4,285 research outputs found
Trade, Growth and Povety: A Case of Pakistan
It is generally argued that open trade is crucial for economic growth and development. The economic literature also argues that growth is an important option for reducing poverty in developing countries. The paper analyzed the causality between the trade, growth and poverty for Pakistan using annual time series data from 1973-2009. Granger causality results based on Error-Correction Models have shown that in the case of Pakistan there exists two way relationship between trade and growth in the long-run but for the short-run growth enhance the trade. For the growth and poverty, there exists long-run relation from growth to poverty while for the short-run there exists no relationship. It may be concluded that international trade can play an important role towards growth and ultimately alleviation of poverty. From the policy perspective government should focus on trade.F14; F41; O19; I3.
Impact of Supply of Money on Food and General Price Indices: A Case of Pakistan
The paper probed the impact of supply of money on food and general price indices by estimating a series of equations taking CPI food, CPI general, WPI food, WPI general, GDP deflator and SPI as measures of inflation and M1, M2 and M3 supply of money as explanatory variables. For analysis, OLS technique is used covering time series data for the years 1975-76 to 2006-07 that was made stationary by Durbin-Watson criterion. AR (1) is used to check autocorrelation. The results for CPI food, CPI general, WPI general, GDP deflator and SPI show that they are negatively related with M1 supply of money. CPI food, CPI general, WPI general, GDP deflator, and SPI are also negatively related with M2 supply of money. The results show that CPI food, CPI general, WPI general, GDP deflator and SPI are positively related with M3 supply of money. It may be concluded that supply of money M1 and M2 affects the food and general indices in the same way. However, M1 supply of money affects the CPI general strongly than CPI food.Inflation, Money supply, Consumer Price Index, Food prices, Sensitive Price Indicator.
La figura del andrógino en el movimiento simbolista de los Rosa+Cruz
Treballs Finals de Grau d'Història de l'Art, Facultat de Geografia i Història, Universitat de Barcelona, Curs: 2013-2014, Tutora: Teresa-M. Sala GarciaEl objetivo principal de este trabajo es estudiar la relación entre la Rosa+Cruz y el
concepto de andrógino durante el fin de siglo XIX a través de las obras de los artistas
donde se trata esta figura. Viendo cómo la teoría influye sobre las formas de
representación, siempre teniendo en cuenta la libertad creadora del artista que puede o no
adaptar estas formas de manera literal a sus obras. Para entender la totalidad de los dos
grandes tema (III y IV) hay en estos bloques temáticos una parte mas introductoria y de
teoría como contextos, breves apuntes aclaratorios e historia. El núcleo del trabajo se
centra en estos dos temas donde primeramente se presenta al personaje de Péladan y a
continuación el grupo de la Rosa+Cruz, con diferentes apartados que dan una visión
general de la escena artística que preceden al estudio del primer Salón de la Rosa+Cruz.
En el tema IV se trata primero de manera teórica la figura del andrógino y después se
ilustra con las imágenes de tres de los participantes de los salones de la Rosa+Cruz. En el
apartado final correspondiente al análisis de artistas y obras la secuencia de imágenes
escogidas son ilustraciones del propio guión discursivo del trabajo; es decir, no responden a un orden cronológico, una catalogación o repertorio iconográfico completo por la
dificultad a la hora de encontrar obras donde explícitamente se reconozca, por el título por ejemplo, a la figura del andrógino
Assessing and controlling bio-deterioration of maize in Tanzania
Agriculture is the backbone of the Tanzanian economy. It accounts for about one-third of the gross domestic product (GDP), provides 85 percent of all exports and serves as a livelihood to over 80 percent of the total population. Maize or corn (Zea mays L.) is the primary staple crop; it’s grown in nearly all agro-ecological zones in the country. Tanzania is a major maize producer in Sub-Saharan Africa. In the last four decades, Tanzania has ranked among the top 25 maize producing countries in the world. Despite the steady production of maize over the past three decades, post-harvest losses of maize remained significantly high, especially for small-holder farmers. Post-harvest handling, poor infrastructure, and weather variability, bio-deterioration brought about by pest organisms such as insects, molds, and fungi, rodent, bacteria, pathogens, and viruses often aggravate such losses.
In tropical countries, a large proportion of the maize is harvested and stored under humid and warm climatic conditions, which subsequently results in rapid deterioration of the grains, mainly because of growth of molds and pests. Deterioration of maize is mainly affected by moisture content, temperature (grain and air), relative humidity, storage conditions, fungal growth, and insect pests. Fungal growth, especially Aspergillus flavus and Fusarium sp in maize, facilitated by hot and humid conditions, poses a major health risk through the production of mycotoxins. Mycotoxins are toxic secondary metabolites of fungi that frequently contaminate the maize in the field and/or during storage. The most important mycotoxins in maize are the aflatoxins, Fumonisins, deoxynivalenol, and ochratoxin. In order to maintain high-quality maize for both short- and long-term storage, maize must be protected from weather, the growth of microorganisms, and insect pests.
Stored product pests such as Sitophilus zeamais (Motschulsky), the maize weevil, are serious pests of economic importance in stored products in tropical and subtropical countries. Infestation often starts in the field, but serious damage is done during maize storage. This study determined the resistance of flint corn and dent corn to infestation by S. zeamais. Improved King Philip hybrid flint corn and Fontanelle 6T-510 hybrid dent corn were used. Two temperature conditions (10 and 27úC) and two storage times (15 and 30 days) were used. Results showed flint corn was more resistant to insect damage than dent corn at 27úC and 30 days storage time. After 30 d storage time and 27úC, the death rate of the weevls was significantly higher in flint corn (R2 = 0.945) compared to dent corn (R2 = 0.634). Likewise, the damaged seed was 10% higher in dent corn than in flint corn at 27úC and 30 days. However, no significant difference was observed for seed weight loss between flint corn and dent corn at the same storage conditions.
Further, the study evaluated S. zeamais infestation on seven varieties of maize. Seven commercial maize varieties (white dent, yellow dent, orange flint, Indian flint, white and yellow popcorn, and sweet corn), two temperature conditions (10 and 27 ðC) and three storage times (30, 60, and 90 days) were used. The moisture contents of all maize samples were adjusted to 15.5 ñ 0.5% (wet basis) prior to initiating storage trials. Numbers of live weevils, seed damage, weight loss, and weight of powder produced were assessed at the end of each storage time. As expected, severe damage was observed at 27úC and 90 d for all maize varieties. Exponential growth rates of S. zeamais were observed in almost all maize varieties. Among seven varieties evaluated, orange flint corn, yellow, and white popcorn show resistance to S. zeamais. Sweet and dent corn were most susceptible to maize weevil infestation. Higher numbers of live S. zeamais were observed on Indian flint corn and sweet corn. Consequently, there was a higher seed weight damage and weight loss. In addition, seed damaged, percentage seed weight loss and weight of powder produced was significantly and positively correlated with a number of live S. zeamais (r = 0.91, P\u3c0.05), (r = 0.88, P\u3c0.05), and (r = 0.89, P\u3c0.05) respectively. Thus, some varieties of flint corn and popcorn can be considered as potential maize varieties to be used to reduce the postharvest loss of maize in tropical countries due to their natural resistance to S. zeamais infestation.
Moreover, the study also determined the techno-economic analysis (TEA) and life cycle analysis (LCA) of maize storage for middle-class farmers in developing countries. Maize is the most widely cultivated cereal crop worldwide. It is produced on a seasonal basis, usually harvested once per year. To maintain a constant supply throughout the year, maize should be properly stored. But this entails high cost and high-energy consumption, which can contribute significant amounts of greenhouse gas emissions. Three storage capacities (25,000 bu, 250,000 bu, and 2,500,000 bu) per year were evaluated for economic analysis and environmental impact. The result shows the total storage cost per kilogram decreased as storage capacity increased (3.69/bu, and 0.42$/bu). Likewise, energy consumption (electricity, diesel, and liquid propane) increased as storage capacity increased. Consequently, more greenhouse gas emissions (CO2, CH4, and NOX) were emitted to the environment. Thus, to obtain an optimal balance between economics and the environment, it is important for the farmers to understand the concepts of techno-economic analysis and life cycle assessment. Furthermore, the study also determined the measured and predicted temperature of maize under hermetic conditions. Three different storage conditions (room at 25ðC, cooling at 4ðC, and freezing at -20ðC) were investigated. Yellow dent corn variety Blue River 571136 from Iowa, harvested in 2011 was used. Maize was stored in two hermetically sealed bins (50-cm diameter x 76-cm height). Five logger sensors were installed inside the bin to measure temperature and relative humidity of the air and maize grain. The sensors were located at the top, center, bottom, left and right at about 12 centimeters apart. After placing each barrel into storage, temperature and relative humidity values were measured every minute for 9 days throughout the duration of the experiment. Model validation was carried out by comparing predicted with measured maize grain temperature data in the radial and vertical directions. The temperature in the hermetically sealed cylindrical bins varied, mostly in the radial direction and very little in the axial vertical directions. No noticeable change in temperature was observed in the room condition. Moreover, the temperature in the grain changed more rapidly in the freezing conditions than in the room temperature and cooling conditions. Furthermore, the lag time between the center temperature and the side (right, left, top, and bottom) was greater in the radial direction compared to in the vertical direction. The maximum difference between predicted and measured temperature was ñ1.5ðC. The predicted and measured values of maize grain temperature at radial and vertical directions were found to be in good agreement. The model shows a good potential application to predict the temperature of maize grain stored at the room, cooling and freezing conditions under hermetic storage.
In addition, the study determined the impact of moisture content and S. zeamais on maize quality during hermetic and non-hermetic storage conditions. Commercially commingled maize kernels were conditioned to target moistures 14, 16, 18, and 20% moisture content (wet basis), and then three replications of 300 grams of maize grain were stored in glass jars or triple Ziplocî slider 66 μm (2.6-mil) polyethylene bags at four conditions: hermetic with weevils, hermetic no-weevils, non-hermetic with weevils, non-hermetic no-weevils. All jars and bags were stored in an environmental chamber at 27ðC and 70% relative humidity for either 30 or 60 days. At the end of each storage period, jars and bags were assessed for visual mold growth, mycotoxin levels, CO2 and O2 concentrations, pH level, the numbers of live and dead S. zeamais, and maize moisture content. The maize stored in non-hermetic conditions with weevils at 18 and 20% exhibited high levels of mold growth and aflatoxin contamination (\u3e150 ppb). Although mold growth was observed, there were no aflatoxins detected in maize stored in hermetic conditions. The CO2 and O2 concentrations were directly related to the maize moisture contents and storage times. In general, CO2 increased and O2 gradually decreased as storage time increased. No significant difference in pH was observed in any storage conditions (P\u3c0.05). Total mortality (100%) of S. zeamais was observed in all hermetically stored samples at the end of 60 days storage. The number of S. zeamais linearly increased with storage time for maize stored in non-hermetic conditions. Moisture content for hermetically stored maize was relatively constant. Moreover, a positive correlation between moisture content and storage time was observed for maize stored in non-hermetic conditions with weevils (r = 0.96, P\u3c0.05). The results indicate that moisture content and the number of S. zeamais play a significant role in maize storage, both under hermetic and non-hermetic conditions.
The study also determined whether there is a synergistic interaction between P. truncatus and S. zeamais during storage. The interaction between the two insects was evaluated in terms of the numbers of the live population, percent damaged grain, the weight of powder (flour) produced, and percentage seed weight loss. Higher damage was observed in non-hermetic storage with P. truncatus and in mixed treatments (P. truncatus and S. zeamais). A significant difference (P\u3c0.05) and positive correlation were observed between the number of live population, percentage grain damage, the weight of powder produced, and percentage seed weight loss on infestation by P. truncates, S. zeamais, and mixed treatments. S. zeamais dominate populations in the early stage but were outnumbered by P. truncatus after 60 d of storage in the individual species as well as in mixed treatments. The high percentage grain damage was observed in non-hermetic storage after 60 days in P. truncatus (58%) and mixed treatments (54%). The weight of powder produced ranged from 0-30 grams per 250 grams of maize. Percentage seed weight loss decreased after 60 days for P. truncatus and mixed treatments, but increased onward for S. zeamais, a low synergistic interaction between P. truncatus and S. zeamais was observed. However, P. truncatus plays a significant role when two insects coexist and cause more severe damage than S. zeamais in maize under non-hermetic storage conditions.
Furthermore, the study determined the practicability of periodic physical disturbance on S. zeamais mortality and adaptation by smallholder farmers in developing countries. S. zeamais is the most widely occurring and important cosmopolitan postharvest insect pest of stored maize in tropic and sub-tropical regions. Preventing infestation of this pest without using chemicals remains a huge challenge for smallholder farmers in the developing countries. Physical control methods are effective and attractive alternative methods to prevent, and control stored product pests in grain handling and storage facilities. Physical techniques are based on the application of some kind of force to manipulate the storage environments. They can provide unfavorable conditions for insect pests to multiply or damage to the grain. In this experiment, disturbed and stationary/control treatments were arranged in a Completely Randomized Design (CRD) with three replications and three-storage times (30, 60, and 90 days) in three regions of Tanzania. A total of 108 clean 20L (L284 x W234 x H391) millimeter plastic containers were each loaded with 10 kilograms of fresh white dent corn and 0.50 kilograms of maize infested with S. zeamais. The initial numbers of S. zeamais were determined. For the turned treatment, containers were disturbed or turned twice a day, whereas, for the controls, the containers were not disturbed until the end of storage. The overall percent mortality after 30, 60, and 90 days of storage were 88, 96, and 98% respectively. A statistically significant difference (P\u3c0.05) was observed for the number of live S. zeamais in the control treatments. While the number of live S. zeamais in the turned treatment significantly decreased as storage time increased. The study shows the potential of a feasible, simple, affordable, safe and effective method of protecting maize grain for small-holder farmers in developing countries without using chemicals.
Lastly, the study assessed the postharvest practices and awareness of mycotoxins contamination in maize grain. Maize is a major cereal crop in Tanzania and it is grown in diverse agro-ecological zones. Like other sub-Saharan countries, postharvest losses of maize during storage in Tanzania remain significantly high, especially for smallholder farmers. Unpredictable weather and poor postharvest practice contribute significantly to rapid deterioration of grain and mold contamination, and subsequent production of mycotoxins. The purpose of this study was to assess the postharvest practices and awareness and knowledge of mycotoxin contamination in maize grain in three agro-ecological zones (Eastern, Central, and Northern) of Tanzania between November 2015 and February 2016. A survey using semi-structured questionnaires was administered to farmers, traders, and consumers of maize. A total of 90 people (30 from each zone) were surveyed with a response rate of was 96% (87). In addition, several samples of maize were collected and analyzed for aflatoxin, fumonisin, and Zearalenone contamination to validate the awareness and knowledge of mycotoxin contamination of maize. The result shows a high level of postharvest losses of maize mainly through insect infestation. Moreover, over 80% of the farmers, traders, and consumers of maize were unaware of mycotoxins contamination. All maize samples collected contained detected levels of mycotoxins. The maximum concentration of aflatoxins, fumonisin, and Zearalenone in maize samples was 19.20 ppb, 7.60 ppm, and 189.90 ppb respectively. Education intervention is necessary to decrease the disconnect observed between actual mycotoxin contamination and the awareness and knowledge of farmers, traders, and consumers of maize in Tanzania. Enhancing awareness and knowledge provide the opportunity to educate on post-harvest practices that reduce postharvest losses of maize in Tanzania
Entrepreneurial characteristics of indigenous housing developers: the case of Malaysia
Since the colonisation era, the immigrants from mainland China (and now their descendents) dominate the Malaysian housing industry. Their high entrepreneurial ethics stimulated early venture in all economic sectors to become dominant in business. To increase the participation of indigenous entrepreneurs in economic activities, Malaysia has practiced its own version of the affirmative policy since the 1970s which is known as National Economic Policy (NEP). Unlike other economic sectors such as construction, manufacturing and agricultural, the government has not provided special assistance (other than those that are generic in nature) for the indigenous populace to penetrate and thrive in housing development. As a consequence, their participation in this sector is conspicuous by their absence. A study was conducted to look into the involvement of indigenous housing developers in housing industry. Data was collected through postal questionnaires followed by face-to-face interviews. The discussion on the data analysis is presented together with interview findings.indigenous housing developer, housing development industry, entrepreneur characteristic
Malaria control dynamics in rural Tanzania : evaluation of implementation of artemisinin based anti-malarial combination therapy
Malaria is the most important parasitic disease caused by protozoans of the
genus plasmodia that are transmitted by female anophelene mosquitoes.
Plasmodium falciparum is the most important species owing to its distribution,
virulence and pathogenicity. World-wide some 500 million infections, 200-300
million episodes and about 1 million malaria-related deaths occur every year
amounting to a burden of some 45 million DALYs (Disability Adjusted Life Years)
[1]. At least 80% of this intolerable burden is concentrated in Sub-Saharan Africa
with young children bearing the biggest share. In Tanzania, malaria accounts for
not less than 30% of the country’s burden of disease [2].
Malaria can be cured if it is diagnosed and treated rapidly with effective drugs.
Delay in diagnosis and treatment leads to the progression of disease and
eventually death. Chloroquine and salfudoxine-pyremethamine (SP) had for a
long time been the first-line treatment of choice for most endemic African
countries but these drugs are no longer effective for treating patients in many
parts owing to the development of resistance [3]. Artemisinin based Combination
Therapy (ACT) is now widely recommended as the first-line treatment of choice
owing to its efficacy, safety profile and the fact that no resistance has, so far,
been described.
Regarding prevention of malaria infections, Insecticide Treated Nets (ITNs) play
the key role, while Indoor Residual Spraying (IRS) and elimination of mosquito
breeding sites using larvicides are additional tools for integrated malaria control
that can be applied dependant on local conditions.
As a reaction to the growing resistance of malaria parasites to Chloroquine and
SP, and when ACTs were being considered for first-line treatment, the
Interdisciplinary Monitoring Project for Anti-malarial Combination Therapy for
Tanzania (IMPACT-Tz) was designed to evaluate the effectiveness of ACT
introduction and application in the Rufiji, Kilombero and Ulanga districts within the
Coast and Morogoro Regions of Southern Tanzania.
The present thesis was undertaken within the frame of IMPACT-Tz from 2001-
2006 with the following aims:
(i) Describing patients’ adherence to ACT
(ii) Following the dynamics of parasite prevalence during ACT
promotion and use
(iii) Analyzing the project’s impact on health facility use, and ITN
coverage and its concomitant delivery strategies within the study areas of
IMPACT-Tz .
The present studies were based on the demographic surveillance systems which
have been well established within the studied districts for many years. We
conducted the study assessments using questionnaires to members of sampled
households, key informant interviews and analyzed blood specimens that we
concurrently collected during the interviews. Follow up visits to the homes of
patients who had been treated with ACT at health facilities was the main method
that we used to analyze patients’ adherence.
Patients’ adherence to ACT showed very promising results with 75% reaching
complete adherence as established by self-reporting and tablet counts. These
results were substantially better than reported elsewhere and compared
favorably with former intervention studies to optimize adherence to chloroquine.
ITN coverage continuously increased through mixed delivery strategies involving
free distribution during an immunization campaign combined with social
marketing and a voucher system. All delivery mechanisms, especially sale of
nets at full market price, tended to under-serve the poorest. Voucher-subsidized
and freely distributed nets did not appear to create inequalities. In 2005, overall
net use reached 62.7% and that among infants 87.2%. Thirty percent of all nets
had been treated six months prior to the interview.
The parasite prevalence declined over the study period and was clearly related to
the interventions. In 2001, parasite prevalence was 26% in the general
population of Rufiji and 18% in Ifakara. Following the deployment of ACT in 2003,
there was a sharp decline of malaria prevalence from 29% in 2002 to 19% in
2004 in Rufiji. It remained the same in 2005 and decreased to 15% in 2006. The
respective estimates for Ifakara were 22% in 2002, 25% in 2004, 11% in 2005
and 14% in 2006. The prevalence of anaemia (Hb<8g/dl) measured from 2004 to
2006 showed a drop from 23% in 2004 to 16% in 2005 and 2006 in Rufiji.
Respective values for Ifakara were 12%, 18% and 10%. Use of any nets
increased from 18% in 2001 to 63% in 2006 in Rufiji and from 69% to 86% in
Ifakara.
Treatment-seeking also changed with the introduction of AC. Starting with 31-
35% of febrile episodes seen at health facility level at the beginning of the study,
an increase to up to 45% was observed as a consequence of ACT introduction.
Treatment seeking in the comparison district where SP was still used as first-line
treatment as stipulated in the national policy, treatment-seeking showed
fluctuations but remained basically unchanged. Young children were those most
seen with febrile episodes. The least poor showed higher health facility usage
than the poorest segments of the population.
Our study suggests that ACT first-line therapy is an accepted and feasible
approach that can reduce both the burden of disease and transmission when
ACT is offered at health facility level. ACT was effective as part of an integrated
approach that also entailed the promotion of ITNs. The study further
demonstrated that high levels of adherence to ACT can be reached provided
treatment is preceded by sufficient health worker training together with innovative
information, education and communication. Provision of ACT at health facilities
improves the use of health facilities in a broad sense. Achieving and sustaining
broad access to ACTs will require other strategies for ACT delivery that include
all providers of services and may include home-based management in order to
reach all segments of a population and, thus, to achieve equitable access.
There are additional other important issues that need to be investigated further
such as how ACTs can be effectively made available to all possible health
service providers in a given area, also including possible home management
strategies to achieve broad and equitable access to rapid diagnosis and
treatment. Finally we need to understand to what extent synergies are created
when different sets of malaria control interventions are implemented
concomitantly and/or sequentially with different time-space dynamics of coverage.
Such information is critical for tailoring strategies to different endemic settings
and for moving from control towards elimination.
References
1. Breman JG, Egan A, Keutsch GT: The intolerable burden of malaria: a
new look at the numbers. American Journal of Tropical Medicine and
Hygiene 2001, 64 (Supplement 1)(1,2):iv-vii.
2. De Savigny D, Kasale H: New weapons in the war on malaria. 2004.
3. Bloland PB: Making malaria treatment policy in the face of drug resistance.
Annals of Tropical Medicine And Parasitology 1999, 93(1):5-23.
Zusammenfassung
Malaria ist die wichtigste parasitäre Erkrankung, welche durch die Protozoen der
Gattung Plasmodia verursacht wird. Die Plasmodien werden durch die weiblichen
Moskitos der Gattung Anopheles übertragen. Plasmodium falciparum ist die
wichtigste Spezies aufgrund ihrer Verbreitung, Virulenz und Pathogenität.
Weltweit gibt es geschätzte 500 Millionen Infizierte, wobei etwa 200-300
Millionen Episoden und 1 Million Tote jedes Jahr durch Malaria verursacht
werden, was 45 Millionen DALYs (Disability Adjusted Life Years) entspricht.
Mindestens 80% von dieser Krankheitslast konzentriert sich auf Afrika südlich der
Sahara und dort wiederum insbesondere auf junge Kinder. In Tansania ist
Malaria für nicht weniger als 30% der gesamten nationalen Krankheitslast
verantwortlich.
Malaria kann geheilt werden, wenn die Krankheit rechtzeitig diagnostiziert und
mit wirksamen Medikamenten behandelt wird. Verzögerungen in der Diagnose
oder Behandlung können zu einem Fortschreiten der Krankheit und letztlich zum
Tod führen. Chloroquine und Salfudoxine-Pyremethamine (SP) waren lange Zeit
in den meisten endemischen Ländern in Afrika als Erstbehandlung vorgesehen,
sind aber heute aufgrund von zunehmenden Resistenzen vielerorts nicht mehr
wirksam. Wegen ihrer Wirksamkeit, ihres Sicherheitsprofils und bisher noch nicht
aufgetretenen Resistenzbildungen wird deshalb heutzutage die so genannte
Artemisinin-based Combination Therapy (ACT) als Erstbehandlung empfohlen. In
Bezug auf die Prävention spielen Insecticide Treated Nets (ITN) eine
Schlüsselrolle. Indoor Residual Spraying (IRS) sowie das Eliminieren von
Moskitobrutstätten mit Larviziden sind zusätzliche Massnahmen für eine lokal
angepasste, integrierte Malariakontrolle.
Als Reaktion auf die zunehmende Resistenz der Malaria-Erreger gegenüber
Chloroquine und SP wurde der Einsatz von ACT als neue Methode der
Erstbehandlung in Betracht gezogen. Um die Wirksamkeit von ACT im Rufiji,
Kilombero und Ulanga Distrikt in der Küsten- und der Morogoro-Region im Süden
von Tansania zu evaluieren, wurde das Interdisciplinary Monitoring Project for
Anti-malarial Combination Therapy for Tanzania (IMPACT-Tz) konzipiert.
Die vorliegende Doktorarbeit wurde im Rahmen von IMPACT-Tz zwischen 2001
und 2006 durchgeführt und beabsichtigte innerhalb des IMPACT-Tz
Studiengebietes (i) die Befolgung der ACT durch die Patienten zu beschreiben, (ii)
die Dynamik der Parasiten-Prävalenz während der ACT Förderung und
Anwendung zu beschreiben, (iii) den Einfluss des Projekts auf die Nutzung von
Gesundheitseinrichtungen und ITNs unter Berücksichtigung von deren
Verfügbarkeit und Belieferungsstrategien zu analysieren. Die Studien stützten
sich auf die seit einigen Jahren in den Studiengebieten etablierten Demographic
Surveillance Systems (DSS). Zur Durchführung der Studien befragten wir
Mitglieder von ausgewählten Haushalten mit Hilfe von Fragebogen, führten
Interviews mit Key Informants und analysierten Blutproben, welche gleichzeitig
mit den Interviews eingesammelt wurden. Hausbesuche bei Patienten, welche in
den Gesundheitseinrichtungen mit ACT behandelt wurden, waren die
grundlegende Methode um die Befolgung der Therapie durch die Patienten zu
beschreiben.
Die Resultate zur Befolgung der ACT-Therapie durch die Patienten waren viel
versprechend. Gemessen an den Aussagen der Patienten und dem Auszählen
der Tabletten befolgten 75% der Patienten die Therapie vollständig. Diese
Resultate waren deutlich besser als anderswo und auch besser als Resultate von
früheren Interventionsstudien zur Optimierung der Befolgung von Chloroquine-
Behandlungen.
Der Deckungsgrad mit ITNs stieg kontinuierlich dank einer gemischten
Belieferungsstrategie, welche eine Gratis-Verteilung während Impfkampagnen
mit Massnahmen des Social Marketing und einem Gutschein-System kombinierte.
Alle Belieferungsmechanismen und insbesondere der Verkauf von ITNs zu
Marktpreisen tendierten dazu die Ärmsten unterzuversorgen. Durch Gutscheine
subventionierte und gratis verteilte Netze schienen am wenigsten Ungleichheiten
zu erzeugen. Gesamthaft erreichte der Anteil von Netzbenutzer im Jahr 2005
62.7% und sogar 87.2% bei Kindern. Dreissig Prozent aller Netze wurde in den
letzten sechs Monaten vor dem Interview mit Insektizid behandelt.
Die Parasiten-Prävalenz war eindeutig mit den Interventionen verbunden und
nahm im Verlauf der Studien ab. 2001 betrug die Prävalenz 26% in der
allgemeinen Bevölkerung von Rufiji und 18% in Ifakara. Nach dem Start der
ATC-Anwendung 2003 sank die Malaria-Prävalenz in Rufiji von 29% im Jahr
2002 auf 19% im Jahr 2004 deutlich, blieb im Jahr 2005 konstant und sank
schliesslich noch einmal auf 15% im Jahr 2006. Dieselben Schätzungen für
Ifakara sind 22% 2002, 25% 2004, 11% 2005 und 14% 2006. Die Anaemie-
Prävalenz (Hb<8g/dl) in Rufiji sank von 23% 2004 auf 16% 2005 und 2006.
Dieselben Werte für Ifakara liegen bei 12%, 18% und 10%. In Rufiji nahm die
Anwendung von Moskitonetzen aller Art von 18% im Jahr 2001 auf 63% im Jahr
2006 zu und in Ifakara von 69% auf 86%.
Durch die Einführung von ACTs änderte sich auch das so genannte Treatment-
Seeking. Als Konsequenz der Einführung von ACTs stieg der Anteil
Fieberepisoden, welche auch zu den Gesundheitseinrichtungen gelangten, von
31-35% auf 45% im Verlauf der Studien. Treatment-Seeking in einem
Vergleichsdistrikt, wo gemäss der nationalen Strategie immer noch SP als
Erstbehandlung verwendet wurde, zeigte zwar Fluktuationen, blieb aber im
Wesentlichen unverändert. Im Zusammenhang mit Fieberepisoden wurden am
häufigsten junge Kinder festgestellt. Die reichsten Bevölkerungssegmente
benützten die Gesundheitseinrichtungen häufiger als die ärmsten.
Unsere Studien zeigen, dass ACT als Erstbehandlung in
Gesundheitseinrichtungen ein akzeptierter und realisierbarer Ansatz ist, der
sowohl die Krankheitslast als auch die Krankheitsübertragung einschränken kann.
ACT war wirksam als ein Teil eines integrierten Ansatzes, der auch die
Förderung von ITNs beinhaltete. Die Studien zeigen auch, dass eine gute
Befolgung der ACT erreicht werden kann, wenn den Behandlungen ein
ausreichendes Training des Gesundheitspersonals und innovative Informations-,
Aufklärungs- und Kommunikationsmassnahmen vorangehen. Die Bereitstellung
von ACT in Gesundheitseinrichtungen verbessert die Nutzung dieser
Einrichtungen in vielerlei Hinsicht. Zur Erreichung und Gewährleistung eines
breiten Zugangs zu ACTs sind aber auch andere Abgabestrategien nötig, welche
alle Anbieter von Gesundheitsleistungen mit einschliessen und für die bessere
Erreichbarkeit und Zugangsgerechtigkeit auch heimbasierte Behandlungen
zulassen.
Dementsprechend gibt es wichtige Probleme, welche weitere
Forschungsanstrengungen benötigen. Wie zum Beispiel können ACTs wirksam
und unter Berücksichtigung sowohl aller Anbieter von Gesundheitsleistungen in
einem bestimmten Gebiet als auch aller Möglichkeiten der heimbasierten
Behandlung zur Verfügung gestellt werden, so dass ein möglichst breiter und
gerechter Zugang zu schnellen Diagnosen und Behandlungen erreicht werden
kann? Zudem sollten wir Synergien, welche entstehen, wenn verschiedene
Malariakontrollinterventionen begleitend und/oder einander nachfolgend in
unterschiedlichen Zeit-Raum-Dynamiken der Abdeckung implementiert werden,
besser verstehen. Diese Informationen sind entscheidend um
massgeschneiderte Strategien für verschiedene endemische Situationen zu
entwerfen und um einen Schritt von der Malariakontrolle hin zur Malariaelimination zu machen.
MUHTASARI
Ugonjwa wa malaria huambukizwa na vimelea vya aina ya P.Falciparum.
Vimelea hivi huenezwa na mbu wa kike wa aina ya anophelene. Vimelea hivi vya
P.Falciparum vina usumbufu wa kipekee kwa vile vipo maeneo mengi na
vinazaliana haraka haraka na kuzaa ugonjwa mbaya. Kila mwaka wata wapatao
millioni 500 humbukizwa vimelea ambapo wagonjwa baina ya millioni 200 mpaka
300 huugua ugonjwa wa malaria na kiasi ya wagonjwa millioni moja hufa kote
duniani. Jumla ya maisha ya binadamu inayopotea kutokana na vifo na kuugua
ugonjwa huu inakadiriwa kufikia miaka millioni 45. Kiasi ya asilimia thamanini ya
hasara hii hupatikana katika bara la Africa na wanaoathirika zaidi ni watoto
wadogo wadogo. Nchini Tanzania kiasi ya asilimia thelathini ya hasara iletwayo
na magonjwa husababishwa na malaria.
Ugonjwa wa malaria unaweza kutambulika na kutibika kwa haraka kwa dawa
imara. Ugonjwa huu hugeuka kuwa hatari sana na kusababisha vifo vingi ikiwa
matibabu yake yatacheleweshwa. Dawa za Chloroquine na salfadoxinepyremethamine
(SP) ambazo kwa muda mrefu zilikuwa zinatumika kutibia
ugonjwa huu katika nchi za Africa zenye kuambukizwa zaidi, sasa hivi hazifanyi
tena kazi kwa sababu ya usugu wa vimelea. Dawa za mseto zenye
mchanganyiko wa artemisinin (ACT) sasa hivi zinapendekezwa zaidi kutokana na
kuthibitika uimara na usalama na kwa vile kwa sasa hakuna matokeo ya usugu
wa vimelea uliotolewa taarifa. Pamoja na hayo, Ugonjwa wa malaria unakingika
kwa kutumia vyandarua vyenye viatilifu (ITN), dawa za kunyunyiza majumbani na
kuuwa mayai ya mbu kwa kutumia dawa katika mazalia ya mbu.
Katika kipindi ambapo dawa za Chloroquine na SP zilikuwa zinashindwa kwa
kasi kubwa kuponesha ugonjwa wa malaria, mradi wa kutathmini dawa mseto za
malaria (IMPACT-TZ) ulibuniwa na ulifanya tathmini ya dawa mseto katika wilaya
za Rufiji, Kilombero na Ulanga zilizopo mikoa ya Pwani na Morogoro nchini
Tanzania.
Kitabu hiki cha uhitimu wangu wa shahada ya udaktari wa falsafa katika fani ya
epidemiology kinatokana na utafiti uliofanywa chini ya muavuli wa mradi wa
IMPACT-Tz kati ya mwaka 2001 mpaka 2006. Madhumuni yake ni (i)kutathmini
jinsi wagonjwa wa malaria waliotibiwa kwa dawa mseto walivykuwa wakitumia
dawa hizo kwa usahihi; (ii) kufuatilia uwepo wa vimelea vya malaria katika kipindi
ambacho dawa mseto zilihamasishwa na kutumika; na (iii) kutafiti athari ya
utekelezaji wa mradi huu kwa matumizi ya vituo vya tiba na pia matumizi ya
vyandarua vyente viatilifu na mikakati mbali mbali ya kuvisambaza katika vijiji
vilivyokuwa kwenye mradi. Tathmini hizi zilifanywa katika vijiji vilivyo kwenye
mpango wa kufuatilia taarifa zinazohusu uhamiaji, uhamaji, vizazi na vifo (DSS
sites) katiak sehemu za Rufiji na Ifaka zilizo chini ya Taasisi ya Utafiti wa afya ya
binadamu ya Ifakara (IHI). Utaratibu huu wa DSS ulishakuwepo kwenye vijiji
hivyo kwa muda mrefu. Tulifanya utafiti huu kwa njia ya mahojiano na wanakaya
wa kaya ambazo zilichaguliwa kwa bahati nasibu na kwa kuhakiki matone ya
damu yaliyokuwa yakichukuliwa wakati wa mahojiano. Katika kuangalia matumizi
ya dawa mseto kwa usahihi, tulikuwa tunawazungukia wagonjwa waliokuwa
walishatibiwa kwa dawa mseto katika vituo vya tiba majumbani mwao na
kuwadodosa jinsi walivyokuwa wametumia dawa hizo.
Jumla ya wagonjwa 253 walifuatiliwa majumbani mwao kuulizwa maswali baada
ya masaa 24 na 48 tokea kwenda kituoni kupata matibabu. Ilionekana kuwa
asilimia 75 ya wagonjwa waliofuatiliwa baada ya masaa 48 walitumia dawa
mseto kiusahihi. Haya yalipimwa kwa kukehasabu idadi ya vidonge vilivyokuwa
vimebaki na taarifa za mgonjwa mwenyewe walipotembelewa majumbani mwao
na kudodoswa na wahojaji. Kwa kweli majibu haya ya wagonjwa kutumia dawa
mseto kiusahihi yalikuwa bora kuliko majibu yaliyokuya yamepatikana huko
nyuma katika tathmini ya dawa za Chloroquine
Matumizi ya vyandarua vyenye viatilifu yalikuwa yanaongezeka kutokana na
vyandaraua hivyo kusambazwa kwa kutumia njia mseto ambazo zilijumuisha
ugawaji wa vyandarua vya bure siku ya chanjo na kwa njia ya soko na hati
punguzo. Njia zote hizo hasa ile ya kuviuza vyandarua dukani haikuwanyanyua
sana watu maskini sana. Vyandarau vilivyotolewa bure na vile vilivyouzwa kwa
hati punguzo havikuonekana kuleta kutokuwepo na usawa. Katika mwaka 2005,
matumizi ya kila aina ya chandarua yalifikia silimia 63 na kwa watoto wachanga
peke yao yalifikia asilimia 87. Asilimia thelathini ya vyandarua vilikuwa
vimewekwa viatilifu kipindi cha miezi 6 kabla ya mahojiano.
Ama katika tathmini ya vimelea vya malaria katika jamii, tuliona kuwa mwaka
2001 uwepo wa vimelea ulikuw asilimia 26 ya watu wote katika DSS upande wa
Rufiji ikilinganishwa na asilimia 18 katika upande wa Ifakara. Uwepo wa vimelea
ulipungua hadi kufikia asilimia 19 mwaka 2004 kwa upande wa Rufiji baada ya
kanzishwa matibabu ya dawa mseto mwaka 2003. Katika mwaka 2002 uwepo
wa vimelea huko ulikuwa 29%. Baadae kiwango hicho cha mwaka 2004 huko
Rufiji kilibaki hivyo kwa mwaka 2005 na kushuka kufikia asilimia 15 mwaka 2006.
Tathmini ya Ifakara ilionesha kuwa uwepo wa vimelea ulikuwa 22% mwaka 2002,
25% katika mwaka 2004, 11% mwaka 2005 na 14% mwaka 2006. Kwa upande
wa upungufu wa damu mwilini , tathmini yetu iliyofanywa mwaka 2004 mpaka
2006 katika upande wa Rufiji ilionesha kuwa upungufu ulipungua kutoka asilimia
23 mwaka 2004 hadi 16% mwaka 2005 na 2006. Upande wa Ifakara hali ilikuwa
12% mwaka 2004, 18% mwaka 2005 na 10% mwaka 2006. Matumizi ya
vyandarua yaliongezeka huko Rufiji kutoka asilimia 18% mwaka 2001 na kufikia
asilimia 63 mwaka 2006. Na huko Ifakara matumizi yalikuwa asilimia 69 mwaka
2001 na kuongezeka kuwa asilimia 86 mwaka 2006.
Katika tathmini yetu ya kujua matumizi ya vituo vya matibabu kwa wale
waliosema waligua homa au malaria wiki mbili kabla ya mahojiano tuligundua
kwamba matumizi ya chanzo hicho yalikuwa 31% na 35% kwa mika ya 2001 na
2002 huko Rufiji. Hii ni miaka kabla ya kuanza kutibu malaria kwa kutumia dawa
mseto katika vituo vya afya sehemu hiyo. Matumizi yaliongezeka kufikia 45%
katika mwaka 2004, mwaka mmoja baada ya kuanza dawa hizo katika vituo vya
afya peke yake. Matumizi hayo yalipungua kidogo na kufikia 41% mwaka 2005.
Yalianguka zaidi mwaka 2006 kwa kufikia 30% tu. Kwa upande wa Ifakara
ambako wagonjwa waliendelea na sera ya serikali kwa nchi nzima ya matibabu
ya dawa isiyo ya mseto ya SP wakati ule , wagonjwa waliopata matibabu yao
kutoka vituo vya Afya yalikuwa 27% kunako mwaka 2001 na 33% katika mwaka
2002. Hali ilishuka na kufikia 29% kunako mwaka 2004 na kuongezeka kufikia
36% katika mwaka 2005 na kutokuwepo na mabadiliko katika mwaka 2006.
Katika kuhusisha matumizi haya ya vituo vya afya na rika za watu, watoto chini
ya miaka 5 walikuwa wanatumia vituo hivyo mara nyingi zaidi kuliko wenye umri
zaidi yao kutoka zote za Rufiji na Ifakara. Aidha, wale wenye unafuu wa maisha
walikuwa na fursa zaidi ya kutumia vituo vya matibabu kwa zaidi ya 50% ya wale
waliokuwa wanaishi maisha ya chini zaidi kutoka katika sehemu zot
The pattern, sources, and growth of remittances to Pakistan: The kinked exponential approach
This paper examines the pattern, sources and growth of remittances to Pakistan. It analyses the growing trend of remittances and share of remittances to GDP over the period 1972-2014. We use the kinked exponential model (Boyce, 1986, 1987) to estimates the growing trend of remittances in Pakistan. The results show that remittances received by Pakistan have three distinct growth phases over the study period – Phase I (1973 – 1983), Phase II (1984 – 2000) and Phase III (2001 – 2014). The remittances received by Pakistan have positive growth during the first and the third period while the second period shows negative growth. Before globalization, the UK was the major source of remittances to Pakistan but after globalization, the sources of remittances to Pakistan have been cantered on Saudi Arabia, the UAE, and other Gulf countries
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