</p> <p>The simulations suggest that PEV will be more cost-effective in low transmission settings, while BSV at higher transmission settings. Combinations of BSV and PEV are more efficient than PEV, especially in moderate to high transmission settings, while compared to BSV they are more cost-effective in moderate to low transmission settings. Combinations of MSTBV and PEV or PEV and BSV improve the effectiveness and the cost-effectiveness compared to PEV and BSV alone only when applied with EPI and mass vaccinations. Adding booster doses to the EPI is unlikely to be a cost-effective alternative to delivering vaccines via the EPI for any vaccine, while mass vaccination improves effectiveness, especially in low transmission settings, and is often a more efficient alternative to the EPI. However, the costs of increasing the coverage of mass vaccination over 50% often exceed the benefits.</p> <p>Conclusion</p> <p>The simulations indicate malaria vaccines might be efficient malaria control interventions, and that both transmission setting and vaccine delivery modality are important to their cost-effectiveness. Alternative vaccine delivery modalities to the EPI may be more efficient than the EPI. Mass vaccination is predicted to provide substantial health benefits at low additional costs, although achieving high coverage rates can lead to substantial incremental costs.</p

Incidence and admission rates for severe malaria and their impact on mortality in Africa

Appropriate treatment of life-threatening Plasmodium falciparum malaria requires in-patient care. Although the proportion of severe cases accessing in-patient care in endemic settings strongly affects overall case fatality rates and thus disease burden, this proportion is generally unknown. At present, estimates of malaria mortality are driven by prevalence or overall clinical incidence data, ignoring differences in case fatality resulting from variations in access. Consequently, the overall impact of preventive interventions on disease burden have not been validly compared with those of improvements in access to case management or its quality.; Using a simulation-based approach, severe malaria admission rates and the subsequent severe malaria disease and mortality rates for 41 malaria endemic countries of sub-Saharan Africa were estimated. Country differences in transmission and health care settings were captured by use of high spatial resolution data on demographics and falciparum malaria prevalence, as well as national level estimates of effective coverage of treatment for uncomplicated malaria. Reported and modelled estimates of cases, admissions and malaria deaths from the World Malaria Report, along with predicted burden from simulations, were combined to provide revised estimates of access to in-patient care and case fatality rates.; There is substantial variation between countries' in-patient admission rates and estimated levels of case fatality rates. It was found that for many African countries, most patients admitted for in-patient treatment would not meet strict criteria for severe disease and that for some countries only a small proportion of the total severe cases are admitted. Estimates are highly sensitive to the assumed community case fatality rates. Re-estimation of national level malaria mortality rates suggests that there is substantial burden attributable to inefficient in-patient access and treatment of severe disease.; The model-based methods proposed here offer a standardized approach to estimate the numbers of severe malaria cases and deaths based on national level reporting, allowing for coverage of both curative and preventive interventions. This makes possible direct comparisons of the potential benefits of scaling-up either category of interventions. The profound uncertainties around these estimates highlight the need for better data

Future use-cases of vaccines in malaria control and elimination

Malaria burden has significantly changed or decreased over the last 20 years, however, it remains an important health problem requiring the rigorous application of existing tools and approaches, as well as the development and use of new interventions. A malaria vaccine has long been considered a possible new intervention to aid malaria burden reduction. However, after decades of development, only one vaccine to protect children has completed phase 3 studies. Before being widely recommended for use, it must further demonstrate safety, impact and feasibility in ongoing pilot implementation studies. Now is an appropriate time to consider the use-cases and health targets of future malaria vaccines. These must be considered in the context of likely innovations in other malaria tools such as vector control, as well as the significant knowledge gaps on the appropriate target antigens, and the immunology of vaccine-induced protection. Here we discuss the history of malaria vaccines and suggest some future use-cases for future malaria vaccines that will support achieving malaria health goals in different settings