13 research outputs found
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Recent SLAC measurements of the spin dependent structure functions for the proton and neutron
No full textThe authors present results from SLAC experiments E142 and E143 for the spin dependent structure functions of the proton g{sub 1}{sup p}(x, Q{sup 2}) and neutron g{sub 1}{sup n}(x,Q{sup 2}) measured in deep inelastic scattering of polarized electrons from a polarized target. Experiment E142 measures {integral}{sub 0}{sup 1} g{sub 1}{sup n}(x)dx = {minus}0.022 {+-} 0.011 at = 2 (GeV/c){sup 2} using a polarized {sup 3}He target. Experiment E143 measures {integral}{sub 0}{sup 1} g{sub 1}{sup p}(x)dx = 0.129 {+-} 0.011 at = 3 (GeV/c){sup 2} using a polarized NH{sub 3} target. These results are combined at Q{sup 2} = 3 (GeV/c){sup 2} to yield {integral}{sub 0}{sup 1} [g{sub 1}{sup p}(x) {minus} g{sub 1}{sup n}(x)]dx = 0.151 {+-} 0.015. The Bjorken sum rule predicts 0.171 {+-} 0.008
Proton structure from deep inelastic and diffractive scattering
No full textWe investigate various aspects of the proton structure in this thesis. The first addresses the distribution of the proton spin among its constituents, quarks and gluons. We derive the framework of distribution functions for these constituents and study the properties of the polarized distributions which describe the spin structure of the proton. A determination of the polarized distributions on the basis of present experimental data is presented and options for future measurements are critically evaluated. A second aspect under consideration is the phenomenology of hard diffractive electron-proton scattering. We show how diffractive interaction and hard scattering can be disentangled and suggest experimental tests for this interpretation. Finally, we illustrate how the knowledge on the proton structure can be used for the computation of observables in proton-antiproton collisions, confirming or extending our knowledge of the physics of elementary particles
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SLAC measurements of the neutron spin-structure function
No full textResults from a measurement of the neutron spin-dependent structure function g{sub 1}{sup n}(x) over a range in x from 0.03 to 0.6 and with Q{sup 2} > 1 (GeV/c){sup 2} are presented. The experiment consisted of scattering a longitudinally polarized electron beam from the Stanford Linear Accelerator off a polarized {sup 3}He target and detecting scattered electrons in two magnetic spectrometers. The results are interpreted in the quark-parton model and used to test the Bjorken sum rule
Microbial larvicide application by a large-scale, community-based program reduces malaria infection prevalence in urban Dar es Salaam, Tanzania.
No full textBACKGROUND\ud
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Malaria control in Africa is most tractable in urban settlements yet most research has focused on rural settings. Elimination of malaria transmission from urban areas may require larval control strategies that complement adult mosquito control using insecticide-treated nets or houses, particularly where vectors feed outdoors.\ud
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METHODS AND FINDINGS\ud
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Microbial larvicide (Bacillus thuringiensis var. israelensis (Bti)) was applied weekly through programmatic, non-randomized community-based, but vertically managed, delivery systems in urban Dar es Salaam, Tanzania. Continuous, randomized cluster sampling of malaria infection prevalence and non-random programmatic surveillance of entomological inoculation rate (EIR) respectively constituted the primary and secondary outcomes surveyed within a population of approximately 612,000 residents in 15 fully urban wards covering 55 km(2). Bti application for one year in 3 of those wards (17 km(2) with 128,000 residents) reduced crude annual transmission estimates (Relative EIR [95% Confidence Interval] = 0.683 [0.491-0.952], P = 0.024) but program effectiveness peaked between July and September (Relative EIR [CI] = 0.354 [0.193 to 0.650], P = 0.001) when 45% (9/20) of directly observed transmission events occurred. Larviciding reduced malaria infection risk among children < or =5 years of age (OR [CI] = 0.284 [0.101 to 0.801], P = 0.017) and provided protection at least as good as personal use of an insecticide treated net (OR [CI] = 0.764 [0.614-0.951], P = 0.016).\ud
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CONCLUSIONS\ud
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In this context, larviciding reduced malaria prevalence and complemented existing protection provided by insecticide-treated nets. Larviciding may represent a useful option for integrated vector management in Africa, particularly in its rapidly growing urban centres
Determination of the neutron spin structure function.
No full textThe spin structure function of the neutron g1n has been determined over the range 0.03 \u3c x \u3c 0.6 at an average Q2 of 2 (GeV/c)2 by measuring the asymmetry in deep inelastic scattering of polarized electrons from a polarized 3He target at energies between 19 and 26 GeV. The integral of the neutron spin structure function is found to be f-10 gn1(x)dx = -0.022 ± 0.011. Earlier reported proton results together with the Bjorken sum rule predict f-10 gn1(x)dx = -0.059 ± 0.019
Deep inelastic scattering of polarized electrons by polarized He and the study of the neutron spin structure
No full textThe neutron longitudinal and transverse asymmetries and have been extracted from deep inelastic scattering of polarized electrons by a polarized He target at incident energies of 19.42, 22.66 and 25.51 GeV. The measurement allows for the determination of the neutron spin structure functions and over the range at an average of 2 (GeV. The data are used for the evaluation of the Ellis-Jaffe and Bjorken sum rules. The neutron spin structure function is small and negative within the range of our measurement, yielding an integral . Assuming Regge behavior at low , we extract . Combined with previous proton integral results from SLAC experiment E143, we find in agreement with the Bjorken sum rule prediction at a value of 3 (GeV evaluated using
Identification of behaviour change techniques and engagement strategies to design a smartphone app to reduce alcohol consumption using a formal consensus method
No full textBackground: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet a strong evidence base on their ability to engage users or on their effectiveness. Objective: This study aimed to identify the behaviour change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone application (app) to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with seven international experts in the field of alcohol and/or behaviour change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analysed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ2(11)=35.77, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ2(15)=59.16, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features
The co-production of gender and technology in HIV prevention research
No full textVaginal microbicides are pharmaceutical products in development that are designed to
reduce the sexual transmission of HIV in women. They are commonly known as a
`woman-controlled technology' and tool for women's empowerment, and form part of a
burgeoning field of clinical research into new biotechnologies for HIV prevention.
Little work has critically examined how such research and new technologies are
produced, and how they in turn contribute to the construction, maintenance or
deconstruction of gender relations.
Adopting a Foucauldian understanding of power and discourse, and using theoretical
insights from science and technology studies (STS), this research explores the coproduction
of gender and technology through the case study of vaginal microbicides.
'T'his account of the relations between science, society and technology draws on
empirical research conducted in the UK and Zambia with the pharmaceutical industry,
trialists, trial participants and trial communities. It interrogates the techniques of power
through which transnational scientific networks are mobilised to test new products, such
as microbicides, and how these affect scientific practices, knowledges and identities
across socio-geographic boundaries. It attends to the potential multiplicity of
interventions in diverse contexts, calling into question the presumed stability and
singularity of both the randomized controlled trial and vaginal microbicides.
This research makes an empirical contribution to knowledge about new biomedical
technologies for HIV prevention, detailing the transformation that may occur when
technologies travel from their site of development to their site of use. It provides a
detailed analysis of the interaction between gender performativity and science in action,
challenging the sense of `gendered' technologies for a `feminized' epidemic.
Theoretically, it contributes to debates about the role of social theory in public health
research and reconstructivist agendas in STS, concluding with a model for greater
collaboration between health technology designers, evaluators, critics, and users
Evaluation of the Quality of Guidelines for the Treatment of Symptoms of Dengue, Zika, and Chikungunya and Management of the Aedes aegypti Mosquito
No full text1. INTRODUCTION
Arboviruses such as Dengue, Zika, and Chikungunya are caused by the DENV, ZIKV, and CHIKV viruses, respectively[1-3]. Symptoms include fever, skin rash, nausea, vomiting, conjunctivitis, easy bleeding, body pain, and hematological changes. Severe complications like Guillain-Barré syndrome, neuropathies, myelitis, hemorrhage, fetal malformations, miscarriages, premature births, and death can occur[2-4]. The treatment for these diseases is symptomatic, generally involving the use of paracetamol or dipyrone, hydration, and rest[5]. Transmission occurs mainly through mosquitoes of the Aedes genus in tropical and subtropical regions, including around 128 countries[6]. In Brazil, the Aedes aegypti mosquito is the primary vector, and mosquito control is the most effective measure to curb the spread of these arboviruses, mainly by eliminating standing water sites necessary for the hatching of eggs[3, 5].
To guide effective public policies in disease treatment and vector control, it is crucial to gather relevant scientific evidence and develop guiding documents known as guidelines[7]. Health guidelines are important tools for improving the quality of healthcare services[8-10] and can be divided into clinical practice guidelines (CPGs) and health system guidelines (HS). CPGs provide recommendations based on systematic reviews to optimize patient care[11, 12], while health system guidelines offer solutions for policy development in health systems[13-15]. To ensure the quality in the development and purpose of these guidelines, tools have been developed since the early 1990s. Today, the most widely used are from the AGREE collaboration: AGREE II[16]– methodological quality of clinical guidelines; AGREE REX[17]– excellence of recommendations; and AGREE HS[18]– methodological quality of health system guidelines.
1.1 JUSTIFICATION
According to the latest epidemiological bulletin from the Ministry of Health, covering the first 7 epidemiological weeks of 2024, the number of probable dengue cases has tripled compared to the same period in 2023, primarily affecting the Southeast, Midwest, South, and North regions of Brazil, with around 700,000 Brazilians affected by the disease. For the same period, approximately 40% of the Chikungunya cases from 2023 have already been recorded (about 150,000)[19]. Thus, considering the dengue epidemic, the large number of Chikungunya cases, and a likely increase in Zika cases, effective sanitary measures are needed to combat these arboviruses, either through mosquito management or symptom treatment, justifying the comparison and verification of the methodological quality and recommendations of existing guidelines.
1.2 OBJECTIVES
1.2.1 General Objective
To evaluate the methodological quality and recommendations for the treatment of symptoms of Dengue, Zika, and Chikungunya and for the management of Aedes aegypti mosquitoes.
1.2.2 Specific Objectives
Evaluate and compare the methodological quality of the guidelines.
Evaluate and compare treatment recommendations for diseases and mosquito management.
1. Guzman, M.G., et al., Dengue: a continuing global threat. Nat Rev Microbiol, 2010. 8(12 Suppl): p. S7-16.
2. Krauer, F., et al., Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain-Barré Syndrome: Systematic Review. PLoS Med, 2017. 14(1): p. e1002203.
3. Weaver, S.C. and W.K. Reisen, Present and future arboviral threats. Antiviral Res, 2010. 85(2): p. 328-45.
4. de Araújo, T.V.B., et al., Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study. Lancet Infect Dis, 2018. 18(3): p. 328-336.
5. Soni, S., et al., Dengue, Chikungunya, and Zika: The Causes and Threats of Emerging and Re-emerging Arboviral Diseases. Cureus, 2023. 15(7): p. e41717.
6. Brady, O.J., et al., Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis, 2012. 6(8): p. e1760.
7. Schunemann, H.J., et al., Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. Canadian Medical Association Journal, 2014. 186(3): p. E123-E142.
8. Woolf, S.H., Practice guidelines: a new reality in medicine. I. Recent developments. Arch Intern Med, 1990. 150(9): p. 1811-8.
9. Woolf, S.H., et al., Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ, 1999. 318(7182): p. 527-30.
10. Harris, R.P., et al., Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med, 2001. 20(3 Suppl): p. 21-35.
11. IOM, Institute of Medicine. Committee on Standards for Developing Trustworthy Clinical Practice, Guidelines. Clinical Practice Guidelines We Can Trust., ed. R. Graham, et al. 2011, Washington (DC): National Academies Press.
12. IOM, Institute of Medicine. Clinical Practice Guidelines: Directions for a New Program, ed. M.J. Field and K.N. Lohr. 1990, Washington, DC: The National Academies Press. 168.
13. Ako-Arrey, D.E., et al., Health systems guidance appraisal--a critical interpretive synthesis. Implement Sci, 2016. 11(1): p. 9.
14. Ako-Arrey, D.E., et al., Health system guidance appraisal--concept evaluation and usability testing. Implement Sci, 2016. 11: p. 3.
15. Brouwers, M.C., et al., Validity and usability testing of a health systems guidance appraisal tool, the AGREE-HS. Health Res Policy Syst, 2018. 16(1): p. 51.
16. Brouwers, M.C., et al., AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010. 182(18): p. E839-42.
17. Florez, I.D., et al., Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement. Implementation Science, 2020. 15(1): p. 79.
18. Brouwers, M.C., et al., Assessment of health systems guidance using the Appraisal of Guidelines for Research and Evaluation - Health Systems (AGREE-HS) instrument. Health Policy, 2019. 123(7): p. 646-651
Pharmaco-epidemiology of artemisinin-based combination therapy in the context of impact evaluation of artemether-lumefantrine on malaria morbidity and mortality during programmatic implementation in rural Tanzania
No full textIn sub-Saharan Africa previous efforts to control malaria have proved less successful mostly
due to prolonged use of less efficacious mono-therapy drugs to which Plasmodium falciparum
has developed drug resistance. In most parts of malaria endemic regions chloroquine (CQ)
was found to be poorly effective for several decades but it was still being prescribed until
recently. In Tanzania, for instance, P.falciparum was already resistant to CQ in more than 60%
of all P. falciparum positive patients back in the late 80’s but was still used until when it was
possible to replace it by sulfadoxine-pyrimethamine (SP) in 2001. SP is anti-folate sulfa
based anti-malaria drug that was adopted as an interim first line drug by many malaria
endemic countries as there was no affordable immediate alternative to CQ. Elsewhere in sub-
Saharan Africa Zambia was the first African country to embrace policy change with efficacious
anti-malaria combination therapy using Artemisinin-based Combination Therapy (ACT) back in
2004 after support from global funds.
Until 1990, the past three decades have had a sustained global focus on malaria control
strategy with the aim of intensifying developing intervention tools. This was preceded by
specific eradication efforts of the 1940s, which were intensified in most parts of Southern
Europe and America. It was during this period that the global focus on malaria sustained a
great deal of change. In that same period therefore, the main focus was on technical issues
as well as research and development for new tools, that could lead to advances in drug and
vaccine development alongside vector control strategies. There were medium term gains
during this period but at the same time some challenges were recorded. Key among these
challenges was the fragmented global efforts, whereby there was total loss of a broad based
global focus to a joint strategy on the fight against malaria. This resulted in little global support
with no clear roadmap for developing states, mostly in Sub Saharan Africa, to establish
adequate health systems and primary health care for comprehensive malaria management.
These challenges resulted in to overuse of ant-malaria mono-therapies that were cheaply
available in most of these countries and led to development of parasite resistance to drugs
with far reaching consequences. Towards the mid of 1990s, the combination of a worsening
malaria situation and emerging positive technical developments led to renewed global focus
on malaria control. It is for the same reason that in 2000 the global head of states developed
a joint position to address the global disease burden most affecting developing countries as part of the Millennium Development Goals (MDG) of global programme on development to be
achieved by 2015. Two goals were developed to improved health for the Under Five (U5e.i,
MDG4 and MGD6. MGD4 sets target to reduce child mortality by two third by 2015 while
MGD6 aims at combating malaria and other major infectious diseases (HIV and TB) by year
2015 as compared to baseline 1990.
As the results of the launch of these global initiatives, a number of new strategies and tools
against malaria have been developed and existing ones sharpened to better address the
problem. Not later than beginning of last decade, Artemisinin-based Combination Therapy
(ACT) emerged as potential therapeutically efficacious proven tool to combat malaria. In the
face of growing anti-malarial drug resistance due to the use of mono-therapies, ACT has
placed itself as a novel treatment for malaria treatment. Use of insecticide Treated Mosquito
bed-Nets (ITN) has also been advocated. With the support of Global Health Partners, ITN
have been made available to the vulnerable persons within endemic communities. Support to
control malaria has exceeded für die Bekämpfung von Malaria ausgegeben wurden, stellt Malaria
weiterhin eine grosse Bedrohung vor allem für Kinder unter 5 Jahren und für schwangere
Frauen dar.
ACT wurde als Haupt-Malaria-Medikament in Tansania gegen Ende 2006 eingeführt und 2007
auf das ganze Land ausgeweitet. Die Realisierung dieses Projekts hatte einige Ähnlichkeiten
mit Ansätzen in anderen afrikanischen Ländern, jedoch gibt es nach wie vor grosse
Unterschiede. Das homogene Gesundheitssystem in Tansania im Allgemeinen und das
„Primary Health Care“ (PHC) System im Speziellen erleichterten die Realisierung dieser
Malaria-Programme erheblich. Auch die Erkenntnisse, die im Rahmen der Nord-Süd-
Forschungskooperationen gewonnen wurden, die Kollaborationen zwischen NGOs und der
Regierung, sowie die Bereitstellung der erforderlichen Nachweise durch die politischen
Entscheidungsträger, führten schliesslich zu einer erfolgreichen Umsetzung. Zusätzlich
ermöglichte die Zusammenarbeit zwischen den wirtschaftlichen Blöcken Ostafrikas und der
„Southern African Development Community“ (SADC) neue Einblicke in die
grenzüberschreitende Kontrolle von Malaria. Einige dieser in Tansania neu entwickelten und praxis-erprobten Instrumente wurden auch in
anderen Staaten südlich der Sahara angewandt und dabei oft von globalen anti-Malaria
Kampagnen unterstützt.
Die politische Stabilität und der Frieden in Tansania während mehr als vier Jahrzehnten haben
ein schnelles Umdenken in der Politik und die landesweite Ausdehnung der ACTKontrollstrategie
überhaupt erst ermöglicht. Viele benachbarte Länder wie Uganda, Sudan,
Mozambique und die Demokratische Republik Kongo erlebten im gleichen Zeitraum viele
Unruhen. Tansania hat sich als eines der wenigen afrikanischen Länder nicht gescheut sich
dem Rest der Welt für Grossversuche der heute erfolgreichsten Interventionen gegen Malaria
zur Verfügung zu stellen.
Der Kilombero River Basin in Ifakara Tansania wird als Wiege von Malaria bezeichnet. Etliche
neue Interventionen wurden auf ihre Wirksamkeit getestet und evaluiert. Die in dieser Arbeit
präsentierten Ergebnisse wurden hauptsächlich aus verschiedenen Studienzentren in
Tansania zusammengetragen, wobei der grösste Teil aus dem „Ifakara Demographic
Surveillance System“ stammt. Die vorliegende Arbeit gewährt Einblicke in das von Tansania
verfolgte Programm zur landesweiten Umsetzung der ACT.
Das Ziel der Doktorarbeit ist es, einen Beitrag zum besseren Verständnis der Auswirkungen,
welche die Einführung der ACT auf die Malaria Morbidität und Mortalität hatte, beizutragen
und die langfristige Sicherheit im landesweiten Einsatz zu überwachen.
Die erfolgreiche Einbindung der Akteure, insbesondere der teilnehmenden Communities,
sowie die grosse Bereitschaft unter den Forschern beschleunigten die Umsetzung der neuen
Richtlinien von Beginn an. Die auf Beweisen basierten Erkenntnisse, die aus dem
“Interdisciplinary Monitoring Project of anti-malaria Combination Therapy” (IMPACT) und dem
“East African Network for Monitoring anti-malaria Treatment” (EANMAT) gewonnen wurden,
werden in die Entwicklung von neuen Richtlinien einfliessen. Die in vivo Studien haben
gezeigt, dass Artemether-Lumefantrin (AL) nach Kontrolle der Reinfektion durch Polymase
Chain Reaction (PCR) bei Kindern unter fünf Jahren nahezu 100% wirksam war. Wir haben
ebenfalls bewiesen, dass es durch eine intensive Zusammenarbeit zwischen Forschung,
Politik und der pharmazeutischen Industrie möglich ist, auch unter Realbedingungen
Strategien für die Überwachung der Sicherheit und dem sachgemäßen Gebrauch von Antixviii Malaria-Medikamenten umzusetzen. Das „Exploring Health Impact“ Programm (ALIVE) war als
erstes Programm überhaupt in der Lage, in einem randomisierten Beurteilungsdesign auf
Community-Level eine Compliance von mehr als 95% zu einer komplexen 6 Dosen Therapie
von Artemether-Lumefantrin (AL) aufzuzeigen. In Kapitel 5 wird berichtet, dass „ALIVEpharmacovigilance“
afrikaweit die erste community-based Pharmakovigilanz-Studie ist, welche
auch die Verwendung von SMS als Überbringer von schweren Nebenwirkungen untersucht.
Das Projekt ALIVE gewährt sowohl einen Einblick in die Auswirkungen von ACT und anderen
Interventionen auf die Kindersterblichkeit und die Prävalenz. ALIVE hat gezeigt, dass eine
Erhöhung der ITN Abdeckung um 10% eine Verringerung von 48% jährlicher Malariabedingten
Parasitämie auf kommunaler Ebene erzielt [IRR=0.52; 95% CI=0.38 to 0.73]. Es
wurde ebenfalls gezeigt, dass im Vergleich zu der Zeit, als in erster Linie noch SP verwendet
wurde, ACT für ungefähr 11% der jährlichen Reduktion der Mortalität verantwortlich war, wenn
man für andere wichtige Faktoren stratifiziert [IRR = 0,89, 95% CI = 0,79 bis 1,0]. Des
Weiteren wurde beobachtet, dass die Erhöhung der Ernährungssicherheit, insbesondere der
Reiserträge, für fast 36% der Reduktion der jährlichen Mortalität von Kindern unter 5 Jahren
verantwortlich war [IRR = 0,64, 95% CI = 0,54 - 0,75]. Hinsichtlich der Übertragung von
Malaria wurde parallel eine Parasiten-Prävalenz Reduktion von 65% bei asymptomatischen
Community-Mitgliedern im DSS in Ifakara aufgezeichnet, im Vergleich zum Ausgangswert im
Jahr 2006 als ACT eingeführt wurde.
Darüber hinaus wurden diese Auswirkungen als nachhaltig beurteilt, da die Wirksamkeit von
AL, wie anhand einer in vivo Studie ein Jahr nach Umsetzung gezeigt, im Kilombero-Tal bei
über 96% liegt.
Die Ergebnisse dieser Arbeit unterstreichen die Bedeutung des politischen Wandels in der
Malariabekämpfung. Dazu gehört die Forschung als systematischer Weg, um das
Gesundheitssystem zu stärken und sich in der Malaria Bekämpfung innerhalb eines
endemischen Entwicklungslands zu engagieren. Die Erfahrungen aus dieser Arbeit werden
relevant sein für Malaria-betroffene Gebiete vor Ort und auf globaler Ebene. Wir haben auch
gelernt, dass die Sicherheit und Compliance von Arzneimitteln, die, wie ACT, im großen
Maßstab eingesetzt werden überwacht und verwaltet werden muss. Dabei sollten das
Gesundheitsministerium und verwandte Fachbereiche sowie die pharmazeutische Industrie
und Forschungspartner, als auch die örtliche Führung miteinbezogen werden. Wir empfehlen,
dass diese Partnerschaft von globalen Gesundheitsorganisationen unterstützt wird. Die rigorose Überwachung der ordnungsgemässen Verwendung von Medikamenten würde zu
einem besseren Verständnis betreffend der Fragen der Sicherheit von Arzneimitteln führen,
sowie deren Lebensdauer verlängern. Ein weiterer kritischer Aspekt, welcher den Vorrang
eingeräumt werden sollte, ist der Aufbau von Kapazitäten. Wir empfehlen, dass Ressourcen
zur Verfügung gestellt werden um das Gesundheitssystem in Malaria-endemischen Gebieten
zu stärken (human resources, Health Information und Infrastruktur), um nachhaltige
Ergebnisse in der Malariabekämpfung zu erreichen. Damit werden günstige
Rahmenbedingungen geschaffen um eine wirksame, regelmässig überwachte, Anti-Malaria-
Politik zu implementieren.
Wie in dieser Arbeit erläutert, kann eine erfolgreiche Kampagne gegen Malaria durch die
Bemühungen der Forscher, politischer Entscheidungsträger, globaler Entwicklungs-Partnern
und der lokalen Gemeinden realisiert werden. Eine solche Partnerschaft hat bereits Erfolge
erzielt, wie das Beispiel in den 1940er Jahren der Malari
