79 research outputs found
Gaining Access to Prompt and Appropriate Malaria Treatment in the Kilombero Valley, Tanzania: A Health Social Science Perspective
Get PDFMalaria is a life-threatening disease causing an estimated one million death annually. Major achievements have recently been noted in Tanzania, child mortality rates are declining. If prompt and effective treatment is initiated, malaria is a curable disease; however, in many places, people still lack access to prompt and effective malaria treatment. This thesis was carried out during the first phase of the ACCESS intervention program (2004-2008) which aimed at improving access to malaria treatment in the Kilombero Valley, Tanzania. The program had three main areas of interventions: 1) in the community, 2) the drug shops and 3) the health facilities. This thesis has grown out of the monitoring and evaluation component of the ACCESS program. It specifically focuses on two monitoring and evaluation activities: 1) treatment seeking surveys which assess interventions at community level and 2) mystery shopping studies at drug shop level. The studies on treatment seeking (Chapters 4-6) investigated whether malaria treatment seeking for children with fever and convulsion has changed during the first phase of the ACCESS program. The key argument is that unprecedented achievements in the availability and affordability of effective drugs do not necessarily imply that people get the medicines they need. Access to medicines is a multifaceted phenomenon: Five dimensions of access (availability, affordability, accessibility, adequacy and acceptability) play an influential role in treatment seeking decisions. Of these dimensions, acceptability has received least attention. This study defines acceptability as the match between local and biomedical understanding and appropriate treatment seeking. Acceptability is of particular relevance if local and biomedical explanatory models of illness differ, as they did, for instance, for severe malaria with convulsions. Previous studies on explanatory models of convulsions have shown that communities may not link convulsions with malaria and prefer local treatment practices. Most of these studies have relied on what people would do in cases of illness. It is therefore impossible to assess whether and what proportion of children gain access to appropriate treatment. The studies presented here contributed to closing this knowledge gap by examining actual convulsion cases. The Explanatory Model Interview Catalogue was used to collect information on symptoms, causes and treatment seeking for fever and convulsion among children under-five years of age in four studies: i) a cross-section fever survey (2004, n= 88); ii) a longitudinal shamba fever study (2005, n=29); iii) a longitudinal degedege study (2004/06 n=135); and iv) longitudinal degedege study (2007/08 n=88). Findings indicated that the match between local and biomedical understandings of convulsions was already high in 2004/06; 68% of caregivers associated convulsion with severe malaria while 85% mentioned mosquito bites as a cause of convulsion. Significant changes were noted in the second round of interviews, specifically on i) 46% point increase among those who reported use of mosquito nets to prevent convulsions; ii) 13% point decrease among caregivers who associated convulsion with ‘evil eye and sorcery’; iii) 14% point increase in prompt use of a health facility; and iv) 16% point decrease among those who did not use a health facility. The contrast of these findings with findings from previous studies can be explained by a) differences in accuracy of data collection and b) changes in explanatory models due to long exposure to biomedical research and interventions, also through the ACCESS program. The studies on mystery shopping (Chapters 7 and 8) examined the usefulness of this methodology for assessing changes in the performance of drug sellers in community pharmacies. Indicators were developed and used to measure the quality of dispensing practices and advice before and after ADDO implementation in 2006. Results showed a 30% increase from 2006 to 2007 among clients who got correct advice and treatment based on the assessed indicators. This thesis provides the first systematic community-based study of actual treatment seeking for children with convulsions in Tanzania and to our best knowledge also in Africa. The methodology developed in this study should be refined and validated in further empirical and comparative research across regions and countries. Improving the match between local and biomedical understanding of disease is fundamental to ensuring acceptability of health care services and successful control of health problems. The thesis further showed that mystery shopping is a useful technique for assessing the impact of ADDO interventions in retail drug stores. Innovative community based participatory research approaches and more systematic mystery shopping techniques would allow for comparative community-based assessments of drug shop interventions across regions and countries
Acceptability - a neglected dimension of access to health care: findings from a study on childhood convulsions in rural Tanzania.
Get PDFABSTRACT: BACKGROUND: Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers' and clients' understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. METHODS: The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. RESULTS: The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1) 46% point increase among those who reported use of mosquito nets to prevent convulsion (2) 13% point decrease among caregivers who associated convulsion with 'evil eye and sorcery', 3) 14% point increase in prompt use of health facility and 4)16% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. CONCLUSION: As an important dimension of access to health care 'social acceptability' seems relevant in studying illnesses that are perceived not to belong to the biomedical field, specifically in trans-cultural societies. Understanding the match between local and biomedical understanding of disease is fundamental to ensure acceptability of health care services, successful control and management of health problems. Our study noted some positive changes in community knowledge and management of convulsion episodes, changes which might be accredited to extensive health education campaigns in the study area. On the other hand it is difficult to make inference out of the findings as a result of small sample size involved. In return, it is clear that well ingrained traditional beliefs can be modified with communication campaigns, provided that this change resonates with the beneficiaries
Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective.
Get PDFBACKGROUND\ud
\ud
To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.\ud
\ud
METHODS\ud
\ud
The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.\ud
\ud
RESULTS\ud
\ud
Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)\ud
\ud
CONCLUSIONS\ud
\ud
The public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake
Assessment of ADDO Owners’ and Dispensers’ Attitudes and Behavior in Ruvuma and Tanga, Tanzania: (Medicine dispensing- Antibiotics)
No full text
Isotropic charge transport in conducting PEDOT:PSS thin films on pre-strained stretchable substrates
No full textImprovements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective.
Get PDFBACKGROUND\ud
\ud
The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment.\ud
\ud
METHODS\ud
\ud
Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS) and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days.\ud
\ud
RESULTS\ud
\ud
Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%); an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%); higher treatment coverage with anti-malarials (86% to 96%) and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs). Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%). The availability of outlets (health facilities or drug shops) is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent.\ud
\ud
CONCLUSIONS\ud
\ud
An integrated approach aimed at improving understanding and treatment of malaria has led to tangible improvements in terms of people's actions for the treatment of malaria. However, progress was hindered by the low availability of the first-line treatment after the switch to ACT
Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania.
Get PDFBACKGROUND\ud
\ud
Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions.\ud
\ud
METHODS\ud
\ud
We conducted community-based treatment-seeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources.\ud
\ud
RESULTS\ud
\ud
After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2-93.8) of the fever cases in children and 80.7% (68.1-90.0) in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine). However, only 22.5% (13.9-33.2) of the children and 10.5% (4.0-21.5) of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR = 7.7) but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers.\ud
\ud
CONCLUSION\ud
\ud
A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health services in delivering antimalarial treatment. Health system factors like these need to be tackled urgently in order to translate the high efficacy of newly introduced artemisinin-based combination therapy (ACT) into equitable community-effectiveness and health-impact
Journal Bibliometric Analysis: A Case Study on Quality Assurance in Education
Get PDFThe paper examines the pattern of publications of the journal Quality Assurance in Education (QAE) from 2008 to 2012 and reveals various facets of its publications through key bibliometric measures. The study analyses publications of the QAE from the year 2008 to 2012. The author explores Scopus and Google Scholar to assess the impact and influence of individual papers through comparative analysis of citations recorded in the respective indexing databases. The study finds that out of 112 articles published in the QAE from 2008 to 2012, the journal published a little over 22 articles per annum, on an average. QAE authors have used 43.25 references per article on an average and the average pages per article in the journal ranges from the lowest average of 16.73 in 2008 to the highest average of 19.26 in the year 2011. Majority of its authors have used 41 to 50 references and e-citations in the journal are found less in comparison to that of journals and books. 2012 ‘Impact Factor’ of the journal based on Scopus citations is found to be 1.047 while it is 1.976 based on Google Scholar citations
Analysis of Time Dependent Bending Response of Ag-IPMC Actuator
No full textAbstractIn this work, time dependent bending characteristics of Silver electrode Ionic Polymer Metal Composite (IPMC) has been studied under potential gradient. Euler-Bernoulli approach has been followed for obtaining the bending moment generates taking into account of the applied voltage. Kinematic modeling is done for the Ag-IPMC actuator after constituting the homogeneous coordinate transformation. Based on the forward kinematic model, energy based dynamic model of the IPMC actuator has been formulated following the Lagrangian principle. The motion of the patches is restricted as planar in 2D. Simulation has been done for Ag-IPMC actuator based on the experimental deflection data to demonstrate the time dependent response for different sequence of input voltages
- …
