72 research outputs found
Comparative analysis of two methods for measuring sales volumes during malaria medicine outlet surveys.
No full textBACKGROUND: There is increased interest in using commercial providers for improving access to quality malaria treatment. Understanding their current role is an essential first step, notably in terms of the volume of diagnostics and anti-malarials they sell. Sales volume data can be used to measure the importance of different provider and product types, frequency of parasitological diagnosis and impact of interventions. Several methods for measuring sales volumes are available, yet all have methodological challenges and evidence is lacking on the comparability of different methods. METHODS: Using sales volume data on anti-malarials and rapid diagnostic tests (RDTs) for malaria collected through provider recall (RC) and retail audits (RA), this study measures the degree of agreement between the two methods at wholesale and retail commercial providers in Cambodia following the Bland-Altman approach. Relative strengths and weaknesses of the methods were also investigated through qualitative research with fieldworkers. RESULTS: A total of 67 wholesalers and 107 retailers were sampled. Wholesale sales volumes were estimated through both methods for 62 anti-malarials and 23 RDTs and retail volumes for 113 anti-malarials and 33 RDTs. At wholesale outlets, RA estimates for anti-malarial sales were on average higher than RC estimates (mean difference of four adult equivalent treatment doses (95% CI 0.6-7.2)), equivalent to 30% of mean sales volumes. For RDTs at wholesalers, the between-method mean difference was not statistically significant (one test, 95% CI -6.0-4.0). At retail outlets, between-method differences for both anti-malarials and RDTs increased with larger volumes being measured, so mean differences were not a meaningful measure of agreement between the methods. Qualitative research revealed that in Cambodia where sales volumes are small, RC had key advantages: providers were perceived to remember more easily their sales volumes and find RC less invasive; fieldworkers found it more convenient; and it was cheaper to implement than RA. DISCUSSION/CONCLUSIONS: Both RA and RC had implementation challenges and were prone to data collection errors. Choice of empirical methods is likely to have important implications for data quality depending on the study context
[[alternative]]A Cultivation, Observation and It's Floristic Study of Coprophilous Fungi
No full text[[abstract]]Abstract
By using moist chamber method, sixteen species of the coprophilous fungi from dungs of herbivorous were isolated and identified namely: Dictyostelium mucoroides Brefeld, Guttulinopsis nivea Raper Worley & Kessler, Pilobolus. crystallinus ( Wiggers ) Tode, Circinella mucoroides Saito, Mucor hiemalis Wehmer, Mucor javanicus Wehmer, Thamnostylum piriforme ( Bain. ) von Arx & Upadhyay, Ascobolus immersus Pers. : Pers., Ascobolus crenulatus P. Karst., Saccobolus citrinus Boud. & Torrend, Ascophanus granulatus (Bull.) Speg., Iodophanus carneus (Pers. : Pers.) Korf, Sordaria fimicola (Rob.) Ces. & De Not., Sordaria superba De Not., Chaetomium globosum Kunze : Fries and Coprinus patouillardii Quel. apud Patouillard. Among these, Guttulinopsis nivea and Circinella mucoroides are described as new records in Taiwan.
Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia.
No full textWhilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme. The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance
Retail sector distribution chains for malaria treatment in the developing world: a review of the literature.
No full textBACKGROUND: In many low-income countries, the retail sector plays an important role in the treatment of malaria and is increasingly being considered as a channel for improving medicine availability. Retailers are the last link in a distribution chain and their supply sources are likely to have an important influence on the availability, quality and price of malaria treatment. This article presents the findings of a systematic literature review on the retail sector distribution chain for malaria treatment in low and middle-income countries. METHODS: Publication databases were searched using key terms relevant to the distribution chain serving all types of anti-malarial retailers. Organizations involved in malaria treatment and distribution chain related activities were contacted to identify unpublished studies. RESULTS: A total of 32 references distributed across 12 developing countries were identified. The distribution chain had a pyramid shape with numerous suppliers at the bottom and fewer at the top. The chain supplying rural and less-formal outlets was made of more levels than that serving urban and more formal outlets. Wholesale markets tended to be relatively concentrated, especially at the top of the chain where few importers accounted for most of the anti-malarial volumes sold. Wholesale price mark-ups varied across chain levels, ranging from 27% to 99% at the top of the chain, 8% at intermediate level (one study only) and 2% to 67% at the level supplying retailers directly. Retail mark-ups tended to be higher, and varied across outlet types, ranging from 3% to 566% in pharmacies, 29% to 669% in drug shops and 100% to 233% in general shops. Information on pricing determinants was very limited. CONCLUSIONS: Evidence on the distribution chain for retail sector malaria treatment was mainly descriptive and lacked representative data on a national scale. These are important limitations in the advent of the Affordable Medicine Facility for Malaria, which aims to increase consumer access to artemisinin-based combination therapy (ACT), through a subsidy introduced at the top of the distribution chain. This review calls for rigorous distribution chain analysis, notably on the factors that influence ACT availability and prices in order to contribute to efforts towards improved access to effective malaria treatment
Methods for implementing a medicine outlet survey: lessons from the anti-malarial market.
No full textBACKGROUND: In recent years an increasing number of public investments and policy changes have been made to improve the availability, affordability and quality of medicines available to consumers in developing countries, including anti-malarials. It is important to monitor the extent to which these interventions are successful in achieving their aims using quantitative data on the supply side of the market. There are a number of challenges related to studying supply, including outlet sampling, gaining provider cooperation and collecting accurate data on medicines. This paper provides guidance on key steps to address these issues when conducting a medicine outlet survey in a developing country context. While the basic principles of good survey design and implementation are important for all surveys, there are a set of specific issues that should be considered when conducting a medicine outlet survey. METHODS: This paper draws on the authors' experience of designing and implementing outlet surveys, including the lessons learnt from ACTwatch outlet surveys on anti-malarial retail supply, and other key studies in the field. Key lessons and points of debate are distilled around the following areas: selecting a sample of outlets; techniques for collecting and analysing data on medicine availability, price and sales volumes; and methods for ensuring high quality data in general. RESULTS AND CONCLUSIONS: The authors first consider the inclusion criteria for outlets, contrasting comprehensive versus more focused approaches. Methods for developing a reliable sampling frame of outlets are then presented, including use of existing lists, key informants and an outlet census. Specific issues in the collection of data on medicine prices and sales volumes are discussed; and approaches for generating comparable price and sales volume data across products using the adult equivalent treatment dose (AETD) are explored. The paper concludes with advice on practical considerations, including questionnaire design, field worker training, and data collection. Survey materials developed by ACTwatch for investigating anti-malarial markets in sub-Saharan Africa and Asia provide a helpful resource for future studies in this area
Lancet Infect Dis
No full textBackgroundRapid declines in malaria prevalence, cases, and deaths have been achieved globally during the past 15 years because of improved access to first-line treatment and vector control. We aimed to assess the intervention coverage needed to achieve further gains over the next 15 years.MethodsWe used a mathematical model of the transmission of Plasmodium falciparum malaria to explore the potential effect on case incidence and malaria mortality rates from 2015 to 2030 of five different intervention scenarios: remaining at the intervention coverage levels of 2011\u201313 (Sustain), for which coverage comprises vector control and access to treatment; two scenarios of increased coverage to 80% (Accelerate 1) and 90% (Accelerate 2), with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention where recommended for both Accelerate scenarios, and rectal artesunate for pre-referral treatment at the community level added to Accelerate 2; a near-term innovation scenario (Innovate), which included longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention; and a reduction in coverage to 2006\u201308 levels (Reverse). We did the model simulations at the first administrative level (ie, state or province) for the 80 countries with sustained stable malaria transmission in 2010, accounting for variations in baseline endemicity, seasonality in transmission, vector species, and existing intervention coverage. To calculate the cases and deaths averted, we compared the total number of each under the five scenarios between 2015 and 2030 with the predicted number in 2015, accounting for population growth.FindingsWith an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19\u201329) and a reduction in mortality rates of 40% (27\u201361) by 2030 compared with 2015 levels. Acceleration to 90% coverage and expansion of treatment at the community level was predicted to reduce case incidence by 59% (Crl 56\u201364) and mortality rates by 74% (67\u201382); with additional near-term innovation, incidence was predicted to decline by 74% (70\u201377) and mortality rates by 81% (76\u201387). These scenarios were predicted to lead to local elimination in 13 countries under the Accelerate 1 scenario, 20 under Accelerate 2, and 22 under Innovate by 2030, reducing the proportion of the population living in at-risk areas by 36% if elimination is defined at the first administrative unit. However, failing to maintain coverage levels of 2011\u201313 is predicted to raise case incidence by 76% (Crl 71\u201380) and mortality rates by 46% (39\u201351) by 2020.InterpretationOur findings show that decreases in malaria transmission and burden can be accelerated over the next 15 years if the coverage of key interventions is increased.FundingUK Medical Research Council, UK Department for International Development, the Bill & Melinda Gates Foundation, the Swiss Development Agency, and the US Agency for International Development.MR/K010174/1/MRC_/Medical Research CouncilUnited Kingdom/MR/K00669X/1/MRC_/Medical Research CouncilUnited Kingdom/K00669X/MRC_/Medical Research CouncilUnited Kingdom/CC999999/ImCDC/Intramural CDC HHSUnited States/G1002284/MRC_/Medical Research CouncilUnited Kingdom/WT_/Wellcome TrustUnited Kingdom/001/WHO_/World Health OrganizationInternational
In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective
No full textPay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs' costs or cost-effectiveness. We conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. We reviewed project accounts and reports, interviewed key stakeholders, and derived outcomes from a controlled before-and-after study. In 2012 US dollars, the financial cost of the pay-for-performance pilot was 2.3 million. The incremental cost per additional facility-based birth ranged from 907 in the pilot and from 261 for a national program. In a low-income setting, the costs of managing the program and generating and verifying performance data were substantial. Pay-for-performance programs can stimulate the generation and use of health information by health workers and managers for strategic planning purposes, but the time involved could divert attention from service delivery. Pay-for-performance programs may become more cost-effective when integrated into routine systems over time
Understanding private sector antimalarial distribution chains : a cross-sectional mixed methods study in six malaria-endemic countries
No full textPrivate for-profit outlets are important treatment sources for malaria in most endemic countries. However, these outlets constitute only the last link in a chain of businesses that includes manufacturers, importers and wholesalers, all of which influence the availability, price and quality of antimalarials patients can access. We present evidence on the composition, characteristics and operation of these distribution chains and of the businesses that comprise them in six endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia).; We conducted nationally representative surveys of antimalarial wholesalers during 2009-2010 using an innovative sampling approach that captured registered and unregistered distribution channels, complemented by in-depth interviews with a range of stakeholders. Antimalarial distribution chains were pyramidal in shape, with antimalarials passing through a maximum of 4-6 steps between manufacturer and retailer; however, most likely pass through 2-3 steps. Less efficacious non-artemisinin therapies (e.g. chloroquine) dominated weekly sales volumes among African wholesalers, while volumes for more efficacious artemisinin-based combination therapies (ACTs) were many times smaller. ACT sales predominated only in Cambodia. In all countries, consumer demand was the principal consideration when selecting products to stock. Selling prices and reputation were key considerations regarding supplier choice. Business practices varied across countries, with large differences in the proportions of wholesalers offering credit and delivery services to customers, and the types of distribution models adopted by businesses. Regulatory compliance also varied across countries, particularly with respect to licensing. The proportion of wholesalers possessing any up-to-date licence from national regulators was lowest in Benin and Nigeria, where vendors in traditional markets are important antimalarial supply sources.; The structure and characteristics of antimalarial distribution chains vary across countries; therefore, understanding the wholesalers that comprise them should inform efforts aiming to improve access to quality treatment through the private sector
An Overview of the Literature on Economic and Financial Factors Influencing Population Access to Vector Control Interventions: Long Lasting Insecticidal Nets, Indoor Residual Spraying and Supplementary Interventions
No full textThe Global Technical Strategy for malaria 2016-2030 includes malaria control and elimination targets for 2030 and interim milestones for 2020 and 2025. The nearest GTS milestone includes a reduction in malaria case incidence and mortality rates of at least 40% by 2020 compared to 2015 levels, the elimination of malaria in at least 10 countries and the prevention of re-establishment of the disease in countries that are malaria-free. After 15 years of success in global malaria control, progress in reducing morbidity and mortality has stalled and the likelihood of reaching the 2020 milestones is small. In 2016, there were an estimated 216 million cases of malaria or 5 million more than in 2015 and around 445,000 deaths [1]. The African Region continues to bear an estimated 90% of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80% of the global malaria burden.This background paper was commissioned by the World Health Organization (WHO) Global Malaria Programme (GMP) to inform the WHO Technical Consultation meeting held between 12–15 February 2018, in Geneva, Switzerland.||Further information on the meeting can be found by following the link under "More details" below
Taxonomy of <i>Phaeangium lefebvrei</i>, a desert truffle eaten by birds
No full text The desert truffle genus Phaeangium Patouillard, synonymized with Picoa by R. Maire, is resurrected. Phaeangium has ornamented spores at maturity and a tomentose peridium, whereas Picoa has smooth spores and no tomentum. Phaeangium and its single species, P. lefebvrei, are redescribed and placed in the family Pyronemataceae, tribe Mycolachneae. In 1978 the senior author collected quantities of a small truffle in several desert habitats in Kuwait. We determined it to be Phaeangium lefebvrei Pat. (Picoa lefebvrei (Pat.) Maire). These collections provided excellent material to redescribe this species and to reexamine its hitherto disputed generic assignment. This truffle fruits from January to April in North Africa and the Middle East during years of adequate rainfall. In Kuwait it is confined to gypsiferous and calcareous, gravelly deserts, where it is scratched out and eaten by several species of migrating birds. </jats:p
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