A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Benin, 2009

In Benin, as in many low‐income countries, private commercial providers play an important role in the treatment of malaria.  To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that influence their stocking and pricing decisions.  Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers, and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access.  However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia). This report presents the results from qualitative interviews with antimalarial drug wholesalers, retailers and other key stakeholders conducted in Benin in June 2009. To provide a complete description of the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the results of the structured supply chain survey also conducted as part of this study, available at www.actwatch.info

A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Benin, 2009

In Benin, as in many low‐income countries, private commercial providers play an important role in the treatment of malaria.  To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that influence their stocking and pricing decisions.  Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers, and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access.  However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia). This report presents the results from qualitative interviews with antimalarial drug wholesalers, retailers and other key stakeholders conducted in Benin in June 2009. To provide a complete description of the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the results of the structured supply chain survey also conducted as part of this study, available at www.actwatch.info

The private commercial sector distribution chain for antimalarial drugs in Madagascar: Findings from a rapid assessment

ACTwatch is a research programme funded by the Bill and Melinda Gates Foundation that aims to provide and promote evidence and recommendations for policy makers on methods to increase availability and decrease the consumer price of quality‐assured Artemisinin‐based Combination Therapies (ACTs) throughout the private sector. Research has been carried out in seven countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and D.R. Congo) and encompasses Household Surveys, Outlet Surveys, as well as Supply Chain Surveys and Assessments.   As is the case in many developing countries, the private sector in Madagascar plays a pivotal role in facilitating access to malaria treatment. The Household and Outlet surveys conducted in Madagascar suggest that the general population tends to seek treatment through the private sector, and that private sector outlets make up a substantial portion of outlets that carry antimalarials.   In order to design future interventions that will improve access to diagnostic and effective treatment options, it is important to understand the structure of the private sector distribution chain for antimalarials, as well as the incentives, restrictions and challenges that actors within the market face. Despite the important role of the private sector in the supply of antimalarials, there is limited rigorous evidence on the subject. This report contributes to addressing this gap for Madagascar

A search for evidence of irradiation in Centaurus X-4 during quiescence

We present a study of the neutron star X-Ray Transient Cen X-4. Our aim is to look for any evidence of irradiation of the companion with a detailed analysis of its radial velocity curve, relative contribution of the donor star and Doppler tomography of the main emission lines. To improve our study all our data are compared with a set of simulations that consider different physical parameters of the system, like the disc aperture angle and the mass ratio. We conclude that neither the radial velocity curve nor the orbital variation of the relative donor's contribution to the total flux are affected by irradiation. On the other hand, we do see emission from the donor star at H${\alpha}$ and HeI 5876 which we tentatively attribute to irradiation effects. In particular, the H${\alpha}$ emission from the companion is clearly asymmetric and we suggest is produced by irradiation from the hot-spot. Finally, from the velocity of the HeI 5876 spot we constrain the disc opening angle to alpha=7-14 deg.Comment: 4 pages, 5 figures, accepted for publication in A&A as a R

Resilience of olive tree cultivars to intensive salt stress

Comunicación oral presentada en: III congreso CAOS, Granada EEZ, España. 4 mayo 2023This work was performed at the Stress, Development and Signaling in Plants of the Estación Experimental del Zaidín – Spanish Council for Scientific Research (CSIC)- and at student’s home. The work was supported by research projects MCIN/AEI/PID2020-113324GB-100, and TED2021130015BC22 both of them co-funded by ERDF program of the EU

The potential for quality assurance systems to save costs and lives:the case of early infant diagnosis of HIV

OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT

Characterization and application of a sterol esterase immobilized on polyacrylate epoxy-activated carriers (DilbeadsTM)

The sterol esterase from the ascomycete Ophiostoma piceae was immobilized on novel polyacrylate-based epoxy-activated carriers (DilbeadsTM). Six supports with particle sizes between 120-165 micrometers were prepared varying the composition of monomers, crosslinkers and porogens. Their surface areas and porosities were determined by N2 adsorption and mercury intrusion porosimetry. The pore volumes ranged from 0.63 to 1.32 cm3/g, but only DilbeadsTM RS and NK had narrow pore size distributions (with maxima at 33.5 and 67.0 nm, respectively). The distribution of the enzyme in the support was studied by fluorescence confocal microscopy. The immobilized esterase on DilbeadsTM TA showed a significant pH and thermal stability and was assayed in the continuous hydrolysis of cholesteryl esters -present in the pulp industry process waters-.We thank Mª Teresa Seisdedos (Centro de Investigaciones Biologicas, CSIC) for help with the confocal microscopy. This research was supported by the Spanish Ministry of Education and Science (Projects BIO2002-00337 and BIO2003-00621) and Comunidad de Madrid (Project S-0505/AMB0100). We thank CSIC for a research fellowshipPeer reviewe

Carotid ultrasound is useful for the cardiovascular risk stratification in patients with hidradenitis suppurativa

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease which has been associated with an increased risk of adverse cardiovascular (CV) outcomes. Adequate stratification of the CV risk is an issue of major importance in patients with HS. To analyze the usefulness of carotid ultrasound (US) assessment for the CV disease risk stratification compared with a traditional score, the Framingham risk score (FRS), in a series of patients with HS. METHODS: Cross-sectional study of 60 patients with HS without history of CV events, diabetes mellitus or chronic kidney disease. Information on CV risk factors was collected and the FRS was calculated. Thus, the patients were classified into low, intermediate and high-CV disease risk categories based on FRS. Carotid US was performed in all participants, and the presence of atherosclerotic plaques was considered as a marker of high CV risk. RESULTS: HS patients had a mean age of 45.1±10.2 years, and 55% were female. The median FRS was 5.7 (IQR: 3.1-14.7). Twenty-four (40%) of the patients were classified into the low risk group, 28 (46.7%) in the intermediate risk group, and 8 (13.3%) into the FRS-high risk category. Noteworthy, carotid US revealed that about one-third of the patients (17/52; 32.6%) in the FRS-based low and intermediate risk categories had carotid plaques, and, therefore, they were reclassified into a high-risk category. CONCLUSION: CV risk in HS patients may be underestimated by using the FRS. Carotid US may be useful to improve the CV risk stratification of patients with HS.This study was funded through an unrestricted grant provided by AbbVie to MGL. AbbVie has not played any role in study design, data collection and analysis, decision to publish or preparation of the manuscript

Reciprocal Tripartite Interactions between the Aedes aegypti Midgut Microbiota, Innate Immune System and Dengue Virus Influences Vector Competence

Dengue virus is one of the most important arboviral pathogens and the causative agent of dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. It is transmitted between humans by the mosquitoes Aedes aegypti and Aedes albopictus, and at least 2.5 billion people are at daily risk of infection. During their lifecycle, mosquitoes are exposed to a variety of microbes, some of which are needed for their successful development into adulthood. However, recent studies have suggested that the adult mosquito's midgut microflora is critical in influencing the transmission of human pathogens. In this study we assessed the reciprocal interactions between the mosquito's midgut microbiota and dengue virus infection that are, to a large extent, mediated by the mosquito's innate immune system. We observed a marked decrease in susceptibility to dengue virus infection when mosquitoes harbored certain field-derived bacterial isolates in their midgut. Transcript abundance analysis of selected antimicrobial peptide genes suggested that the mosquito's microbiota elicits a basal immune activity that appears to act against dengue virus infection. Conversely, the elicitation of the mosquito immune response by dengue virus infection itself influences the microbial load of the mosquito midgut. In sum, we show that the mosquito's microbiota influences dengue virus infection of the mosquito, which in turn activates its antibacterial responses