Poor quality vital anti-malarials in Africa - an urgent neglected public health priority

BACKGROUND: Plasmodium falciparum malaria remains a major public health problem. A vital component of malaria control rests on the availability of good quality artemisinin-derivative based combination therapy (ACT) at the correct dose. However, there are increasing reports of poor quality anti-malarials in Africa. METHODS: Seven collections of artemisinin derivative monotherapies, ACT and halofantrine anti-malarials of suspicious quality were collected in 2002/10 in eleven African countries and in Asia en route to Africa. Packaging, chemical composition (high performance liquid chromatography, direct ionization mass spectrometry, X-ray diffractometry, stable isotope analysis) and botanical investigations were performed. RESULTS: Counterfeit artesunate containing chloroquine, counterfeit dihydroartemisinin (DHA) containing paracetamol (acetaminophen), counterfeit DHA-piperaquine containing sildenafil, counterfeit artemether-lumefantrine containing pyrimethamine, counterfeit halofantrine containing artemisinin, and substandard/counterfeit or degraded artesunate and artesunate+amodiaquine in eight countries are described. Pollen analysis was consistent with manufacture of counterfeits in eastern Asia. These data do not allow estimation of the frequency of poor quality anti-malarials in Africa. CONCLUSIONS: Criminals are producing diverse harmful anti-malarial counterfeits with important public health consequences. The presence of artesunate monotherapy, substandard and/or degraded and counterfeit medicines containing sub-therapeutic amounts of unexpected anti-malarials will engender drug resistance. With the threatening spread of artemisinin resistance to Africa, much greater investment is required to ensure the quality of ACTs and removal of artemisinin monotherapies. The International Health Regulations may need to be invoked to counter these serious public health problems

Assessing the impact of microfinance programming on children: an evaluation from post-tsunami Aceh

This paper presents an evaluation of the long‐term impact of microfinance programmes on Acehnese children during the post‐tsunami recovery. The study, conducted from June to August 2010, examined the impact of microfinance programming six years after the tsunami. The sample consisted of 185 microfinance participants, with a comparison group of 192 individuals who did not participate in microfinance programmes. All respondents were parents, interviewed through a structured survey. The study used four child protection indicators—diet, health, childcare and education—in contrast to traditional repayment rate indicators. The primary results were insignificant with respect to all four child protection indicators, suggesting that, with respect to these indicators, there was no long‐term difference between the impact of microfinance on beneficiaries' children and non‐beneficiaries' children. These findings signify a need for microfinance actors to move beyond traditional indicators of economic success to evaluate the social changes microfinance programmes are presumed to effect

Murder, Capital Punishment, and Deterrence: A Review of the Evidence and an Examination of Police Killings.

This paper reviews and assesses the empirical literature on murder, capital punishment, and deterrence. There is a large body of evidence regarding these issues, with studies yielding a rather consistent pattern of nondeterrence. However, most investigations are limited because they rely upon the general homicide rate as the criterion variable, although both legally and theoretically, different types of murder may be differentially subject to deterrence. As an example of how deterrence investigations may benefit from examining different types of homicide, we conduct a monthly time-series analysis of the possible deterrent effect of the provision for capital punishment, levels of execution, and the amount and type of television news coverage executions receive on overall and different types of police killings for 1976-1989. The analysis reveals no evidence that police are afforded an added measure of protection against death by capital punishment

Repurposing NGO data for better research outcomes: A scoping review of the use and secondary analysis of NGO data in health policy and systems research

Background Non-government organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytic approach provided a comprehensive overview and descriptive analyses of the studies which: 1) used data produced or collected by or about NGOs; 2) performed secondary analysis of the NGO data (beyond use of an NGO report as a supporting reference); 3) used NGO-collected clinical data. Results Of the 156 studies which performed secondary analysis of NGO-produced or collected data, 64% (n=100) used NGO-produced reports (e.g. to critique NGO activities and as a contextual reference) and 8% (n=13) analysed NGO-collected clinical data.. Of the studies, 55% investigated service delivery research topics, with 48% undertaken in developing countries and 17% in both developing and developed. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), with some limitations such as inconsistencies and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics, such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. Their use could enable relevant and timely research in the areas of health policy, programme evaluation and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries

Marketing Strategies and Market Prospects for Environmentally Friendly Consumer Products

Recent evidence suggests that the extent of consumer adoption of 'green' products is much less than would be indicated by the enthusiastic opinion poll evidence concerning public attitudes towards environmentally-friendly consumption. This paper reports on an empirical analysis of firms' marketing strategies and their influence on consumer demand for green products. In twenty 2-3 hour interviews with senior managers, four representative groups of markets were analysed: household detergents, paper (recycled), petrol (unleaded) and automobile technology (focusing on catalytic converters). According to managers, firms' marketing strategies influenced consumer demand by making green technologies available in the first instance. However, barriers to supplying green products that show parity with, or better performance than, conventional technologies constrain pricing and communication efforts. Managers stressed that, in the absence of clarity of green products' environmental benefits, product performance and other attributes, not green benefits, remain the main determinants of product preference and choice. Promotions focused much more on consumers than distribution channels, yet channel acceptance and support of green innovations are paramount in facilitating sales. Firms see the costs of generating and promoting desirable green technologies as barriers to diffusion in the immediate future. Legislation and/or economic incentives may help, but manufacturers are not optimistic that future green consumption rates will accelerate. The results also highlight several propositions concerning the discrepancy between consumer environmental concerns and purchasing actions which warrant further testing: there is mis-specification of green products in relation to consumers' needs; there are barriers to perceptions of green products' environmental impact and consumers' free ride due to individual self-interest

The role of p44/42 activation in tributyltin-induced inhibition of human natural killer cells: effects of MEK inhibitors

Destruction of tumor cells is a key function of NK cells. Previous studies have shown that tributyltin (TBT) can significantly reduce the lytic function of the human NK cells with accompanying increases in the phosphorylation (activation) states of the mitogen activated protein kinases (MAPKs), p44/42. The current studies examine the role of p44/42 activation in the TBT-induced reduction of NK-lytic function, by using MAPK kinase (MEK) inhibitors, PD98059 and U0126. A 1 h treatment with PD98059 or U0126 or both decreased the ability of NK cells to lyse K562 tumor cells. PD98059, U0126 or a combination of both inhibitors were able to completely block TBT-induced activation of p44/42. However, when p44/42 activation was blocked by the presence of PD98059, U0126, or the combination, subsequent exposure to TBT was still able to decrease the lytic function of NK cells. These results indicate that TBT-induced activation of p44/42 occurs via the activation of its upstream activator, MEK, and not by a TBT-induced inhibition of p44/42 phosphatase activity. Additionally, as lytic function was never completely blocked by MEK inhibitors, the results indicate that activation of p44/42 pathway is not solely responsible for the activation of lytic function of freshly isolated human NK cells. Finally, the results showed that TBT-induced activation of p44/42 is not solely responsible for the loss of lytic function