16 research outputs found
The Theory of Interhybridity: Socio-political Dimensions and Migration Experiences of Post-communist Western Balkan States
No full textThe Western Balkans integration within the EU has started a legal process which is the rejection of former communist legal/political approaches and the transformation of former communist institutions. Indeed, the EU agenda has brought vertical/horizontal integration and Europeanization of national institutions (i.e. shifting power to the EU institutions and international authorities). At this point, it is very crucial to emphasize the fact that the Western Balkans as a whole region has currently an image that includes characteristics of both the Soviet socialism and the European democracy. The EU foreign policies and enlargement strategy for Western Balkans have significant effects on four core factors (i.e. Schengen visa regulations, remittances, asylum and migration as an aggregate process). The convergence/divergence of EU member states’ priorities for migration policies regulate and even shape directly the migration dynamics in migrant sender countries. From this standpoint, the research explores how main migration factors are influenced by political and judicial factors such as; rule of law and democracy score, the economic liberation score, political and human rights, civil society score and citizenship rights in Western Balkan countries. The proposal of interhybridity explores how the hybridization of state and non-state actors within home and host countries can solve labor migration-related problems. Indisputably, hybrid model (i.e. collaboration state and non-state actors) has a catalyst role in terms of balancing social problems and civil society needs. Paradigmatically, it is better to perceive the hybrid model as a combination of communicative and strategic action that means the reciprocal recognition within the model is precondition for significant functionality. This will shape social and industrial relations with moral meanings of communication
Performance of the Emprint and Amica Microwave Ablation Systems in ex vivo Porcine Livers: Sphericity and Reproducibility Versus Size
No full textPurpose: To investigate the performance of two microwave ablation (MWA) systems regarding ablation volume, ablation shape and variability. Materials and Methods: In this ex vivo study, the Emprint and Amica MWA systems were used to ablate porcine livers at 4 different settings of time and power (3 and 5 minutes at 60 and 80 Watt). In total, 48 ablations were analysed for ablation size and shape using Vitrea Advanced Visualization software after acquisition of a 7T MRI scan. Results: Emprint ablations were smaller (11,1 vs. 21,1 mL p < 0.001), more spherical (sphericity index of 0.89 vs. 0.59 p < 0.001) and showed less variability than Amica ablations. In both systems, longer ablation time and higher power resulted in significantly larger ablation volumes. Conclusion: Emprint ablations were more spherical, and the results showed a lower variability than those of Amica ablations. This comes at the price of smaller ablation volumes.Medical Instruments & Bio-Inspired Technolog
Quantitative three-dimensional evaluation of ablation margins for the prediction of local tumor progression
No full textIntroduction The objective of this research is to assess whether there is a correlation between quantitatively assessed ablation margins and the occurrence of local tumor progression (LTP) using dedicated image processing software.Methods 28 patients with 45 de novo HCCs treated with percutaneous thermal ablation, e.g. radiofrequency ablation (RFA) and microwave ablation (MWA) between January 2014 and March 2019 were retrospectively included. Semi-automated segmentation of the liver and the ablation zone, manual segmentation of the tumor, and semi-automated registration of pre- and postprocedural contrast enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) images was performed using in-house developed software deLIVERed. The image processing results were used for quantitative analysis of the minimal ablation margin (MAM) and the ablation margin surface area. The outcome of the quantitative analysis was compared to LTP occurence.Results Image processing of the scans of 39 of the 45 tumors was feasible. 5/39 tumors developed LTP. Based on quantitative analysis, thermal ablation was insufficient in 29/39 tumors. Of these 29 tumors, 4 developed LTP. The median MAM for the LTP group and no LTP group was -4.6 and -1.7 mm, respectively. There was no clear correlation between the MAM and LTP occurrence.The median tumor surface area exposed to insufficient margins was 28.9% and 7.7.% with and without development of LTP, respectively.Conclusion Quantitative analysis of postablation images can provide insight in ablation margins and the development of LTP. The ablation margin surface area provides additional information to the MAM. However, additional research is needed in order to further investigate the implications of ablation margin surface area.Technical Medicine | Imaging and Interventio
Ballistic superconductivity in semiconductor nanowires
No full textSemiconductor nanowires have opened new research avenues in quantum transport owing to their confined geometry and electrostatic tunability. They have offered an exceptional testbed for superconductivity, leading to the realization of hybrid systems combining the macroscopic quantum properties of superconductors with the possibility to control charges down to a single electron. These advances brought semiconductor nanowires to the forefront of efforts to realize topological superconductivity and Majorana modes. A prime challenge to benefit from the topological properties of Majoranas is to reduce the disorder in hybrid nanowire devices. Here we show ballistic superconductivity in InSb semiconductor nanowires. Our structural and chemical analyses demonstrate a high-quality interface between the nanowire and a NbTiN superconductor that enables ballistic transport. This is manifested by a quantized conductance for normal carriers, a strongly enhanced conductance for Andreev-reflecting carriers, and an induced hard gap with a significantly reduced density of states. These results pave the way for disorder-free Majorana devices
A normação do ensino Superior em Moçambique, perspetivas e desafios para as Unidades Orgânicas na província do Niassa: Um estudo de caso
No full textAbstract: This article is the result of theoretical, documentary research, presenting a perspective on some standards that regulate higher education in Mozambique, a nation located in Southern Africa. The standards based on Decree 43/2023 of August 2nd and Decree 91/2023 of December 29th, aim to strengthen inspection and quality assurance mechanisms. The choice of the theme is a concern for the author, regarding the study of the path of higher education institutions in the province of Niassa. Observe the parts of the instruments, as challenges for the Organic Units existing in the province. The reforms brought, if observed, on the one hand will be beneficial for the development of the higher education subsystem and on the other hand, the reforms will force higher education institutions to discontinue some course or program due to lack of requirements. Still from the author\u27s perspective, the requirements formulated aim to bring credibility to universities with regard to their principles that they value in teaching, research, extension, technological incubation, internationalization and other standards for their consolidation. The specific objectives aim to verify the existence of all normative elements for the full functioning of the organic units of the HEI existing in the province of Niassa. In this context, the reforms are expected to accelerate the quality of teaching in existing higher education institutions in the Province of Niassa. Inspection must serve as a means of preventing risks, and expected sanctions serve as a basis for stopping the operation of higher education institutions that commit irregularities. The inspection must apply the Law, as it is judged to be ineffective in sanctioning institutions that violate the Law.
Keywords: Decree, normalization, higher education, reforms and challenges, perspectives for Niassa.Resumo: O presente artigo é decorrente de uma pesquisa do cunho teórico, documental, apresentando uma perspectiva sobre algumas normas que regulam o ensino superior em Moçambique, nação situada na Africa Austral. As normas assentes no Decreto 43/2023 de2 de Agosto e Decreto 91/2023 de 29 de Dezembro, visam fortalecer os mecanismos de fiscalização e garantia de qualidade. A escolha do tema constitui preocupação no autor, no que toca ao estudo sobre o percurso das instituições de ensino superior na província de Niassa. Observar as partes dos instrumentos, como desafios para as Unidades Orgânicas existentes na província. As reformas trazidas, se observadas, por um lado serão benéficas para o desenvolvimento do subsistemado ensino superior e por outro lado, asreformas irão obrigar as instituições de ensino superior adescontinuar algum curso ou programa por falta de requisitos. Ainda na óptica do autor, as exigências formuladas visam trazer credibilidade das universidades no que diz respeito aos seus princípios que prezam sobre o ensino, pesquiza, extensão, incubação tecnológica, internacionalização e outros padrões para sua consolidação. O artigo tem como objectivo geral: Verificar a conformidade do funcionamento da instituição com base nas normas vigentes. Os objectivos específicos visam verificara existência de todos elementosnormativos para o funcionamento pleno das unidades orgânicas da IES existente na província de Niassa. Neste contesto, se espera diante das reformas acelerar a qualidade de ensinonas instituições de ensino superior existentes na Província de Niassa. A fiscalização deve servir como um meio de prevenção de riscos, e sanções prevista sirvam como fundamento para parar com o funcionamento de instituições de ensino superior que, cometem irregularidades. A inspecção deve aplicar a Lei, pós se julga ser inoperante em sancionar as instituições infratoras da Lei.
Palavras-chave: Decreto,normalização, ensino superior, reformas e desafios, perspectivas para Niassa.
Ciwunganyo: Aci cibuukuci cikuteenda upaande um usoomi wa n’ciganicisyo, yibuuku, n’kusaala ya kuloleela midingo jiine jaakwe já jikuloleela n’nyikoola yeekuluungwa m’Mosambiki, cilaambo ca cidi kwivaanda kwa n’cigoombo ca África. Midingo já jidi um ulamusi 43/2023 wa 2 mweesi wa Agostu ni ulamusi 91/2023 wa 29 wa mweesi wa Deseemba, wu kupeleka matala ga ulonda pa kusaka cipatikane citupyo. Kusagula kwa awu n’tengaawu wu kuoneka yisawusyo ya va kuleembava, pa kujaaga matala ga ga-kujigala yikoola yeekuluungwa n’cigoombo ca ku-Nyassa. Kuloleela n’tupaande, m’pela yidimbi-dimbi n’nyijiiji kapena yikoola yeekuluungwa ya yidi ku-Niassa. Ya yicenjileeyo, naaga kuyilolecesya, m’paka yipelece cikamucisyo n’nyikoola yeekuluungwa, naambo paane paakwe, ci yiteendekaasye kuva laasima yikoola yeekulungwa yine yakwe yikajeendelecela kuluso sine syaakwe digoongo dya kusova yisuuso. Pa kulola kwa va kuleembaava, malamusi ga nyuuwaniga gakusaka kujigadila cikulupi n’nyikoola yeekuluungwayi pakujaaga m’myaambo já jikuloleela m’masoomo-mo, kusosa-sosa,cituuwo, ku wukamicisya m’ma Tekenolojia, kutaandicila m’paka yilaambo yiine ni yipiimo yine yakwe pakuti yikamulane. Aci cibuukuci cikweete cidiimbi- cekuluungwa: Kupima ya yikuti kuseveesa yikoola yeekuluungwayo pa kukuuya midingo. Yidimbi-dimbi yamwana ni yidi ya kuloleela anaaga yipadi yoose ya yikusacikwa pakuti yikoola yeekuluungwa yiveeje ya kuseveesa mwa n’tendeele ku-Nyassa. Pelepo, yikudindidwa kwa yiciimdu ya yikudindidwa kwa yiciimdo ya yicenjileeyo, kuutusya wusoomi wambone wa yikusacikwa n’nyikoola yeekuluungwa ku-Nyassa. Ulonda uveeje wa kusosegwa pa kuyikaanya yiciindu yakana maate, ni, ukayidi uveeje wa kusosegwa pa kuyiciga yikoola yeekuluungwa ya yikuleka kukuuya midingo. N’kutula wa ulonda uveeje wa kupikunicisya ulamusi, n’taande yikupiikanika kuti ukuteenda uleesi pa kupeleka ukayidi n’nyituwo ya ngayikuuya ulamusi.
Aluvu sya kuwidisya-widisya: Ulamusi, midingo, yikoola, yeekuluunwa, ya kuloleela, yidimbi-dimbi pakujaaga ku-NyaasaO presente artigo é decorrente de uma pesquisa do cunho teórico, documental, apresentando uma perspectiva sobre algumas normas que regulam o ensino superior em Moçambique, nação situada na Africa Austral. As normas assentes no Decreto 43/2023 de2 de Agosto e Decreto 91/2023 de 29 de Dezembro, visam fortalecer os mecanismos de fiscalização e garantia de qualidade. A escolha do tema constitui preocupação no autor, no que toca ao estudo sobre o percurso das instituições de ensino superior na província de Niassa. Observar as partes dos instrumentos, como desafios para as Unidades Orgânicas existentes na província. As reformas trazidas, se observadas, por um lado serão benéficas para o desenvolvimento do subsistemado ensino superior e por outro lado, asreformas irão obrigar as instituições de ensino superior adescontinuar algum curso ou programa por falta de requisitos. Ainda na óptica do autor, as exigências formuladas visam trazer credibilidade das universidades no que diz respeito aos seus princípios que prezam sobre o ensino, pesquiza, extensão, incubação tecnológica, internacionalização e outros padrões para sua consolidação. O artigo tem como objectivo geral: Verificar a conformidade do funcionamento da instituição com base nas normas vigentes. Os objectivos específicos visam verificara existência de todos elementosnormativos para o funcionamento pleno das unidades orgânicas da IES existente na província de Niassa. Neste contesto, se espera diante das reformas acelerar a qualidade de ensinonas instituições de ensino superior existentes na Província de Niassa. A fiscalização deve servir como um meio de prevenção de riscos, e sanções prevista sirvam como fundamento para parar com o funcionamento de instituições de ensino superior que, cometem irregularidades. A inspecção deve aplicar a Lei, pós se julga ser inoperante em sancionar as instituições infratoras da Lei.
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CIWUNGANYO
Aci cibuukuci cikuteenda upaande um usoomi wa n’ciganicisyo, yibuuku, n’kusaala ya kuloleela midingo jiine jaakwe já jikuloleela n’nyikoola yeekuluungwa m’Mosambiki, cilaambo ca cidi kwivaanda kwa n’cigoombo ca África. Midingo já jidi um ulamusi 43/2023 wa 2 mweesi wa Agostu ni ulamusi 91/2023 wa 29 wa mweesi wa Deseemba, wu kupeleka matala ga ulonda pa kusaka cipatikane citupyo. Kusagula kwa awu n’tengaawu wu kuoneka yisawusyo ya va kuleembava, pa kujaaga matala ga ga-kujigala yikoola yeekuluungwa n’cigoombo ca ku-Nyassa. Kuloleela n’tupaande, m’pela yidimbi-dimbi n’nyijiiji kapena yikoola yeekuluungwa ya yidi ku-Niassa. Ya yicenjileeyo, naaga kuyilolecesya, m’paka yipelece cikamucisyo n’nyikoola yeekuluungwa, naambo paane paakwe, ci yiteendekaasye kuva laasima yikoola yeekulungwa yine yakwe yikajeendelecela kuluso sine syaakwe digoongo dya kusova yisuuso. Pa kulola kwa va kuleembaava, malamusi ga nyuuwaniga gakusaka kujigadila cikulupi n’nyikoola yeekuluungwayi pakujaaga m’myaambo já jikuloleela m’masoomo-mo, kusosa-sosa,cituuwo, ku wukamicisya m’ma Tekenolojia, kutaandicila m’paka yilaambo yiine ni yipiimo yine yakwe pakuti yikamulane. Aci cibuukuci cikweete cidiimbi- cekuluungwa: Kupima ya yikuti kuseveesa yikoola yeekuluungwayo pa kukuuya midingo. Yidimbi-dimbi yamwana ni yidi ya kuloleela anaaga yipadi yoose ya yikusacikwa pakuti yikoola yeekuluungwa yiveeje ya kuseveesa mwa n’tendeele ku-Nyassa. Pelepo, yikudindidwa kwa yiciimdu ya yikudindidwa kwa yiciimdo ya yicenjileeyo, kuutusya wusoomi wambone wa yikusacikwa n’nyikoola yeekuluungwa ku-Nyassa. Ulonda uveeje wa kusosegwa pa kuyikaanya yiciindu yakana maate, ni, ukayidi uveeje wa kusosegwa pa kuyiciga yikoola yeekuluungwa ya yikuleka kukuuya midingo. N’kutula wa ulonda uveeje wa kupikunicisya ulamusi, n’taande yikupiikanika kuti ukuteenda uleesi pa kupeleka ukayidi n’nyituwo ya ngayikuuya ulamusi
Ballistic Majorana nanowire devices
No full textData that belong to the paper "Ballistic Majorana nanowire devices"
Quantized Majorana conductance
No full textMajorana zero-modes - a type of localized quasiparticle - hold great promise for topological quantum computing. Tunnelling spectroscopy in electrical transport is the primary tool for identifying the presence of Majorana zero-modes, for instance as a zero-bias peak in differential conductance. The height of the Majorana zero-bias peak is predicted to be quantized at the universal conductance value of 2e 2 /h at zero temperature (where e is the charge of an electron and h is the Planck constant), as a direct consequence of the famous Majorana symmetry in which a particle is its own antiparticle. The Majorana symmetry protects the quantization against disorder, interactions and variations in the tunnel coupling. Previous experiments, however, have mostly shown zero-bias peaks much smaller than 2e 2 /h, with a recent observation of a peak height close to 2e 2 /h. Here we report a quantized conductance plateau at 2e 2 /h in the zero-bias conductance measured in indium antimonide semiconductor nanowires covered with an aluminium superconducting shell. The height of our zero-bias peak remains constant despite changing parameters such as the magnetic field and tunnel coupling, indicating that it is a quantized conductance plateau. We distinguish this quantized Majorana peak from possible non-Majorana origins by investigating its robustness to electric and magnetic fields as well as its temperature dependence. The observation of a quantized conductance plateau strongly supports the existence of Majorana zero-modes in the system, consequently paving the way for future braiding experiments that could lead to topological quantum computing
InSb nanowires with built-in GaxIn1-xSb tunnel barriers for Majorana devices
No full textMajorana zero modes (MZMs), prime candidates for topological quantum bits, are detected as zero bias conductance peaks (ZBPs) in tunneling spectroscopy measurements. Implementation of a narrow and high tunnel barrier in the next generation of Majorana devices can help to achieve the theoretically predicted quantized height of the ZBP. We propose a material-oriented approach to engineer a sharp and narrow tunnel barrier by synthesizing a thin axial segment of GaxIn1–xSb within an InSb nanowire. By varying the precursor molar fraction and the growth time, we accurately control the composition and the length of the barriers. The height and the width of the GaxIn1–xSb tunnel barrier are extracted from the Wentzel–Kramers-Brillouin (WKB) fits to the experimental I–V traces
Safety, efficacy and pharmacokinetics profile of antimalarial drugs in pregnancy : pharmacoepidemiology studies
No full textBackground: Malaria in pregnancy is an important public health problem in sub Saharan Africa. It is known to be the most common and preventable cause of harmful birth outcomes in malaria endemic areas. It is therefore important for a pregnant woman to be treated with safe and effective antimalarial medication. Drug safety in pregnancy is of a greater concern due to limited safety data available in this vulnerable group. This is because pregnant women are not involved in clinical trials related to drug development process due to safety reasons and hence, most of these medicines come to market with limit information available about their safety in pregnancy. Hence, establishing a drug safety monitoring mechanism would be important to generate safety data when a given medicine is already in the market, especially medications against tropical diseases.
Pregnant women are at increased risk of malaria infection and illness than non-pregnant individuals due to physiological, hormonal and immunological changes that occur in their body after conception. The changes are also responsible for various therapeutic challenges that face this vulnerable group. This explains the presence of significant alteration of antimalarial pharmacokinetic (PK) properties in pregnancy and hence lead to a reduced drug blood concentration, which will ultimately lower antimalarial cure rate. Another factor that affects antimalarial effectiveness in pregnancy is parasite resistance against sulfadoxine-pyrimethamine (SP), a drug that is used for intermittent preventive treatment of malaria in pregnancy (IPTp).
The objectives of the thesis were to assess the magnitude of drugs exposure during pregnancy in relation to pregnancy outcomes, to describe the feasibility of establishing active pharmacovigilance system in developing countries using Health Demographic Surveillance System (HDSS) platform, to determine safety of artemether-lumefantrine (AL) exposure in first trimester of pregnancy, to evaluate pharmacokinetics and pharmacodynamics properties of artemether-lumefantrine in pregnant and non-pregnant women, and to determine the effectiveness of IPTp-SP in prevention of placental malaria, maternal anaemia and low birth weight in areas with different malaria transmission intensity.
Method: Three different study designs were used independently to respond to different specific objectives of this thesis; (i) a longitudinal follow up study was conducted to generate artemether/lumefantrine (AL) safety data in first trimester secondary to its inadvertent exposure in two Health Demographic Surveillance System (HDSS) areas in Tanzania. Pregnant women with gestational age ? 20 weeks were enrolled and followed up on monthly bases until delivery. Drugs exposures during the entire pregnancy period were also recorded. The latter was used to document the feasibility of establishing active pharmacovigilance system using HDSS platform in one of the studied HDSS area. (ii) To determine AL PK, a prospective study involving pregnant in second and third trimester and non-pregnant women, both with uncomplicated P falciparum malaria. Plasma samples were collected at pre-defined dates for bioassay to determine drug level. Participants were followed up on pre-defined schedule visits until day 42. Inter- and intra-individual variability was assessed and covariated effects quantified using a nonlinear mixed-effect modeling approach (NONMEM®). (iii) Another prospective study enrolling pregnant women to assess the effectiveness of IPTp in two areas with different malaria transmission intensity. Pregnant women were recruited in the labor ward and structured questionnaire was used for interview. Placental parasitaemia was screened by using both light microscope and real-time quantitative PCR.
Findings
Pharmacovigilance system
91% (994 of 1089) of pregnant women who were piloted to assess feasibility of establishing active PV system completed the follow up until delivery. 98% of pregnant women reported to have taken at least one medication during pregnancy, mainly drugs provided in the antenatal program. Other most reported drugs were analgesics (24%), antibiotics (17%) and antimalarials (15%), excluding IPTp. Iron and folate supplementations were associated with decreased risk of miscarriage/stillbirth (OR 0.1; 0.08 – 0.3).
AL safety
82% (1783 of 2167) of pregnant women who used and not used antimalarial drugs in first trimester were followed until delivery and recorded their pregnancy outcome. 319 (17.9%) used antimalarial drugs in first trimester and AL was the most frequent antimalarial used [53.9% (172 of 319)]. Others were 24.4 % quinine, 20.7% SP and 3.4% amodiaquine. Quinine exposure in first trimester was associated with increased risk of miscarriage/stillbirth (OR 2.5; 1.3 – 5.1) and premature birth (OR 2.6; 1.3 – 5.3). AL, SP and amodiaquine exposure were found not to be harmful.
PK analysis
33 pregnant women and 22 non-pregnant women with malaria were treated with AL (80/480mg) twice daily for 3 days. Lumefantrine (LF) bioavailability and metabolism rate into desmethyl-lumefantrine were respectively 34% lower and 78% higher in pregnant than in non-pregnant patients. Overall PCR uncorrected therapeutic failure was 18% in pregnant and 5% in non-pregnant women (OR 4.0; p value 0.22). A higher median day 7 LF concentration was associated with adequate clinical and parasitological response.
Effectiveness of IPTp
350 pregnant women were recruited and screened for placental parasitaemia (175 each from high and low malaria transmission areas). Prevalence of placenta parasitaemia was 16.6% in high transmission area and 2.3% in low transmission area. One or more doses of IPTp in high transmission area had 80% impact against placental malaria (OR 0.2; CI 0.06 – 0.7; p=0.015) and 60% in low transmission (OR 0.4; CI 0.04 – 4.5; p=0.478). Primigravida and residing in high transmission area were significant risk factors for placental malaria (OR 2.4; CI 1.1 – 5.0) and (OR 9.4; CI 3.2 – 27.7), respectively. The numbers needed to treat (NNT) was 4 (CI 2 – 4) women in high transmission area and 33 (CI 20 – 50) low transmission area to prevent one placental malaria. IPTp use was not statistically significant associated with decreased risk of maternal anaemia or low birth weight, regardless are of transmission intensity.
Conclusion:
Overall medicine use in pregnancy period is very high, including AL exposure in first trimester albeit this drug is not the first line treatment for malaria in early pregnancy. AL use in first trimester was safer as opposed to quinine, the first line drug which was associated with adverse pregnancy outcomes. We therefore recommend to consider other options than quinine for standard antimalarial drug in first trimester, and AL could be the best one.
HDSS platforms represent a reliable and feasible support to build on a pharmacovigilance system to assess safety of drugs in pregnancy since it has proved to be feasible. We recommend that pharmaceutical companies and other global financial bodies should invest more on the establishment of active pharmacovigilance system in pregnancy in tropical developing countries. The latter will boost safety data pool of newly marketed medicines and anti-infective agents for treating different illnesses in pregnancy.
LF bioavailability is significantly lowered in pregnant women due to altered PK properties as opposed to non-pregnant women in the same area. This may be responsible for therapeutic failure among pregnant women secondary to the observed low post-treatment prophylaxis. We recommend to evaluate a modified treatment regimen of malaria in pregnancy. ---------- Muhtasari
Utangulizi: Ugonjwa wa malaria kwa mama mjamzito ni tatizo kuu kwenye afya ya jamii hasa Africa kusini mwa jangwa la Sahara. Malaria ni miongoni mwa magonjwa yanayoweza kuzuilika. Ugonjwa huu unasababisha mazara makubwa sana kwa mtoto mchanga tokea akiwa tumboni kwa mama yake hasa sehemu zenye malaria kwa kiwango cha juu. Hivyo basi ni vema mama mjamzito atibiwe na dawa salama na zenye uwezo mkubwa wa kuangamiza vidudu vya malaria. Usalama wa dawa kwa mama mjamzito ni kitu chenye changamoto kubwa kutokana na uhaba wa takwimu muhimu za usalama wa dawa za malaria kwa wajawazito. Sababu kuu inatokana na mama wajawazito kutohusishwa kwenye majaribio ya dawa kipindi cha za mwanzoni pale ambapo dawa husika bado hazijapewa kibali cha kuingia sokoni kwa sababu ya kuhofia usalama wa kiafya hasa kwa mtoto aliyopo tumboni. Hilo linapelekea kwa dawa nyingi kuingia sokoni zikiwa na upungufu wa taarifa muhimu juu ya usalama wake kwa mama mjamzito. Kwa sababu hiyo, ni muhimu kuwa na mfumo wa kipekee wa kumfuatilia mama mjamzito pale atakapotumia dawa ambazo zipo tayari sokoni ili kuboresha taarifa za kiusalama kiafya kutokana na matumizi yake kipindi cha ujauzito.
Mama mjamzito anahatari kubwa ya kuambukizwa ugonjwa wa malaria pamoja na kuuguwa kuliko mama ambaye hana ujauzito. Hili linatokana na mabadiliko kipindi cha ujauzito ambayo yanasababishwa na kupunguwa kwa kinga ya mwili na mabadiliko ya homoni mwilini mwake. Mabadiliko haya yanachangia pia kuathiri ufanisi wa dawa mwilini kwake kupambana na vijidudu vya malaria na hivyo kupunguza uwezo wa uponyaji. Usugu wa dawa dhidi ya vijidudu vya malaria, kwa mfano dawa ya SP huchangia pia kuathiri uwezo wa kumponya mgonjwa wa malaria.
Dhumini kuu la utafiti huu ni (i) kujuwa wingi wa dawa anazotumia mama mjamzito ukilinganisha na matokeo ya mimba yake, (ii) kuonyesha uwezekano wa kuwa na mfumo pekee wa kudhibitisha matumizi ya dawa ambao utaweza kufuatilia usalama na matumizi ya dawa kwa ujumla kwa mama mjamzito, kwenye nchi inayoendelea kwa kutumia mfumo wa HDSS (Health Demographic Surveillance System), (iii) kuhakiki usalama wa matumizi ya dawa mseto (ALU) ya malaria kipindi cha mimba changa, (iv) kutathimini unyambulisho wa dawa ya mseto mwilini mwa mgonjwa sambamba na kulinganisha ufanisi wake wa kuangamiza vijidudu vya malaria, na (v) kutathimini ufanisi wa dawa ya SP ambayo mama mjamzito anapatiwa kliniki kama inasaidia kuangamiza vijidudu vya malari kwenye kondo la uzazi, kuzuia upungufu wa damu kwa mama na mtoto kutozaliwa na kilo pungufu kwenye maeneo yenye viwango tofauti vya maambukizo ya malaria.
Methodolojia: Njia tatu tofauti zilitumika kupata majibu husika ya malengo ya utafiti huu; (i) Kufuatilia mama wajawazito tokea kipindi cha mwanzo cha ujauzito wao hadi wanapojifungua na kurekodi taarifa za matumizi ya dawa (ikiwemo dawa mseto) na matokeo ya ujauzito. Zoezi hili lilifanyika kwenye vituo vya HDSS huko Rufiji na Kigoma mjini. (ii) Unyambulisho wa ufanisi wa dawa mseto uliwahusisha wanawake ambao ni wajawazito (wenye umri wa mimba kuanzia wiki 13 na kuendelea) na wale wasio wajawazito lakini wote wakiwa wametambulika hawana malaria kali. Walipewa dawa mseto na kutolewa damu kwa kipindi tofauti tofauti ndani ya siku 42 za kuwafuatilia ili kupima kiwango cha dawa kwenye damu na kuhakiki vijidudu vya malaria vinavyo angamia. (iii) Kuhakiki ufanisi wa SP kama kinga ya malaria kwa mama mjamzito (IPTp) ilihusisha kuwatambua akina mama wajawazito wakiwa kwenye hospitali mbili tofauti ambazo zipo kwenye maeneo yanye viwango tofauti vya uambukizaji wa malaria. Utambuzi wa akinamama hawa ulikuwa muda mfupi kabla hawajajifungua na ulihusisha kukusanya damu toka kwenye kondo la uzazi mara tu baada ya kujifungua na kupima kama kuna maambukizi ya vijidudu vya malaria.
Matokea: (i) Mfumo wa ukusanyaji taarifa ya matumizi ya dawa kipindi chote cha ujauzito. Asilimia 90 (994/1089) ya mama wajawazito waliweza kufuatiliwa mpaka walipo jifunguwa. Jumla ya 98% waliripoti kutumia walau aina moja ya dawa kipindi cha ujauzito, hasa zikiwa dawa zinazotolewa kwenye mpango maalumu wa mama na mtoto. Dawa nyingi zikiwa ni dawa za kuzuia maumivu (24%), antibayotiki (17%) na dawa za kutibu malaria (15%). Imeonekana dawa za kuongeza wingi wa dama zinahusiana na kupunguza hatari ya mimba kuharibika na mtoto kuzaliwa njiti.
(ii) Usalama wa dawa mseto: Jumla ya mama wajawazito 1783 kati ya 2167 (82%) waliyotumia na ambao hawajatumia dawa za malaria kipindi cha miezi mitatu ya mwanzo ya ujauzito walifuatiliwa na kurekodi matokeo yao ya ujauzito wao. 319 (17.9%) walitumia dawa za malaria kipindi hicho cha mwanzo cha ujauzito na kati ya hawa 53.9% walitumia dawa mseto. Wengine walitumia quinine (24.4%), SP (20.7%) na amodiaquine (3.4%). Matumizi ya quinine kipindi cha miezi mitatu ya mwanzo ya mimba yalihusishwa na kuharibika kwa mimba na kuzaa mtoto njiti. Dawa ya mseto, SP na amodiaquine zilionyesha kutokuwa na mathara yeyote.
(iii) Unyambulisho wa ufanisi ya dawa mseto: Utafiti huu ulihusisha wajawazito 33 na wanawake wasio wajawazito 22 waliyo na malaria na kutibiwa na dozi kamili ya dawa mseto mara mbili kutwa kwa siku 3. Sehemu ya dawa ya mseto ilionekana kuwa pungufu kwa wajawazito ukilinganisha na wale wasiyo wajawazito. Kwenye kipindi cha kuwafuatiliya wagonjwa (ndani ya siku 42), 18% ya wajawazito na 5% ya wasiyo wajawazito waligundulika kuwa bado wana vijidudu vya malaria. Kuwa na kiwango kikubwa cha dawa ya mseto kwenye mzunguko wa damu ulihusishwa na kupona malaria kwa ufasaha.
(iv) Ufanisi wa SP kama kinga ya malaria kwa mama mjamzito. Jumla ya mama wajawazito 350 walihusiswa kwenye utafiti huu, 175 toka kila sehemu yenye malaria ya kwa kiwango cha juu na pia toka kwenye sehemu ya malaria kwa kiwango cha chini. Maambukizo ya malaria kwenye kondo la uzazi ilikuwa 16.6% kwenye eneo la malaria cha kiwango cha juu na 2.3% kwenye eneo lenye malaria kwa kiwango cha chini. Matumizi ya SP yalionyesha uwezekano wa kuzuia maambukizi ya kondo la uzazi hasa eneo lenye malaria ya juu. Kuwa na ujauzito wa kwanza na kuishi eneo lenye malaria ya juu ni kiambata hatarishi cha kupata maambukizo ya kondo la uzazi
Hitimisho: Kwa ujumla matumizi ya dawa kipindi cha ujauzito yapo kwenye kiwangu cha juu, ikiwemo matumizi ya dawa mseto kwenye kipindi cha mimba changa, japokuwa dawa hii siyo chaguo la kwanza kwenye tiba ya malaria kwenye kipindi hichi. Dawa mseto imeonekana kuwa salama zaidi kuliko quinine hivyo ni bora kuanza kufikiria jinsi itakavyoweza kupendekezwa kwa matumizi kipindi cha mimba changa.
Kupitia HDSS imeonyesha inaweza kusaidia kuwa na mfumo wa uhakika na kuaminika wa kukusanya taarifa muhimu za matumizi ya dawa kwa mama mjamzito kwenye nchi masikini. Hivyo ni bora makampuni ya dawa, wafadhili kwa kushirikiana na taasisi za afya ndani na nje ya nchi wafikirie jinsi ya kufadhili mfumo huu ili kusaidia kuboresha takwimu za usalama wa dawa kwa mama wajawazito.
Imethibitika kuwa dawa mseto inapunguwa kwa kiasi kikubwa mwilini mwa mwanamke mjamzito ukilinganisha na mwanamke asiyo mjamzito. Hili huenda ikapelekea mama mjamzito kutopona kwa ufasaa na kupungukiwa uwezekano wa kukabiliyana na maambukizo mapya ya malaria kipindi cha usoni hasa baada ya kumaliza dozi ya malaria. Hivyo tunapendekeza kupitiwa upya dozi ya malaria inayotumika sasa na mama mjamzito na kushauri upatikanaji wa dozi mpya kwa hili kundi la wajawazito
