Understanding Malaria Persistence: A Mixed-Methods Study on the Effectiveness of Malaria Elimination Strategies in South-Central Vietnam

Despite the scale-up of vector control, diagnosis and treatment, and health information campaigns, malaria persists in the forested areas of South-Central Vietnam, home to ethnic minority populations. A mixed-methods study using an exploratory sequential design was conducted in 10 Ra-glai villages in Bac Ai district of Ninh Thuan province to examine which social factors limited the effectiveness of the national malaria elimination strategy in the local setting. Territorial arrangements and mobility were found to directly limit the effectiveness of indoor residual spraying and long-lasting insectidical treated nets (LLINs). Households (n=410) were resettled in the “new villages” by the government, where they received brick houses (87.1%) and sufficient LLINs (97.3%). However, 97.6% of households went back to their “old villages” to continue slash-and-burn agriculture. In the old village, 48.5% of households lived in open-structured plot huts and only 5.7% of them had sufficient LLIN coverage. Household representatives believed malaria could be cured with antimalarials (57.8%), but also perceived non-malarial medicines, rituals, and vitamin supplements to be effective against malaria. Household members (n = 1,957) used public health services for their most recent illness (62.9%), but also reported to buy low-cost medicines from the private sector to treat fevers and discomfort as these were perceived to be the most cost-effective treatment option for slash-and-burn farmers. The study shows the relevance of understanding social factors to improve the uptake of public health interventions and calls for contextually adapted strategies for malaria elimination in ethnic minority populations in Vietnam and similar settings

PLoS One

Introduction Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda. Methods A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients’ health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care. Results Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient’s health and illness experience, and the quality of the relationship between patient and health worker (range 62.1–78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes. Discussion and conclusion Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients’ expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients’ responsibilities and patient’s rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC

SO₂ emission rates and incorporation into the air pollution dispersion forecast during the 2021 eruption of Fagradalsfjall, Iceland

During the low-effusion rate Fagradalsfjall eruption (19 March – 18 September 2021), the emission of sulfur dioxide (SO₂) was frequently measured using ground-based UV spectrometers. The total SO₂ emitted during the entire eruption was 970 ± 540 kt, which is only about 6% of the SO₂ emitted during the similar length Holuhraun eruption (2014–2015). The eruption was divided into five phases based on visual observations, including the number of active vents and the occurrence of lava fountaining. The SO₂ emission rate ranged from 44 ± 19 kg/s in Phase 2 to 85 ± 29 kg/s in Phase 5, with an average of 64 ± 34 kg/s for the entire eruption. There was notable variability in SO₂ on short timescales, with measurements on 11 August 2021 ranging from 17 to 78 kg/s. SO₂ flux measurements were made using scanning DOAS instruments located at different distances from and orientations relative to the eruption site augmented by traverses. Four hundred and forty-four scan and traverse measurements met quality criteria and were used, along with plume height and meteorological data, to calculate SO₂ fluxes while accounting for wind-related uncertainties. A tendency for stronger SO₂ flux concurrent with higher amplitude seismic tremor and the occurrence of lava fountaining was observed during Phases 4 and 5 which were characterized by intermittent crater activity including observable effusion of lava and gas release interspersed with long repose times. This tendency was used to refine the calculation of the amount of SO₂ emitted during variably vigorous activity. The continuous seismic tremor time series was used to quantify how long during these eruption phases strong/weak activity was exhibited to improve the calculated SO₂ flux during these Phases. The total SO₂ emissions derived from field measurements align closely with results obtained by combining melt inclusion and groundmass glass analyses with lava effusion rate measurements (910 ± 230 kt SO₂). Specifically, utilizing the maximum S content found in evolved melt inclusions and the least remaining S content in accompanying quenched groundmasses provides an identical result between field measurements and the petrological calculations. This suggests that the maximum SO₂ release calculated from petrological estimates should be preferentially used to initialize gas dispersion models for basaltic eruptions when other measurements are lacking. During the eruption, the CALPUFF dispersion model was used to forecast ground-level exposure to SO₂. The SO₂ emission rates measured by DOAS were used as input for the dispersion model, with updates made when a significant change was measured. A detailed analysis of one mid-distance station over the entire eruption shows that the model performed very well at predicting the presence of volcanic SO₂ when it was measured. However, it frequently predicted the presence of SO₂ that was not measured and the concentrations forecasted had no correlation with the concentrations measured. Various approaches to improve the model forecast were tested, including updating plume height and SO₂ flux source terms based on measurements. These approaches did not unambiguously improve the model performance but suggest that improvements might be achieved in more-polluted conditions

Modelling Dynamic Conditional Correlations in WTI Oil Forward and Futures Returns

This paper estimates the dynamic conditional correlations in the returns on WTI oil one-month forward prices, and one-, three-, six-, and twelve-month futures prices, using recently developed multivariate conditional volatility models. The dynamic correlations enable a determination of whether the forward and various futures returns are substitutes or complements, which are crucial for deciding whether or not to hedge against unforeseen circumstances. The models are estimated using daily data on WTI oil forward and futures prices, and their associated returns, from 3 January 1985 to 16 January 2004. At the univariate level, the estimates are statistically significant, with the occasional asymmetric effect in which negative shocks have a greater impact on volatility than positive shocks. In all cases, both the short- and long-run persistence of shocks are statistically significant. Among the five returns, there are ten conditional correlations, with the highest estimate of constant conditional correlation being 0.975 between the volatilities of the three-month and six-month futures returns, and the lowest being 0.656 between the volatilities of the forward and twelve-month futures returns. The dynamic conditional correlations can vary dramatically, being negative in four of ten cases and being close to zero in another five cases. Only in the case of the dynamic volatilities of the three-month and six-month futures returns is the range of variation relatively narrow, namely (0.832, 0.996). Thus, in general, the dynamic volatilities in the returns in the WTI oil forward and future prices can be either independent or interdependent over time

Equilibrium with a Market of Permits

In this paper we present the main results of three original studies on the equilibrium with a market of tradeable permits in a static framework. In first study, we have considered an international equilibrium of two countries which depend on the quantity of permits to each country. The allocation is efficient if and only if it is proportional to efficient labor. A redistribution in favor of the less developed country implies a redistribution to this country but leads to a dilemma with efficiency. In the second study, we analyze the consequences of the choice between giving free permits to firms and other possibilities. We show that for equalizing incomes of production factors with there marginal productivities, each factor should receive a quantity of free permits proportional to its contribution to production. In the third study, we consider the partial equilibrium of an industry where each firm is characterized by a parameter combining production efficiency and pollution effect. We define a theoretical indicator of environmental efficiency and we analyze its properties

A Climate-Change Policy Induced Shift from Innovations in Energy Production to Energy Savings

We develop an endogenous growth model with capital, labor and energy as production factors and three productivity variables that measure accumulated innovations for energy production, energy savings, and neutral growth. All markets are complete and perfect, except for research, for which we assume that the marginal social value exceeds marginal costs by factor four. The model constants are calibrated so that the model reproduces the relevant trends over the 1970-2000 period. The model contains a simple climate module, and is used to assess the impact of Induced Technological Change (ITC) for a policy that aims at a maximum level of atmospheric CO2 concentration (450 ppmv). ITC is shown to reduce the required carbon tax by about a factor 2, and to reduce costs of such a policy by about factor 10. Numerical simulations show that knowledge accumulation shifts from energy production to energy saving technology