Is ALT control really necessary for routine ART monitoring in resource poor settings?

2006 AIDS Conference in Toront

Workers’ compensation, minimum wages, and moral hazard scope. Stylized considerations on a South African case

Viewing issues from the perspective of workers’ compensation, the article highlights how for some South African sectors the simultaneous provision of a minimum wage and a permanent disablement coverage increases moral hazard scope. From an economy-wide perspective this increasing scope means that employers (and society) not only pay too much to provide workers’ compensation, but are doing so at a mounting pace. The article considers some policy options that are overall not too drastic as regards the elimination of the increasing scope, and in so doing it also reminds us about the crucial importance of careful institutional design

A survey on the occurrence of resistance to anthelmintics of gastrointestinal nematodes of goats in Mozambique

A survey to study the extent of anthelmintic resistance was conducted in Maputo and Gaza, two of the ten provinces of Mozambique, during February and March 1999. A total of 12 flocks, six in Maputo and six in Gaza, was surveyed. The faecal egg count reduction test was used to assess the efficacy of three anthelmintics most often used in Mozambique, namely albendazole fenbendazole and levamisole. The degree of resistance was calculated using two different methods, and varied according to the method used. Using the formula of Coles, Bauer, Borgsteede, Geerts, Klei, Taylor and Waller (1992), resistance to the benzimidazoles was detected in one flock in Maputo and one in Gaza, and to levamisole in three flocks in Maputo and one in Gaza. When the formula of Dash, Hall and Barger (1988) was used, however, resistance to the benzimidazoles was detected in only one flock in Maputo, and no resistance to levamisole was detected. The 12 farms surveyed were too few for conclusions to be made on the prevalence of anthelmintic resistance in goats in Mozambique as a whole. Therefore, an extensive survey at national level is needed. This study gives evidence, however, that anthelmintic resistance in nematode parasites of goats is an emerging problem, to which special attention should be paid.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Swedish International Development and Cooperation Agency (SIDA).mn201

The Impact of Charcoal Production on Forest Degradation: a Case Study in Tete, Mozambique

Charcoal production for urban energy consumption is a main driver of forest degradation in sub-Saharan Africa. Urban growth projections for the continent suggest that the relevance of this process will increase in the coming decades. Forest degradation associated to charcoal production is difficult to monitor and commonly overlooked and underrepresented in forest cover change and carbon emission estimates. We use a multi-temporal dataset of very high-resolution remote sensing images to map kiln locations in a representative study area of tropical woodlands in central Mozambique. The resulting maps provided a characterization of the spatial extent and temporal dynamics of charcoal production. Using an indirect approach we combine kiln maps and field information on charcoal making to describe the magnitude and intensity of forest degradation linked to charcoal production, including aboveground biomass and carbon emissions. Our findings reveal that forest degradation associated to charcoal production in the study area is largely independent from deforestation driven by agricultural expansion and that its impact on forest cover change is in the same order of magnitude as deforestation. Our work illustrates the feasibility of using estimates of urban charcoal consumption to establish a link between urban energy demands and forest degradation. This kind of approach has potential to reduce uncertainties in forest cover change and carbon emission assessments in sub-Saharan Africa

What drives policy change for REDD+? : A qualitative comparative analysis of the interplay between institutional and policy arena factors

Reducing Emissions from Deforestation and forest Degradation (REDD+) has emerged as a promising climate change mitigation mechanism in developing countries. In order to identify the enabling conditions for achieving progress in the implementation of an effective, efficient and equitable REDD+, this paper examines national policy settings in a comparative analysis across 13 countries with a focus on both institutional context and the actual setting of the policy arena. The evaluation of REDD+ revealed that countries across Africa, Asia and Latin America are showing some progress, but some face backlashes in realizing the necessary transformational change to tackle deforestation and forest degradation. A Qualitative Comparative Analysis (QCA) undertaken as part of the research project showed two enabling institutional configurations facilitating progress: (1) the presence of already initiated policy change; and (2) scarcity of forest resources combined with an absence of any effective forestry framework and policies. When these were analysed alongside policy arena conditions, the paper finds that the presence of powerful transformational coalitions combined with strong ownership and leadership, and performance-based funding, can both work as a strong incentive for achieving REDD+ goals. Key policy insights The positive push of already existing policy change, or the negative stress of resource scarcity together with lack of effective policies, represents institutional conditions that can support REDD+ progress. Progress also requires the presence of powerful transformational coalitions and strong ownership and leadership. In the absence of these internal drivers, performance-based funding can work as a strong incentive. When comparing three assessments (2012, 2014, 2016) of REDD+ enabling conditions, some progress in establishing processes of change can be observed over time; however, the overall fluctuation in progress of most countries reveals the difficulty in changing the deforestation trajectory away from business as usual.Peer reviewe

Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019)

Publisher Copyright: © 2021 Chissaque et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Mozambique introduced the monovalent rotavirus vaccine (Rotarix®, GSK Biologicals, Rixensart, Belgium) in September 2015. Previous analysis, showed that Nampula province continues reporting a high frequency of Rotavirus A (RVA) infection and the emergence of G9P[6], G9P[4] and G3P[4] genotypes. This analysis aimed to determine the RVA frequency; risk factors; genotype distribution by vaccination status and age between pre- and post-vaccine periods in children under-five years old with diarrhea in Nampula. A cross-sectional, hospital-based surveillance study was conducted in the Hospital Central de Nampula in Mozambique. Socio-demographic and clinical data were collected to assess factors related to RVA infection in both periods. Stool specimens were screened to detect RVA by ELISA, and positive samples were genotyped. Between 2015 (pre-vaccine period) and 2016-2019 (post-vaccine period), 614 stool specimens were collected and tested for RVA in which 34.9% (67/192) were positive in pre-vaccine period and 21.8% (92/422) in post-vaccine (p = 0.001). In the post-vaccine period, age, year, and contact with different animal species (chicken, duck, or multiple animals) were associated with RVA infection. RVA infection was higher in children partially vaccinated (40.7%, 11/27) followed by the fully vaccinated (29.3%, 56/191) and the unvaccinated (15.3%, 21/137) (p = 0.002). G1P[8] and G9P[4] were common in vaccinated children less than 12 months. The present analysis showed that RVA infection reduced slightly in the post-vaccine period, with a high proportion of infection and genotype diversity in children, under 12 months of age, vaccinated. Further research on factors associated with RVA infection on vaccinated compared to unvaccinated children and vaccination optimization should be done.publishersversionpublishe

The Impact of Delayed Treatment of Uncomplicated \u3ci\u3eP. falciparum\u3c/i\u3e Malaria on Progression to Severe Malaria: A Systematic Review and a Pooled Multicentre Individual-Patient Meta-Analysis

BACKGROUND: Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as \u27test-and-treat\u27 policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM. METHODS AND FINDINGS: A search using Ovid MEDLINE and Embase was initially conducted to identify studies on severe Plasmodium falciparum malaria that included information on treatment delay, such as fever duration (inception to 22nd September 2017). Studies identified included 5 case-control and 8 other observational clinical studies of SM and UM cases. Risk of bias was assessed using the Newcastle-Ottawa scale, and all studies were ranked as \u27Good\u27, scoring ≥7/10. Individual-patient data (IPD) were pooled from 13 studies of 3,989 (94.1% aged \u3c15 years) SM patients and 5,780 (79.6% aged \u3c15 years) UM cases in Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda, Yemen, and Zambia. Definitions of SM were standardised across studies to compare treatment delay in patients with UM and different SM phenotypes using age-adjusted mixed-effects regression. The odds of any SM phenotype were significantly higher in children with longer delays between initial symptoms and arrival at the health facility (odds ratio [OR] = 1.33, 95% CI: 1.07-1.64 for a delay of \u3e24 hours versus ≤24 hours; p = 0.009). Reported illness duration was a strong predictor of presenting with severe malarial anaemia (SMA) in children, with an OR of 2.79 (95% CI:1.92-4.06; p \u3c 0.001) for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p \u3c 0.001) for a delay of \u3e7 days, compared with receiving treatment within 24 hours from symptom onset. We estimate that 42.8% of childhood SMA cases and 48.5% of adult SMA cases in the study areas would have been averted if all individuals were able to access treatment within the first day of symptom onset, if the association is fully causal. In studies specifically recording onset of nonsevere symptoms, long treatment delay was moderately associated with other SM phenotypes (OR [95% CI] \u3e3 to ≤4 days versus ≤24 hours: cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In addition to unmeasured confounding, which is commonly present in observational studies, a key limitation is that many severe cases and deaths occur outside healthcare facilities in endemic countries, where the effect of delayed or no treatment is difficult to quantify. CONCLUSIONS: Our results quantify the relationship between rapid access to treatment and reduced risk of severe disease, which was particularly strong for SMA. There was some evidence to suggest that progression to other severe phenotypes may also be prevented by prompt treatment, though the association was not as strong, which may be explained by potential selection bias, sample size issues, or a difference in underlying pathology. These findings may help assess the impact of interventions that improve access to treatment