Protective efficacy of malaria case management for preventing malaria mortality in children: a systematic review for the Lives Saved Tool

<p>Abstract</p> <p>Background</p> <p>The Lives Saved Tool (LiST) model was developed to estimate the impact of the scale-up of child survival interventions on child mortality. New advances in antimalarials have improved their efficacy of treating uncomplicated and severe malaria. Artemisinin-based combination therapies (ACTs) for uncomplicated <it>Plasmodium falciparum</it> malaria and parenteral or rectal artemisinin or quinine for severe malaria syndromes have been shown to be very effective for the treatment of malaria in children. These interventions are now being considered for inclusion in the LiST model. However, for obvious ethical reasons, their protective efficacy (PE) compared to placebo is unknown and their impact on reducing malaria-attributable mortality has not been quantified.</p> <p>Methods</p> <p>We performed systematic literature reviews of published studies in <it>P. falciparum</it> endemic settings to determine the protective efficacy (PE) of ACT treatment against malaria deaths among children with uncomplicated malaria, as well as the PE of effective case management including parenteral quinine against malaria deaths among all hospitalized children. As no randomized placebo-controlled trials of malaria treatment have been conducted, we used multiple data sources to ascertain estimates of PE, including a previously performed Delphi estimate for treatment of uncomplicated malaria.</p> <p>Results</p> <p>Based on multiple data sources, we estimate the PE of ACT treatment of uncomplicated <it>P. falciparum</it> malaria on reducing malaria mortality in children 1–23 months to be 99% (range: 94-100%), and in children 24-59 months to be 97% (range: 86-99%). We estimate the PE of treatment of severe <it>P. falciparum</it> malaria with effective case management including intravenous quinine on reducing malaria mortality in children 1-59 months to be 82% (range: 63-94%) compared to no treatment.</p> <p>Conclusions</p> <p>This systematic review quantifies the PE of ACT used for treating uncomplicated malaria and effective case management including parenteral quinine for treating severe <it>P. falciparum</it> malaria for preventing malaria mortality in children <5. These data will be used in the Lives Saved Tool (LiST) model for estimating the impact of scaling-up these interventions against malaria. However, in order to estimate the reduction in child mortality due to scale-up of these interventions, it is imperative to develop standardized indicators to measure population coverage of these interventions.</p

Is the Scale Up of Malaria Intervention Coverage Also Achieving Equity?

Malaria in Africa is most severe in young children and pregnant women, particularly in rural and poor households. In many countries, malaria intervention coverage rates have increased as a result of scale up; but this may mask limited coverage in these highest-risk populations. Reports were reviewed from nationally representative surveys in African malaria-endemic countries from 2006 through 2008 to understand how reported intervention coverage rates reflect access by the most at-risk populations.Reports were available from 27 Demographic and Health Surveys (DHSs), Multiple Indicator Cluster Surveys (MICSs), and Malaria Indicator Surveys (MISs) during this interval with data on household intervention coverage by urban or rural setting, wealth quintile, and sex. Household ownership of insecticide-treated mosquito nets (ITNs) varied from 5% to greater than 60%, and was equitable by urban/rural and wealth quintile status among 13 (52%) of 25 countries. Malaria treatment rates for febrile children under five years of age varied from less than 10% to greater than 70%, and while equitable coverage was achieved in 8 (30%) of 27 countries, rates were generally higher in urban and richest quintile households. Use of intermittent preventive treatment in pregnant women varied from 2% to more than 60%, and again tended to be higher in urban and richest quintile households. Across all countries, there were no significant male/female inequalities seen for children sleeping under ITNs or receiving antimalarial treatment for febrile illness. Parasitemia and anemia rates from eight national surveys showed predominance in poor and rural populations.Recent efforts to scale up malaria intervention coverage have achieved equity in some countries (especially with ITNs), but delivery methods in other countries are not addressing the most at-risk populations. As countries seek universal malaria intervention coverage, their delivery systems must reach the rural and poor populations; this is not a small task, but it has been achieved in some countries

Comparison of Lives Saved Tool model child mortality estimates against measured data from vector control studies in sub-Saharan Africa

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated mosquito nets (ITNs) and indoor-residual spraying have been scaled-up across sub-Saharan Africa as part of international efforts to control malaria. These interventions have the potential to significantly impact child survival. The Lives Saved Tool (LiST) was developed to provide national and regional estimates of cause-specific mortality based on the extent of intervention coverage scale-up. We compared the percent reduction in all-cause child mortality estimated by LiST against measured reductions in all-cause child mortality from studies assessing the impact of vector control interventions in Africa.</p> <p>Methods</p> <p>We performed a literature search for appropriate studies and compared reductions in all-cause child mortality estimated by LiST to 4 studies that estimated changes in all-cause child mortality following the scale-up of vector control interventions. The following key parameters measured by each study were applied to available country projections: baseline all-cause child mortality rate, proportion of mortality due to malaria, and population coverage of vector control interventions at baseline and follow-up years.</p> <p>Results</p> <p>The percent reduction in all-cause child mortality estimated by the LiST model fell within the confidence intervals around the measured mortality reductions for all 4 studies. Two of the LiST estimates overestimated the mortality reductions by 6.1 and 4.2 percentage points (33% and 35% relative to the measured estimates), while two underestimated the mortality reductions by 4.7 and 6.2 percentage points (22% and 25% relative to the measured estimates).</p> <p>Conclusions</p> <p>The LiST model did not systematically under- or overestimate the impact of ITNs on all-cause child mortality. These results show the LiST model to perform reasonably well at estimating the effect of vector control scale-up on child mortality when compared against measured data from studies across a range of malaria transmission settings. The LiST model appears to be a useful tool in estimating the potential mortality reduction achieved from scaling-up malaria control interventions.</p

Copreneurial sustainability: optimizing structures in small and medium U.S. enterprises

In the 40 years since dual-career households were inspired by the women&amp;rsquo;s movement, few studies have examined the long-term achievements of entrepreneurial couples (copreneurs) from start-up through maturity. This thesis explores and analyzes the structures created by copreneurs that optimize sustainability of the copreneurial enterprise. The enterprise &amp;ldquo;system&amp;rdquo; under study includes both the business and the life-partner relationship over 20+ years together (in business and marriage) in small and medium enterprises in the United States. To support the aim of the thesis, the following research question was derived from the literature review: What optimizing structures are created by copreneurs to achieve sustainability of both the business and the family? The thesis comprises four phases of research: 1. Development of the Conceptual Model of the Copreneurial Enterprise; 2. Testing of the conceptual model; 3. Identification of optimizing structures; and 4. Development of the Model of Harmonized Copreneurial Enterprise Management. The thesis follows a constructivist-interpretive (qualitative) research approach using a theoretical framework &amp;ndash; The Conceptual Model of the Copreneurial Enterprise &amp;ndash; based on seminal family business models and literature. The conceptual model was empirically tested with a sample of 10 couples (20 individuals) from four regions in the United States (East, Midwest, Southwest and West). Data collection included historical archive review, a business site visit, and in-depth face-to-face, phone and emailed interviews. Two independent analyses were conducted based on the interview data: a manual theme-category analysis, producing 11 themes; and an NVivo software analysis, generating 40 nodes. The analyses were compiled in an Operationalization of the Conceptual Model of the Copreneurial Enterprise. The analysis of the empirical data produced comprehensive findings which were compared with family business, entrepreneurial and copreneurial literature. A Model of Harmonized Copreneurial Enterprise Management was developed from the findings. The findings show that although copreneurs do not follow best practices, they achieve highly successful outcomes through harmonized management of business, family and individual domains. These outcomes are anchored in four foundational structures: (1) personal attributes (creativity, freedom, quality, commitment); (2) organizational elements (integrated goals, mutual respect, equality, trust, opportunistic thinking, checks and balances, synergy); (3) reciprocal relationships (career, marriage, family, business); and (4) enterprise culture (connection, harmony, equality, balance). The four central structures create a foundation for growth and sustainability &amp;ndash; profitable businesses, functional families (with marriage longevity), and individual development &amp;ndash; with the Model of Harmonized Copreneurial Enterprise Management reflecting a holistic optimizing &amp;ldquo;system&amp;rdquo; structure underpinning successful, sustainable copreneurship. This knowledge may be used to guide future research, develop educational programs for copreneurs, and inform couples in copreneurial enterprises (or those considering copreneurship) how to achieve sustainability and success

On the IYB-property in some solvable groups

A finite group G is called Involutive Yang-Baxter (IYB) if there exists a bijective 1-cocycle χ:G⟶M for some ZG -module M. It is known that every IYB-group is solvable, but it is still an open question whether the converse holds. A characterization of the IYB property by the existence of an ideal I in the augmentation ideal ωZG complementing the set 1−G leads to some speculation that there might be a connection with the isomorphism problem for ZG . In this paper we show that if N is a nilpotent group of class two and H is an IYB-group of order coprime to that of N, then N⋊H is IYB. The class of groups that can be obtained in that way (and hence are IYB) contains in particular Hertweck’s famous counterexample to the isomorphism conjecture as well as all of its subgroups. We then investigate what an IYB structure on Hertweck’s counterexample looks like concretely

African Malaria Control Programs Deliver ITNs and Achieve What the Clinical Trials Predicted

Thomas Eisele and Richard Steketee discuss new research in PLoS Medicine by Stephen Lim and colleagues that examined the association of insecticide-treated nets with the reduction of P. falciparum prevalence in children under 5 and all-cause post-neonatal mortality

Observation of neutral sulfuric acid-amine containing clusters in laboratory and ambient measurements

Recent ab initio calculations showed that amines can enhance atmospheric sulfuric acid-water nucleation more effectively than ammonia, and this prediction has been substantiated in laboratory measurements. Laboratory studies have also shown that amines can effectively displace ammonia in several types of ammonium clusters. However, the roles of amines in cluster formation and growth at a microscopic molecular scale (from molecular sizes up to 2 nm) have not yet been well understood. Processes that must be understood include the incorporation of amines into sulfuric acid clusters and the formation of organic salts in freshly nucleated particles, which contributes significantly to particle growth rates. We report the first laboratory and ambient measurements of neutral sulfuric acid-amine clusters using the Cluster CIMS, a recently-developed mass spectrometer designed for measuring neutral clusters formed in the atmosphere during nucleation. An experimental technique, which we refer to as Semi-Ambient Signal Amplification (SASA), was employed. Sulfuric acid was added to ambient air, and the concentrations and composition of clusters in this mixture were analyzed by the Cluster CIMS. This experimental approach led to significantly higher cluster concentrations than are normally found in ambient air, thereby increasing signal-to-noise levels and allowing us to study reactions between gas phase species in ambient air and sulfuric acid containing clusters. Mass peaks corresponding to clusters containing four H&lt;sub&gt;2&lt;/sub&gt;SO&lt;sub&gt;4&lt;/sub&gt; molecules and one amine molecule were clearly observed, with the most abundant sulfuric acid-amine clusters being those containing a C2- or C4-amine (i.e. amines with masses of 45 and 73 amu). Evidence for C3- and C5-amines (i.e. amines with masses of 59 and 87 amu) was also found, but their correlation with sulfuric acid tetramer was not as strong as was observed for the C2- and C4-amines. The formation mechanisms for those sulfuric acid-amine clusters were investigated by varying the residence time in the inlet. It was concluded that the amines react directly with neutral clusters and that ion-induced clustering of sulfuric acid cluster ions with amines was not a dominant process. Results from ambient measurements using the Cluster CIMS without addition of sulfuric acid have shown that the sulfuric acid-amine clusters were reasonably well correlated with sulfuric acid tetramer and consistent with the SASA experiments at the same Boulder sampling site. Also, clusters that contain C2- or C4-amines were more abundant and better correlated with sulfuric acid tetramer than other types of amine containing clusters. However, ambient measurements of sulfuric acid-amine clusters remain difficult and highly uncertain because their concentrations are only slightly above background levels, even during nucleation events