An analysis of factors determining malaria incidence in India with particular reference to Uttar Pradesh

This thesis identies, inter alia, the socio-economic factors that affect malaria incidence at both the household and district levels and investigates how these differ across rural and urban settlement-types. In addition, state level data for India are used to examine the effect of aggregate income relative to that of public health expenditure on malaria incidence. The household and district-level analysis focuses on the state of Uttar Pradesh and exploits the National Family Health Survey, which is the Demographic Health Survey (DHS) for India, for two time periods - 1992-93 and 1998-99 - and combines these data with the district-level census data for 1991 and 2001. A key theme of the micro-level analyses is whether household wealth exerts a negative impact on malaria incidence. Wealth is measured using the DHS data by constructing a consumer durable asset-index by Principal Components Analysis and malaria incidence was modelled using a probability model. The household-level analysis reveals that the relationship between socio-economic status and malaria incidence is not always negative. For example, owning a water pump, indicative of a higher socio-economic status, has a positive impact on malaria incidence and being of a lower caste has a negative impact. Variables that support the negative socio-economic status and health relationship include having an electricity connection in the house, having access to a protected public drinking water supply rather than an open source, and living farther away from open water sources. The aggregate (or panel data) analysis was undertaken using data for 15 states in India covering the time period 1978 to 2000. The aggregate analysis reveals that income has a negative impact on malaria incidence but direct expenditure on health is more effective in bringing about a decline in malaria incidence - an increase of a rupee in aggregate income per person reduces malaria incidence by 0.1 percent whereas an equivalent increase in real health expenditure per capita results in a 0.4 percent decline in malaria incidence. The research undertaken for this thesis is unique in using the DHS to identify the factors aecting malaria incidence and shows that these data are very useful in exploring the relationship between malaria incidence and a host of socio-economic factors in order to identify areas for effective policy intervention. Such a holistic approach is critical in controlling and, eventually, eradicating malaria rather than relying primarily on more direct treatment strategies based on insecticide-treated bed nets and drug therapy. The areas where public spending could be directed to attack malaria identied by the empirical analysis include education, particularly raising awareness on prophylactic measures through adult literacy centres, controlling the breeding of mosquitoes in open water collection sites such as public taps and around water pumps and improving water flow in agricultural fields to prevent stagnant water collection

Performance Analysis of MEMS Based Oscillator for High Frequency Wireless Communication Systems

The frequency oscillator is a basic component found in many electrical, electronic, and communications circuits and systems. Oscillators come in a variety of shapes and sizes, depending on the frequency range employed in a given application. Some applications need oscillators that generate low frequencies and other applications need oscillators that generate extremely high and high frequencies. As a result of the expansion and speed of modern technologies, new oscillators appeared that operating at extremely high frequencies. Most wireless communication systems are constrained in their performance by the accuracy and stability of the reference frequency. Because of its compatibility with silicon, micro-electro-mechanical system (MEMS) is the preferred technology for circuit integration and power reduction. MEMS are a rapidly evolving area of advanced microelectronics. The integration of electrical and mechanical components at the micro size is referred to as a MEMS. MEMS based oscillators have demonstrated tremendous high frequency application potential in recent years. This is owing to their great characteristics such as small size, integration of CMOS IC technology, high frequency-quality factor product, low power consumption, and cheap batch manufacturing cost. This paper's primary objective is to describe the performance of MEMS oscillator technology in high-frequency applications, as well as to discuss the challenges of developing a new MEMS oscillator capable of operating at gigahertz frequencies

Benefit-cost analysis of iron fortification of rice in India: modelling potential economic gains from improving haemoglobin and averting anaemia

This paper presents an ex-ante Benefit-Cost analysis of proposed fortification of extruder rice with iron under the social safety net in India. The benefits of iron fortification are estimated in terms of economic gains from increases in current work productivity among adults and future productivity from improvements in learning among school-going children. The base case scenario indicates a benefit cost ratio of 8.2, with 69 percent coming from improved learning in school and the remainder through enhanced work productivity. Benefit-cost ratios are also presented for a range of alternative assumptions, all of these resulting in ratios greater than 1. Nevertheless, despite decades of fortification at scale, a principal conclusion of this study is that future benefit cost models would gain confidence if more evidence is generated on the relationship of improved biomarkers for iron and changes in measures of cognition and labour productivity

Sequential ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) scan findings in patients with extrapulmonary tuberculosis during the course of treatment—a prospective observational study

BACKGROUND: Initial studies of tuberculosis (TB) in macaques and humans using ¹⁸F-FDG positron emission tomography (PET) imaging as a research tool suggest its usefulness in localising disease sites and as a clinical biomarker. Sequential serial scans in patients with extrapulmonary TB (EPTB) could inform on the value of PET-CT for monitoring response to treatment and defining cure. PATIENTS AND METHODS: HIV-negative adults with EPTB from eight sites across six countries had three ¹⁸F-FDG PET/CT scans: (i) within 2 weeks of enrolment, (ii) at 2 months into TB treatment and (iii) at end of ATT treatment. Scanning was performed according to the EANM guidelines. ¹⁸F-FDG PET/CT scans were performed 60 ± 10 min after intravenous injection of 2.5–5.0 MBq/kg of ¹⁸F-FDG. FINDINGS: One hundred and forty-seven patients with EPTB underwent 3 sequential scans. A progressive reduction over time of both the number of active sites and the uptake level (SUVmax) at these sites was seen. At the end of WHO recommended treatment, 53/147 (36.0%) patients had negative PET/CT scans, and 94/147 (63.9%) patients remained PET/CT positive, of which 12 patients had developed MDR TB. One died of brain tuberculoma. INTERPRETATION: Current ⁸F-FDG PET/CT imaging technology cannot be used clinically as a biomarker of treatment response, cure or for decision-making on when to stop EPTB treatment. PET/CT remains a research tool for TB and further development of PET/CT is required using new Mycobacterium tuberculosis-specific radiopharmaceuticals targeting high-density surface epitopes, gene targets or metabolic pathways

PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational ¹⁸F-FDG imaging study across six countries

BACKGROUND: A large proportion of the huge global burden of Extrapulmonary tuberculosis (EPTB) are treated empirically without accurate definition of disease sites, and extent of multi-organ disease involvement. Positron emission tomography (PET) imaging using 18F-FDG in TB could be a useful imaging technique for localising disease sites and extent of disease. METHODS: We conducted a study of HIV-negative adult patients with a new clinical diagnosis of EPTB across 8 centres located in 6 countries: India, Pakistan, Thailand, South Africa, Serbia, and Bangladesh to assess the extent of disease and common sites involved at first presentation. 18F-FDG PET/CT scans were performed within 2 weeks of presentation. FINDINGS: A total of 358 patients with EPTB (189 females; 169 males) were recruited over 45 months. Age range 18-83 years (females: median 30 years; males: median 38 years). 350/358 (98%) patients (183 female, 167 male) had positive scan. 118/350 (33.7%) had a single extrapulmonary site and 232/350 (66.3%) had more than one site (organ) affected. Lymph nodes, skeletal, pleura and brain were common sites. 100/358 (28%) of EPTB patients had 18F-FDG PET/CT positive sites in the lung. 110 patients were 18F-FDG PET/CT positive in more body sites than were noted clinically at first presentation and 160 patients had the same number of positive body sites. INTERPRETATION: 18F-FDG PET/CT scan has potential for further elucidating the spectrum of disease, pathogenesis of EPTB, and monitoring the effects of treatment on active lesions over time, and requires longitudinal cohort studies, twinned with biopsy and molecular studies