French version available in IDRC Digital Library: Nouvelles armes dans la guerre contre le paludisme : éradiquer la maladie pour améliorer la santé générale en TanzanieEvidence showing the large impact of malaria on Tanzanians’ health has provided
the impetus for significant policy changes on how to treat and prevent the
disease across the country. The fight against malaria is now proceeding on many
fronts, from preventative measures such as the promotion of insecticide-treated
bednets to the introduction of more effective treatments, such as new drug
therapies

Bashkirov S.

Belavin V.

Kutsenko S.

Lyubimov V.

Popov E.

Bulletin of the Russian Academy of Sciences Physics

The quantum interference effects occurring in resonant scattering of a γ photon in the multilevel γ-optical medium 57Fe, affected by an external RF field, have been theoretically investigated. It is shown that a significant reconstruction of the hyperfine structure of nuclear states leads to the interference of partial forwardscattering amplitudes of a γ photon and, therefore, to a significant change in the nuclear refractive index of the γ-optical medium, depending on the amplitude, frequency, and phase of the external RF field. The conditions are found under which the effect of electromagnetically induced transparency can be observed in the technique of in-phase detection of γ photons. © Allerton Press, Inc. 2007

National Open Repository Aggregator (NORA)

Quantum interference effects of γ radiation under crossing-anticrossing of nuclear levels in an RF field

Dale, Stephen

International Development Research Centre: IDRC Digital Library

A plastic bag hangs from the ceiling of a village clinic inMorogoro, Tanzania, where mothers and babies wait patientlyfor treatment. Inside the bag is a large colourful net. The pictureon the bag shows an enormous mosquito held at bay by thesymmetrical grid of a mosquito net. A few feet away, tacked upon a wooden door, a bright yellow poster depicts a warrior  —shield and spear extended  —  ready to repel malaria-carryingmosquitoes. Still another poster shows a smiling mother andbaby resting securely against the warrior’s shield. The unmistak-able message of all these images? That insecticide-treated nets(ITNs) provide vital protection against the mosquitoes that carrymalaria. That message is being heard throughout Tanzania. Asthe message spreads, treated bednets are becoming increasinglycommon. More than an illustration of the rising acceptance of ITNs, thoseposters are proof of the new prominence antimalaria effortshave acquired as health officials struggle to reduce Tanzania’shigh levels of mortality. The fight against malaria is proceedingon many fronts, from preventative measures such as the promo-tion of ITNs, to the introduction of more effective treatments,such as new drug therapies.IDRC: P. BennettInsecticide-treated nets provide vital protectionagainst the mosquitoes that carry malaria. www.idrc.ca/tehipNew Weapons in the War on MalariaHalting the disease is crucial to improving overall health in TanzaniaEvidence showing the large impact of malaria on Tanzanians’ health has providedthe impetus for significant policy changes on how to treat and prevent thedisease across the country. The fight against malaria is now proceeding on manyfronts, from preventative measures such as the promotion of insecticide-treatedbednets to the introduction of more effective treatments, such as new drugtherapies. 5C a s e  s t u d yHealthFixingSystemsCombating a major killerThis multipronged effort comes in response to the realiza-tion of the high toll malaria takes on the health and well-being of Tanzanians. Statistics compiled by the TanzaniaEssential Health Interventions Project (TEHIP) show thatmalaria accounts for roughly 30% of the country’s burdenof disease (BOD). In some districts, such as Morogoro, it isthe largest single contributor to loss of life. Even thosewho survive can pay a heavy price, with recurrent bouts ofdebilitating illness.This, in turn, has a large economic impact in countrieswhere malaria is endemic. A recent study by the Centre forInternational Development at Harvard University and theLondon School of Hygiene and Tropical Medicine suggeststhat malaria-prone countries pay an economic “growthpenalty” as high as 1.3 percentage points per year, withthe cumulative effect that — when the loss is compoundedover 15 years — the gross national product of those coun-tries can be reduced by nearly 20%. TEHIP — a joint project of the Tanzanian Ministry of Healthand Canada’s International Development Research Centre(IDRC) — contributed to this new focus on malaria. Bydeveloping a series of computer-based planning tools,TEHIP made it possible for District Health ManagementTeams (DHMTs) in two highly populated Tanzanian districtsto weigh their budget commitments and priorities againstthe local BOD. The research showed that malariaaccounted for 30% of the years of life lost to death anddisease in the  two regions. Yet, in 1996, only 5% of healthbudgets went toward malaria treatment and prevention.Today this has changed: spending on malaria has increasedto 25% of the health budget. In the test districts of Rufiji and Morogoro, DHMTs redi-rected funding priorities toward two large but previouslyunder-supported problems: malaria and a cluster of child-hood ailments that could be addressed collectively by asystem of treatment known as the Integrated Managementof Childhood Illness (IMCI). At the national level, the pres-entation of data showing the large impact of malaria onTanzanians’ health provided the impetus for significantpolicy changes on how to treat and prevent the diseaseacross the country. The two test districts’ new focus on malaria and IMCI weremutually reinforcing. TEHIP Project Coordinator Dr HarunKasale recalls that it was the districts’ inability to effec-tively implement IMCI without changes to the standardprocedure for treating malaria that led TEHIP to lobby theMinistry for a new antimalaria drug policy. Malaria, herecounts, was one of that interlocking group of childhoodillnesses that IMCI was designed to address. Yet sincechloroquine, the standard drug for treating malaria, hadlost much of its effectiveness as the malaria parasite hasgrown increasingly resistant to the drug, IMCI could notsignificantly improve children’s health until a betterremedy was found. A need for effective treatment“We reported to the Ministry that IMCI would not work ifwe continued working with the wrong drug, chloroquine,because the research showed that resistance ranges from50% to 70%,” says Dr Kasale. “If you look at data from thesurveillance, it showed that children suffering from malariadid attend the clinic, but they still died. That’s because theywere getting the wrong medicine. The Ministry did allowthe districts to change to new drugs, and that meant thatIMCI became a viable intervention using viable drugs —using credible, effective drugs.” At first it was decided to replace choroquine with alterna-tive drugs that would comprise three new tiers of treat-ment. The first-line drug for treating malaria would besulfadoxine-pyrimethamine (SP), with amodiaquine (AQ) asthe second line, and quinine as the third line (althoughquinine would be the first-line drug in severe cases). Theproblem that remained, however, was that resistance wasalready being observed with these new drugs: SP’s treat-ment failure was calculated at 9.5%, and AQ’s treatmentfailure was 4.6%. It was therefore suggested to get ready to move to “com-bination therapy” (CT) in which malaria patients would beprescribed a course of pills containing more than one anti-malaria medicine. The advantage of CT to the patient isthat if one drug fails, the other one takes over. Moregenerally, it is believed that CT can slow the progression of drug resistance in malaria parasites. This resistancegenerally develops when a malaria parasite that is partiallyresistant to a drug survives long enough to reproduce.With combination therapy, however, the second drug killsthe malaria parasite before it has an opportunity to passon its genetic material, thus interrupting the process ofselection of resistant strains. A powerful demonstration effectAccording to Dr Kasale, introducing more effectiveapproaches for managing malaria has bolstered thepublic’s confidence that the health system can deal withthe disease. For instance, many mothers whose childrensuffered from late stage malaria with convulsions werereluctant to have those children treated in a health facility.Although malaria with convulsions is very dangerous —likely to lead to death — the condition, known in Tanzaniaas ndegedege, is often not associated with malaria, but tothe presence of spirits or changes in the weather. Theseparents were more likely to consult traditional healers. Thiswas reinforced by the fact that health practitioners con-ventionally gave the child an injection to treat the convul-sions. “The parents also believed that if that child got aninjection [to treat convulsions], that was a ticket for thatchild to die,” says Dr Kasale.To assuage parents’ fears, practitioners in communityhealth facilities opted for a new form of treatment to stopthe convulsions: they mixed valium with water and admin-istered the solution rectally. “Within a minute the child isbetter,” says Dr Kasale, adding that the child who is nolonger convulsing can then be treated with oral anti-malarial drugs and transferred to a larger health centre for treatment. This nearly instant recovery from convulsions had a miracu-lous impact on the public perception of the health system.“The health worker gave the child this treatment in frontof the rest of the mothers,” continues Dr Kasale. “Afterseeing the child recover without an injection, they wereamazed. So the word went around, and mothers startedbringing these children to the health facilities.” Dr Kasalebelieves that this demonstration effect — patients seeingthe beneficial results and then telling others aboutthem — is one reason that attendance at clinics in Rufjiand Morogoro has risen dramatically. The efficacy of treated netsBetter treatment, however, is only half of the struggleagainst malaria. Policymakers and practitioners know thatmaking inroads against this devastating disease alsorequires an effective prevention program. The main tool:insecticide-treated bednets.According to Dr Kasale, communities have long understoodthat there are advantages to being shielded from mosquitobites. In Rufiji, for instance, many households used tradi-tional woven grass sleeping bags to protect againstmosquito bites. But while untreated nets and traditionalbarriers can reduce the nuisance factor associated withmosquitoes, they have their limitations. Mosquitoes canenter the net if it is torn or hung badly, and can bite anypart of the body in contact with the net. By contrast, nets treated with pyrethroid insecticides (ITNs)provide much more than a physical barrier; they actuallykill or deter mosquitoes from feeding and drive them fromtheir hiding places. Even a treated net with large holes init provides as much protection as an intact one, reducingmosquito bites by up to 95%. Mosquitoes are killed by theinsecticide before they can find a place to bite through thenet or push through a hole. The Ifakara Health Researchand Development Centre has determined that ITNs couldavert 30 000 deaths and more than 5 million clinicalepisodes of malaria annually in Tanzania.Research results summarized in Net Gain: A New Methodfor Preventing Malaria Deaths1, a copublication of IDRCand the World Health Organization, indicate that ITNscould reduce child mortality by at least 17%. The benefitsof using treated nets also accrue to the entire community.Recent evidence shows that a high-concentration oftreated nets in a community will afford some protection toall people in the area, even those who do not own a bed-net themselves.Not surprisingly, promoting the use of ITNs has become akey weapon in health officials’ battle against malaria.Because the high cost of the early treated nets  —  aboutUS $10 for a family-sized net  —  discouraged many peoplefrom purchasing them, the nets were promoted through asocial marketing campaign in Tanzania, led by PopulationServices International, a nongovernmental organization,with support from the UK Department for InternationalDevelopment. These efforts proved effective at enhancingawareness of the benefits of ITNs, dramatically decreasingthe cost of nets and increasing their use.Today, the nets are widely available. As their popularityspread, the cost declined to about US $4 and public healthofficials have turned their attention to those at highest riskfrom malaria  —  pregnant women and young children.The goal: to see 60% of children and pregnant womenprotected by a net by 2005. In the next phase of thenational ITN strategy, every pregnant woman who visits ahealth centre will receive a voucher for a bednet. She canredeem the voucher for an ITN by visiting a private vendor.In turn, the vendor will be reimbursed after bringing thevoucher to an authorized government agent.Delivering multiple benefitsThe voucher system is expected to bring multiple benefits.First, it transfers responsibility for procuring and distribut-ing the nets away from overburdened community healthworkers to private manufacturers, wholesalers, retailers,IDRC: P. BennettMaking inroads against this devastating diseaserequires an effective prevention program. The maintool: insecticide-treated bednets.1 Net Gain: A New Method for Preventing Malaria Deaths,edited by Christian Lengeler, Jacqueline Cattani, and Don deSavigny. IDRC 1996, ISBN 0-88936-792-2; 260 pp.http://web.idrc.ca/en/ev-9338-201-1-DO_TOPIC.htmland distributors. Second, it focuses on a particularly vulnerablegroup: pregnant women and young children. Research has shownthat women infected with malaria during pregnancy are highlylikely to deliver low birth weight babies. As well, infants quicklylose the immunity they may have acquired passively from theirmothers. This makes them highly susceptible to malaria and arange of secondary conditions (anemia, malnutrition, febrileseizures, sudden cardiac arrest, and a general failure to thrive,among others) that are a direct result of malaria.The voucher system also entices women who may not otherwisereceive care to establish a relationship with a health facility.Offering a pregnant woman a voucher for an ITN —  an item ofsignificant value — is a powerful incentive for her to visit a clinicwhere she can receive antenatal care. The baby can also be immu-nized and mother and child can receive follow-up health care. This is just one of the many ways in which more effective andintegrated initiatives against malaria have become a cornerstoneof broader efforts to revitalize Tanzania’s health system. This case study was written by Stephen Dale on behalf of IDRC’sCommunications Division.www.idrc.ca/tehipFixing Health SystemsMore information on the capacity building of District Health Management teamsin Morogoro and Rufiji can be found in Fixing Health Systems, by Don deSavigny, Harun Kasale, Conrad Mbuya, and Graham Reid. The book describes theTanzania Essential Health Interventions Project – its origins, impact, importantlessons, observations, and recommendations for decision-makers and policy ana-lysts. The full text of the book is available on a thematic Web dossier, which leadsthe reader into a virtual web of resources that explores the TEHIP story:www.idrc.ca/tehip. More information on malaria control can be found at:http://www.rbm.who.int/Published in collaboration with the Ministry of Health, Tanzania.For more information:Dr Hassan MshindaIfakara Health Research Development CentreMikocheni Plot No. 463Kiko StreetPO Box 78378Dar es SalaamTanzaniaIDRC: P. BennettPublic health officials have turned their attention tothose at highest risk from malaria  —  pregnantwomen and young children. Governance, Equity, and HealthProgram InitiativeInternational Development Research CentrePO Box 8500, Ottawa, ONCanada  K1G 3H9Tel.: +1 (613) 236-6163Fax: +1 (613) 567-7748Email: health@idrc.caWeb: www.idrc.caThe International Development Research Centre(IDRC) is a public corporation created by theParliament of Canada in 1970 to help researchersand communities in the developing world findsolutions to their social, economic, andenvironmental problems. Support is directedtoward developing an indigenous researchcapacity to sustain policies and technologiesdeveloping countries need to build healthier,more equitable, and more prosperous societies. Tel.: +255-23-2625164Fax: +255-23-2625312Email: hmshinda@ifakara.mimcom.netAugust 2004 CASE-TEHIP-5E