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Singh A.,Clinton Health Access Initiative and 7B | Dysoley L.,House of Control | Dysoley L.,National Institute of Public Health | Sovannaroth S.,House of Control | Rekol H.,House of Control
Malaria Journal | Year: 2016

Background: For over a decade, Cambodia has implemented a number of policies and innovative strategies to increase access to quality malaria case management services and address the drivers of multi-drug resistance. This paper utilizes outlet survey trend data collected by the ACTwatch project to demonstrate how changes in Cambodian policy and strategies have led to shifts in anti-malarial markets. Methods: Anti-malarial ACTwatch outlet surveys were conducted in Cambodia in 2009 (June-July), 2011 (June-August) and 2013 (September-October). A census of all outlets with the potential to sell or distribute anti-malarials was conducted within a nationally representative sample of communes. Drug information, sales/distribution in the previous week, and retail price were collected for each anti-malarial in stock. Information on availability of malaria blood testing was also collected. Results: A total of 7833 outlets were enumerated in 2009, 18,584 in 2011, and 16,153 in 2013. The percentage of public health facilities with at least one anti-malarial in stock on the day of the survey increased between 2009 (65.8 %) and 2011 (90.0 %) and remained high in 2013 (82.0 %). Similar trends were found for village malaria workers (VMW). Overall, private sector availability of anti-malarials declined over time and varied by outlet type. By 2013 most anti-malarial stocking public health facilities (81.5 %), VMW (95.4 %), private for-profit health facilities (64.8 %), and pharmacies (71.9 %) had the countries first-line artemisinin-based combination therapy (ACT) treatment in stock. In 2013, 60 % of anti-malarials were delivered through the private sector, 40 % through the public sector, and the most common anti-malarial to be sold or distributed was the first-line ACT, comprising 62.8 % of the national market share. Oral artemisinin monotherapy, which had accounted for 6 % of total anti-malarial market share in 2009, was no longer reportedly sold/distributed in 2013. Malaria blood testing availability remained high over time among public facilities and VMW, with availability over 90 % in 2011 and 2013. Moderate availability was observed in the private sector. Conclusions: Continued implementation of successful public and private sector strategies in support of evolving malaria drug treatment policies will be important to protect the efficacy of anti-malarial medicines and ultimately facilitate malaria elimination in Cambodia by 2025. © 2016 ACTwatch Group et al.


PubMed | House of Control, Center for Global Health and Center for Global Health Research
Type: Journal Article | Journal: Malaria journal | Year: 2016

Although anti-malarial medicines are free in Kenyan public health facilities, patients often seek treatment from private sector retail drug outlets. In mid-2010, the Affordable Medicines Facility-malaria (AMFm) was introduced to make quality-assured artemisinin-based combination therapy (ACT) accessible and affordable in private and public sectors.Private sector retail drug outlets stocking anti-malarial medications within a surveillance area of approximately 220,000 people in a malaria perennial high-transmission area in rural western Kenya were identified via a census in September 2013. A cross-sectional study was conducted in September-October 2013 to determine availability and price of anti-malarial medicines and malaria rapid diagnostic tests (RDTs) in drug outlets. A standardized questionnaire was administered to collect drug outlet and personnel characteristics and availability and price of anti-malarials and RDTs.Of 181 drug outlets identified, 179 (99%) participated in the survey. Thirteen percent were registered pharmacies, 25% informal drug shops, 46% general shops, 13% homesteads and 2% other. One hundred sixty-five (92%) had at least one ACT type: 162 (91%) had recommended first-line artemether-lumefantrine (AL), 22 (12%) had recommended second-line dihydroartemisinin-piperaquine (DHA-PPQ), 85 (48%) had sulfadoxine-pyrimethamine (SP), 60 (34%) had any quinine (QN) formulation, and 14 (8%) had amodiaquine (AQ) monotherapy. The mean price (range) of an adult treatment course for AL was $1.01 ($0.35-4.71); DHA-PPQ was $4.39 ($0.71-7.06); QN tablets were $2.24 ($0.12-4.71); SP was $0.62 ($0.24-2.35); AQ monotherapy was $0.42 ($0.24-1.06). The mean AL price with or without the AMFm logo did not differ significantly ($1.01 and 1.07, respectively; p=0.45). Only 17 (10%) drug outlets had RDTs; 149 (84%) never stocked RDTs. The mean RDT price was $0.92 ($0.24-2.35).Most outlets never stocked RDTs; therefore, testing prior to treatment was unlikely for customers seeking treatment in the private retail sector. The recommended first-line treatment, AL, was widely available. Although SP and AQ monotherapy are not recommended for treatment, both were less expensive than AL, which might have caused preferential use by customers. Interventions that create community demand for malaria diagnostic testing prior to treatment and that increase RDT availability should be encouraged.


Teisl M.F.,University of Maine, United States | Fromberg E.,House of Control | Smith A.E.,House of Control | Boyle K.J.,Virginia Polytechnic Institute and State University | Engelberth H.M.,University of Maine, United States
Science of the Total Environment | Year: 2011

Eating fish provides health benefits; however, nearly all fish contain at least some methylmercury which can impair human health. While government agencies have been issuing fish consumption advisories for 40. years, recent evaluation efforts highlight their poor performance. The benefit of an advisory can be measured by its ability to inform consumers as to both the positive and negative attributes of their potential choices, leading to appropriate changes in behavior. Because of the health benefits, fish advisories should not reduce fish consumption, even among at-risk individuals, but should lead consumers to switch away from highly contaminated fish toward those less contaminated. Although studies document how advisories reduce fish consumption (a negative outcome), no study indicates whether they lead to switching behavior (a positive outcome).We explore the effects of Maine Center of Disease Control and Prevention's advisory aimed at informing women who may become pregnant, nursing mothers and pregnant women about the benefits and risks of fish consumption. We examine how the advisory changes consumption, especially related to switching behavior. We demonstrate such changes in behavior both during and after pregnancy and compare the advisory-induced changes with those induced by other information sources. Although we find the advisory reduced some women's consumption of fish, we find the decrease is short-lived. Most importantly, the advisory induced appropriate switching behavior; women reading the advisory decreased their consumption of high-risk fish and increased their consumption of low-risk fish. We conclude a well-designed advisory can successfully transform a complex risk/benefit message into one that leads to appropriate knowledge and behavioral changes. © 2011 Elsevier B.V.


Arora M.,House of Control | Chauhan K.,House of Control | John S.,Health Bridge | Mukhopadhyay A.,Indian Institute of Technology Delhi
Indian Journal of Community Medicine | Year: 2011

Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.


Speers D.J.,Hospital Avenue | Speers D.J.,University of Western Australia | Fisk R.E.,Hospital Avenue | Goire N.,Hospital Avenue | Mak D.B.,House of Control
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: Unlike most of the world, penicillin resistance in Neisseria gonorrhoeae from remote regions of Western Australia (WA) with high gonorrhoea notification rates has not increased despite many years of empirical oral therapy. With the advent of non-culture molecular diagnosis of gonorrhoea and the consequent decline in culture-based susceptibility, it is imperative to ensure the ongoing reliability of combination oral azithromycin, amoxicillin and probenecid for uncomplicated gonorrhoea in this setting. PCR-based non-culture N. gonorrhoeae antimicrobial resistance surveillance for penicillinase production was therefore employed. Methods: Genital and non-genital specimens that were PCR-positive for N. gonorrhoeae were assessed for penicillinase production by detection of the N. gonorrhoeae TEM-1 plasmid using specific real-time PCR. Results: In remote regions ofWAwhere gonorrhoea is highly endemic,<5%of N. gonorrhoeae isolateswere penicillinase-producing. This contrasts with rates of up to 20% observed in the more densely populated metropolitan and rural regions. Conclusions: In the era of molecular diagnosis of gonorrhoea, non-culture-based antimicrobial resistance surveillance proved useful when developing evidence-based guidelines for the clinical management of locally acquired gonorrhoea in highly endemic regions in WA. The continued efficacy of combination oral amoxicillin, probenecid and azithromycin therapy despite many years of use in a setting highly endemic for gonorrhoea mayexplain the lowrate of penicillin resistance in these remote regions and supports the concept of adding azithromycin to β-lactam antibiotics to help delay the emergence of multiresistant N. gonorrhoeae. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


The introduction of mandatory surveillance of Clostridium difficile infection (CDI) in 2004 showed the scale of the challenge: cases in patients >64 years old reached 55,681 in 2006. The first type 027 outbreaks had been in 2005 and CDI was a headline issue. The prevention and control of CDI requires a tripartite partnership between clinicians, health service managers, and the government/Department of Health which needs to set standards, ensure that CDI is a priority, set targets and monitor outcome. Government can also legislate; the Health Act 2006 introduced a statutory Code of Practice for infection prevention and control for the NHS and extended to all independent health and care settings in 2010. In 2008, a national target was set for a 30% reduction in CDI by 2010-11 (baseline 2007-8). It was population-based and set a standard (ceiling) rate/10,000 in each area, within which acute hospitals had a target/1000 admissions (diagnosed after day 3). In the first year (2008-9), a 35% reduction was achieved from 55,499 to 36,079 cases in all ages and in 2009-10 the total was 25,604, a 54% reduction from 2007-8. However, in 2009, cases >64 years old were 29% down from 2008 but only 9% down in the 2-64 year old group; also, by this stage, cases in acute hospitals and in other settings were almost equal. Death certification showing CDI fell for the first time in 2008 and in 2009 there were 3550 total mentions (7816 in 2007) of which 1510 (42%) were as underlying cause (3875, 49%, in 2007). The reductions in CDI have been achieved by a raft of measures. Crucially, the targets focused management emphasis on infection prevention and control. This was supported by enhanced surveillance. Clinical practice protocols were implemented through the high impact interventions (care bundle) approach, and there was a major emphasis on cleanliness and hygiene (particularly hand washing for clinical staff and environmental cleaning and disinfection in patient areas). Achievement of the target is not the end of the road; it is to be transformed into an objective (benchmark) for 2011 and beyond based on median rates to maintain pressure for reduction. © 2010.


Humphreys K.,House of Control | Humphreys K.,Stanford University
Substance Abuse | Year: 2012

The Obama Administration is striving to promote both public health and public safety by improving the public policy response to criminal offenders who have substance use disorders. This includes supporting drug courts, evidence-based probation and parole programs, addiction treatment and re-entry programs. Scientists and clinicians in the addiction field have a critical role to play in this much-needed effort to break the cycle of addiction, crime and incarceration. Copyright © 2012 Taylor and Francis Group, LLC.


Gorrell M.,House of Control
Journal of Infection Prevention | Year: 2012

The National Health Service (NHS) in England is facing significant challenges ahead as a result of the government's plans to reduce national debt. The challenge for infection control practitioners will be to continue to support the development and delivery of high quality clinical services without the level of funding previously experienced over the last decade. In order to achieve this all healthcare professionals will be required to embrace improvement strategies. The purpose of this paper is therefore to report on a review of a clinical reporting and root cause analysis (CRRCA) process coordinated by a community-based infection prevention and control team. The paper outlines the issues surrounding the current CRRCA process and analyses the process using lean concepts. A series of change options are put forward in order to illustrate how a failure to effectively scope improvement project boundaries can constrain change thereby limiting the potential for productivity and quality improvement. © The Author(s) 2012.


Grimble M.J.,University of Strathclyde | Majecki P.,House of Control
IET Control Theory and Applications | Year: 2015

A non-linear predictive generalised minimum variance control algorithm is introduced for the control of nonlinear discrete-time state-dependent multivariable systems. The process model includes two different types of subsystems to provide a variety of means of modelling the system and inferential control of certain outputs is available. A statedependent output model is driven from an unstructured non-linear input subsystem which can include explicit transportdelays. A multi-step predictive control cost function is to be minimised involving weighted error, and either absolute or incremental control signal costing terms. Different patterns of a reduced number of future controls can be used to limit the computational demands. © The Institution of Engineering and Technology 2015.


PubMed | House of Control and Clinton Health Access Initiative and 7B
Type: | Journal: Malaria journal | Year: 2016

For over a decade, Cambodia has implemented a number of policies and innovative strategies to increase access to quality malaria case management services and address the drivers of multi-drug resistance. This paper utilizes outlet survey trend data collected by the ACTwatch project to demonstrate how changes in Cambodian policy and strategies have led to shifts in anti-malarial markets.Anti-malarial ACTwatch outlet surveys were conducted in Cambodia in 2009 (June-July), 2011 (June-August) and 2013 (September-October). A census of all outlets with the potential to sell or distribute anti-malarials was conducted within a nationally representative sample of communes. Drug information, sales/distribution in the previous week, and retail price were collected for each anti-malarial in stock. Information on availability of malaria blood testing was also collected.A total of 7833 outlets were enumerated in 2009, 18,584 in 2011, and 16,153 in 2013. The percentage of public health facilities with at least one anti-malarial in stock on the day of the survey increased between 2009 (65.8%) and 2011 (90.0%) and remained high in 2013 (82.0%). Similar trends were found for village malaria workers (VMW). Overall, private sector availability of anti-malarials declined over time and varied by outlet type. By 2013 most anti-malarial stocking public health facilities (81.5%), VMW (95.4%), private for-profit health facilities (64.8%), and pharmacies (71.9%) had the countries first-line artemisinin-based combination therapy (ACT) treatment in stock. In 2013, 60% of anti-malarials were delivered through the private sector, 40% through the public sector, and the most common anti-malarial to be sold or distributed was the first-line ACT, comprising 62.8% of the national market share. Oral artemisinin monotherapy, which had accounted for 6% of total anti-malarial market share in 2009, was no longer reportedly sold/distributed in 2013. Malaria blood testing availability remained high over time among public facilities and VMW, with availability over 90% in 2011 and 2013. Moderate availability was observed in the private sector.Continued implementation of successful public and private sector strategies in support of evolving malaria drug treatment policies will be important to protect the efficacy of anti-malarial medicines and ultimately facilitate malaria elimination in Cambodia by 2025.

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