Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey

BACKGROUND: Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. METHODS: Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, health facility survey was conducted in Malawi to assess patient-, health worker-, and health facility-level factors associated with malaria case management quality using multivariate Poisson regression models. RESULTS: Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (p < 0.0001). Complaint of cough was associated with a 27% decreased likelihood of correct malaria treatment (p = 0.001). Lower-level cadres of health workers were more likely to prescribe anti-malarials for patients, increasing the likelihood of both correct treatment and overtreatment, but no other health worker or health facility-level factors were significantly associated with case management quality. CONCLUSIONS: Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools

A dynamical model for longitudinal wave functions in light-front holographic QCD

We construct a Schrodinger-like equation for the longitudinal wave function of a meson in the valence qq-bar sector, based on the 't Hooft model for large-N two-dimensional QCD, and combine this with the usual transverse equation from light-front holographic QCD, to obtain a model for mesons with massive quarks. The computed wave functions are compared with the wave function ansatz of Brodsky and De Teramond and used to compute decay constants and parton distribution functions. The basis functions used to solve the longitudinal equation may be useful for more general calculations of meson states in QCD.Comment: 12 pages, 2 figures, RevTeX 4.1; expanded discussion, with calculation details moved to appendice

Spontaneous symmetry breaking of (1+1)-dimensional ϕ4\bf \phi^4 theory in light-front field theory (III)

We investigate (1+1)-dimensional $\phi^4$ field theory in the symmetric and broken phases using discrete light-front quantization. We calculate the perturbative solution of the zero-mode constraint equation for both the symmetric and broken phases and show that standard renormalization of the theory yields finite results. We study the perturbative zero-mode contribution to two diagrams and show that the light-front formulation gives the same result as the equal-time formulation. In the broken phase of the theory, we obtain the nonperturbative solutions of the constraint equation and confirm our previous speculation that the critical coupling is logarithmically divergent. We discuss the renormalization of this divergence but are not able to find a satisfactory nonperturbative technique. Finally we investigate properties that are insensitive to this divergence, calculate the critical exponent of the theory, and find agreement with mean field theory as expected.Comment: 21 pages; OHSTPY-HEP-TH-94-014 and DOE/ER/01545-6

The High Burden of Malaria in Primary School Children in Southern Malawi.

Malaria among school children has received increased attention recently, yet there remain few detailed data on the health and educational burden of malaria, especially in southern Africa. This paper reports a survey among school children in 50 schools in Zomba District, Malawi. Children were assessed for Plasmodium infection, anemia, and nutritional status and took a battery of age-appropriate tests of attention, literacy, and numeracy. Overall, 60.0% of children were infected with Plasmodium falciparum, 32.4% were anemic and 32.4% reported sleeping under a mosquito net the previous night. Patterns of P. falciparum infection and anemia varied markedly by school. In multivariable analysis, higher odds of P. falciparum infection were associated with younger age and being stunted, whereas lower odds were associated with reported net use, higher parental education, and socioeconomic status. The odds of anemia were significantly associated with P. falciparum infection, with a dose-response relationship between density of infection and odds of anemia. No clear relationship was observed between health status and cognitive and educational outcomes. The high burden of malaria highlights the need to tackle malaria among school children

La praxis liberadora de la teología de la discapacidad en la Misión de la Fe Apostólica de Zimbabue: Una perspectiva teológica Cristiana

Despite the inter-disciplinary inclusivity of Disability Studies in the globe over time, the religious organization’s systems are still repulsive to accept the physical and psychosocial realities of people living with Disabilities. The growing literature that should be influencing religious perspectives about people with disabilities has not been able to extricate the dogmatic stereotypes and myths associated with Disability. As such, the prevalence of the diverse responses Disability from different contexts has compromised the ideological and material investment in Disability Studies. We used the combination of phenomenological observation and informal conversation qualitative methodologies to establish the experiences, feelings and behaviors of the Apostolic Faith Mission of Zimbabwe (AFMZ) congregants in Harare on the impact of the liberation praxis of Disability Theology. The findings showed that people with disabilities are most often marginalized, excluded and discriminated against and perpetually subjugated within the religious circles. This complexity of disabilities is exacerbated by the fluidity of policies, culture and religious ideologies when dealing with issues of disabilities. In conclusion, this study emphasized that Disability Theology within Christian tradition should function as a liberating praxis when dealing with issues of disabilities and being effectively used to enhance the participation of people with disabilities in all the religious liturgical activities.A pesar de la inclusividad interdisciplinaria de los estudios sobre la discapacidad a lo largo del tiempo, los sistemas de las organizaciones religiosas son todavía reacios a aceptar las realidades físicas y psicosociales de las personas en condición de discapacidad. La creciente literatura que debería influir en las perspectivas religiosas sobre las personas en condición de discapacidad no ha sido capaz de desmontar los estereotipos y mitos dogmáticos asociados a la discapacidad. Así, el predominio de diversas respuestas en relación con la discapacidad desde diferentes contextos ha comprometido la inversión material e ideológica en los estudios sobre la discapacidad. En el trabajo se combinó la observación fenomenológica con la conversación informal de los métodos cualitativos para caracterizar las experiencias, sentimientos y comportamientos en relación con el impacto de la praxis liberadora de la teología de la discapacidad de los miembros de la Misión de la Fe Apostólica de Zimbabue en Harare. Los resultados revelan que las personas en condición de discapacidad son marginalizadas, excluidas, discriminadas y subyugadas con mayor frecuencia en los círculos religiosos. Esta complejidad de las discapacidades es exacerbada por las políticas, la cultura y las ideologías religiosas relacionadas con las discapacidades. En conclusión, el trabajo enfatiza que la teología de la discapacidad dentro de la tradición cristiana debería funcionar como una praxis liberadora al tratar con asuntos relacionados con la discapacidad y ser utilizada para aumentar la participación de las personas en condición de discapacidad en todas las actividades litúrgicas religiosas

Design, implementation and evaluation of a training programme for school teachers in the use of malaria rapid diagnostic tests as part of a basic first aid kit in southern Malawi.

BACKGROUND: With increasing levels of enrolment, primary schools present a pragmatic opportunity to improve the access of school children to timely diagnosis and treatment of malaria, increasingly recognised as a major health problem within this age group. The expanded use of malaria rapid diagnostic tests (RDTs) and artemisinin combination therapy (ACT) by community health workers (CHWs) has raised the prospect of whether teachers can provide similar services for school children. We describe and evaluate the training of primary school teachers to use a first aid kit containing malaria RDTs and ACT for the diagnosis and treament of uncomplicated malaria in school children in southern Malawi. METHODS: We outline the development of the intervention as: (1) conception and design, (2) pilot training, (3) final training, and (4) 7-month follow up. The training materials were piloted at a four-day workshop in July 2013 following their design at national stakeholders meetings. The evaluation of the pilot training and materials were assessed in relation to increased knowledge and skill sets using checklist evaluations and questionnaires, the results of which informed the design of a final seven-day training programme held in December 2013. A follow up of trained teachers was carried out in July 2014 following 7 months of routine implementation. A total of 15 teachers were evaluated at four stages: pilot training, two weeks following pilot, final training and seven months following final training. RESULTS: A total of 15 and 92 teachers were trained at the pilot and final training respectively. An average of 93 % of the total steps required to use RDTs were completed correctly at the final training, declining to 87 % after 7 months. All teachers were observed correctly undertaking safe blood collection and handling, accurate RDT interpretation, and correct dispensing of ACT. The most commonly observed errors were a failure to wait 20 minutes before reading the test result, and adding an incorrect volume of buffer to the test cassette. CONCLUSION: Following training, teachers are able to competently use RDTs and ACTs test and treat children at school for uncomplicated malaria safely and accurately. Teachers demonstrate a comparable level of RDT use relative to non-health professional users of RDTs, and sustain this competency over a period of seven months during routine implementation

Learner Treatment Kit (school-based malaria diagnosis and treatment in southern Malawi): Study data and support materials

A set of data collection tools, STATA .do processing scripts, and resultant datasets produced as part of the Learner Treatment Kit (LTK) Project, a study funded to evaluate the impact of a school-based programme of malaria diagnosis and treatment (malaria case management) as part of a wider school first-aid kit exploring school attendance, health and education outcomes. The study conducted a cluster randomized controlled trial in 58 primary schools in TA Chikowi, Zomba district of southern Malawi. The intervention, implemented between 2013-2015 in 29 randomly selected schools from the total of 58 schools, comprised providing free-of-charge malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) to primary schools to be used by trained teachers to diagnose and treat uncomplicated malaria, as part of basic first aid kits known as "Learner Treatment Kits" (LTKs). The primary outcome was school attendance, assessed through teacher-recorded school attendance registers and periodic spot checks. Secondary outcomes included prevalence of Plasmodium spp. infection, anaemia, educational performance, self-reported child wellbeing, and health seeking behaviour. The trial is registered with ClinicalTrials.gov, NCT02213211