Bio-efficacy of selected long-lasting insecticidal nets against pyrethroid resistant Anopheles arabiensis from South-Western Ethiopia.

The emergence and spread of insecticide resistance in the major African malaria vectors Anopheles gambiae s.s. and Anopheles arabiensis may compromise control initiatives based on insecticide-treated nets (ITNs) or indoor residual spraying (IRS), and thus threaten the global malaria elimination strategy. We investigated pyrethroid resistance in four populations of An. arabiensis from south-western Ethiopia and then assessed the bio-efficacy of six World Health Organization recommended long lasting insecticidal nets (LLINs) using these populations. For all four populations of An. arabiensis, bottle bioassays indicated low to moderate susceptibility to deltamethrin (mortality at 30 minutes ranged between 43 and 80%) and permethrin (mortality ranged between 16 and 76%). Pre-exposure to the synergist piperonylbutoxide (PBO) significantly increased the susceptibility of all four populations to both deltamethrin (mortality increased between 15.3 and 56.8%) and permethrin (mortality increased between 11.6 and 58.1%), indicating the possible involvement of metabolic resistance in addition to the previously identified kdr mutations. There was reduced susceptibility of all four An. arabiensis populations to the five standard LLINs tested (maximum mortality 81.1%; minimum mortality 13.9%). Bio-efficacy against the four populations varied by net type, with the largest margin of difference observed with the Jimma population (67.2% difference). Moreover, there were differences in the bio-efficacy of each individual standard LLIN against the four mosquito populations; for example there was a difference of 40% in mortality of Yorkool against two populations. Results from standard LLINs indicated reduced susceptibility to new, unused nets that was likely due to observed pyrethroid resistance. The roof of the combination LLIN performed optimally (100% mortality) against all the four populations of An. arabiensis, indicating that observed reductions in susceptibility could be ameliorated with the combination of PBO with deltamethrin, as used in PermaNet® 3.0. Our results suggest that bio-efficacy evaluations using local mosquito populations should be conducted where possible to make evidence-based decisions on the most suitable control products, and that those combining multiple chemicals such as PBO and deltamethrin should be considered for maintaining a high level of efficacy in vector control programmes

Monitoring health inequalities when the socio-economic composition changes : are the slope and relative indices of inequality appropriate? : results of a simulation study

Background. The slope (SII) and relative (RII) indices of inequality are commonly recommended to monitor health inequality policies. As an upwards shift of the educational level distribution (ELD) can be part of those policies, we examine how such a shift affects the SII, the RII and the population attributable fraction (PAF). Methods. We simulated 632 distributions of 4 educational levels (ELs) by varying the share (p1 to p4) of each EL, with constant mortality rates (MR) and calculated the corresponding RII, SII and PAF. Second, we decomposed the effect on the three indices of a change affecting both the ELD and the MRs, into the contributions of each component. Results. RIIs and SIIs sharply increase with p4 at fixed p1 values and evolve as reversed U-curves for p1 changing in complement to p4. The RII reaches a maximum, at much higher p4 values than the SII. PAFs monotonically decrease when p4 increases. Conclusion. If improving the educational attainment is part of a policy, an upwards shift of EL should be assessed as a progress; however the RII, and to a lesser extent the SII, frequently translate an increased EL4 share as a worsening. We warn against the use of SII and RII for monitoring inequality-tackling policies at changing socio-economic structures. Rather, we recommend to complement the assessment of changes in absolute and relative pairwise differentials, with changes in PAF and in the socio-economic group shares

Mapping EQ-5D utilities to GBD 2010 and GBD 2013 disability weights : results of two pilot studies in Belgium

Background: Utilities and disability weights (DWs) are metrics used for calculating Quality-Adjusted Life Years and Disability-Adjusted Life Years (DALYs), respectively. Utilities can be obtained with multi-attribute instruments such as the EuroQol 5 dimensions questionnaire (EQ-5D). In 2010 and 2013, Salomon et al. proposed a set of DWs for 220 and 183 health states, respectively. The objective of this study is to develop an approach for mapping EQ-5D utilities to existing GBD 2010 and GBD 2013 DWs, allowing to predict new GBD 2010/2013 DWs based on EQ-5D utilities. Methods: We conducted two pilot studies including respectively four and twenty-seven health states selected from the 220 DWs of the GBD 2010 study. In the first study, each participant evaluated four health conditions using the standard written EQ-5D-5 L questionnaire. In the second study, each participant evaluated four health conditions randomly selected among the twenty-seven health states using a previously developed web-based EQ-5D-5 L questionnaire. The EQ-5D responses were translated into utilities using the model developed by Cleemput et al. A loess regression allowed to map EQ-5D utilities to logit transformed DWs. Results: Overall, 81 and 393 respondents completed the first and the second survey, respectively. In the first study, a monotonic relationship between derived utilities and predicted GBD 2010/2013 DWs was observed, but not in the second study. There were some important differences in ranking of health states based on utilities versus GBD 2010/2013 DWs. The participants of the current study attributed a relatively higher severity level to musculoskeletal disorders such as ‘Amputation of both legs’ and a relatively lower severity level to non-functional disorders such as ‘Headache migraine’ compared to the participants of the GBD 2010/2013 studies. Conclusion: This study suggests the possibility to translate any utility derived from EQ-5D scores into a DW, but also highlights important caveats. We observed a satisfactory result of this methodology when utilities were derived from a population of public health students, a written questionnaire and a small number of health states in the presence of a study leader. However the results were unsatisfactory when utilities were derived from a sample of the general population, using a web-based questionnaire. We recommend to repeat the study in a larger and more diverse sample to obtain a more representative distribution of educational level and age

Agent-based modelling for rethinking the socioeconomic determinants of child health in sub-Saharan Africa

Socioeconomic factors play distal roles in shaping populations’ health. In sub-Saharan Africa, these structural health determinants are strongly associated with intermediate determinants of under-5 mortality such as lifestyle factors, health seeking behaviour, or exposure to a health threat. The aim of the study was to use simulation tools for rethinking the dynamics between socioeconomic factors, preventive health measures, and child health. An agent-based model was developed, consisting of rules and equations based on data from four Demographic and Health Surveys conducted in sub-Saharan countries. The model, visualizing the impact of different factors and complex effects, enhanced the understanding and debate on causal pathways of socioeconomic inequalities in under-5 mortality

Novel Insights in the Fecal Egg Count Reduction Test for Monitoring Drug Efficacy against Soil-Transmitted Helminths in Large-Scale Treatment Programs

The reduction in number of eggs excreted in stools after drug administration is a primary parameter to monitor the efficacy of drugs against parasitic worms. Guidelines on how to perform such a fecal egg count reduction test (FECRT) are provided by the World Health Organization. However, it remains unclear to which extent these guidelines are cost-effective. We, therefore, performed a simulation study in which the FECRT was performed under varying conditions to determine the critical values for sample size, the detection limit of the fecal egg count (FEC) method, mean baseline FEC, and variation of FEC across host population that allow for conclusive FECRT results. The results revealed that a reliable monitoring system demands a sample size of 200 subjects and that in some cases FECRT results may be thwarted by low mean baseline FEC. For this sample size, the detection of the FEC method or the variation of FEC across the host population did not affect the FECRT results. Our findings underscore that the current guidelines are not cost-effective, demanding too much financial and technical resources. We, therefore, propose novel guidelines to support future monitoring programs

Household level spatio-temporal analysis of Plasmodium falciparum and Plasmodium vivax malaria in Ethiopia

Background: The global decline of malaria burden and goals for elimination has led to an increased interest in the fine-scale epidemiology of malaria. Micro-geographic heterogeneity of malaria infection could have implications for designing targeted small-area interventions. Methods: Two-year longitudinal cohort study data were used to explore the spatial and spatio-temporal distribution of malaria episodes in 2040 children aged < 10 years in 16 villages near the Gilgel-Gibe hydropower dam in Southwest Ethiopia. All selected households (HHs) were geo-referenced, and children were followed up through weekly house-to-house visits for two consecutive years to identify febrile episodes of P. falciparum and P. vivax infections. After confirming the spatial dependence of malaria episodes with Ripley's K function, SatScan(TM) was used to identify purely spatial and space-time clusters (hotspots) of annual malaria incidence for 2 years follow-up: year 1 (July 2008-June 2009) and year 2 (July 2009-June 2010). Results: In total, 685 P. falciparum episodes (in 492 HHs) and 385 P. vivax episodes (in 290 HHs) were identified, representing respectively incidence rates of 14.6 (95% CI: 13.4-15.6) and 8.2 (95% CI: 7.3-9.1) per 1000 child-months at risk. In year 1, the most likely (128 HHs with 63 episodes, RR = 2.1) and secondary (15 HHs with 12 episodes, RR = 5.31) clusters of P. vivax incidence were found respectively in southern and north-western villages; while in year 2, the most likely cluster was located only in north-western villages (85 HHs with 16 episodes, RR = 4.4). Instead, most likely spatial clusters of P. falciparum incidence were consistently located in villages south of the dam in both years: year 1 (167 HHs with 81 episodes, RR = 1.8) and year 2 (133 HHs with 67 episodes, RR = 2.2). Space-time clusters in southern villages for P. vivax were found in August-November 2008 in year 1 and between November 2009 and February 2010 in year 2; while for P. falciparum, they were found in September-November 2008 in year 1 and October-November 2009 in year 2. Conclusion: Hotspots of P. falciparum incidence in children were more stable at the geographical level and over time compared to those of P. vivax incidence during the study period

Bizneset e vogla familjare garant i zhvillimit ekonomik e social

Integrimi global ekonomik si proces gjithnjë e më shumë po ka ndikim edhe në politikat nacionale të zhvillimit, ndaj si i tillë është jashtëzakonisht vështir që të kontrollohet me aplikimin e metodave dhe instrumenteve tradicionale të zhvillimit ekonomik. Kjo mbase vështirëson që në vitet në vijim, të planifikohen qëllime të caktuara ekonomike në nivel shteti. Të gjitha ndërmarrjet në botë, të mëdha apo të vogla, familjare dhe jo familjare, publike apo jo publike, të zhvilluara dhe të pa zhvilluara, po përballen me një sërë pyetjesh të cilat kanë të bëjnë me ardhmërinë dhe perspektivën e tyre, respektivisht vije në pikëpyetje ekzistenca e tyre në situata të paparapara turbulente për rrethinën. Çfarë do të jenë nevojat e tregut, çfarë synon konkurrenca, a po lëkunden qëndrimet e blerësve, kah pretendon përparimi i teknikës dhe teknologjisë, çfarë me zhvillimin e prodhimeve të reja, a ka mundësi të sigurimit të resurseve të nevojshme, kah udhëzon globalizimi i biznesit,cilat nevoja duhet përdorur për arritjen e efikasitetit, efektiviteti dhe inovacionet, etj… të gjitha këto pyetje u adresohen çdo ditë ndërmarrjeve – pa marrë parasysh nëse ato janë në pronësi të familjes apo nuk janë të tilla. Ajo çka ndërmarrjet familjare i bënë të veçanta dhe që i dallon nga ndërmarrjet e tjera që nuk janë në pronësi apo kontroll të familjes, paraqet diversitetin e interesit familjar dhe interesit të ndërmarrjes në sistemin e unik të biznesit familjar. Pronarët e kompanive familjare në të gjithë botën ndajnë filozofinë dhe vlerat e njëjta, ata mendojnë në perspektivë, kapitali i tyre është durimi dhe zelli, interesohen për bashkësinë ku veprojnë dhe punojnë ashtu që kompaninë në gjendjen më të mirë të mundshme t’ua lënë trashëgimtarëve të tyre. Modeli i biznesit të kompanive familjare është tejet inovativ dhe largpamës, kërkon në realizim më të mirë, krijon më shumë vlera, ruan vendet e punës, përkundër rënieve dhe recesioneve ciklike. Zhvillimi i ndërmarrjeve të vogla dhe të mesme familjare, paraqet rrugën më të shpejtë dhe më të lirë të zhvillimit të ekonomive kombëtare. NVM janë shtyllat kurrizore të zhvillimit ekonomik të shteteve në tranzicion dhe përkrah rolit të madh që kanë në punësim ato janë mjaft domethënëse për demokratizimin e shoqërisë

Malnutrition and the disproportional burden on the poor: the case of Ghana

Background. Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups. Methods. This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey. Results. The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population. Conclusion. Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition