Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries.

The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening

Doing more harm than good? Community based natural resource management and the neglect of local institutions in policy development

Approaches to natural resource management emphasise the importance of involving local people and institutions in order to build capacity, limit costs, and achieve environmental sustainability. Governments worldwide, often encouraged by international donors, have formulated devolution policies and legal instruments that provide an enabling environment for devolved natural resource management. However, implementation of these policies reveals serious challenges. This article explores the effects of limited involvement of local people and institutions in policy development and implementation. An in-depth study of the Forest Policy of Malawi and Village Forest Areas in the Lilongwe district provides an example of externally driven policy development which seeks to promote local management of natural resources. The article argues that policy which has weak ownership by national government and does not adequately consider the complexity of local institutions, together with the effects of previous initiatives on them, can create a cumulative legacy through which destructive resource use practices and social conflict may be reinforced. In short, poorly developed and implemented community based natural resource management policies can do considerably more harm than good. Approaches are needed that enable the policy development process to embed an in-depth understanding of local institutions whilst incorporating flexibility to account for their location-specific nature. This demands further research on policy design to enable rigorous identification of positive and negative institutions and ex-ante exploration of the likely effects of different policy interventions

The Fourth Law of Black Hole Thermodynamics

We show that black holes fulfill the scaling laws arising in critical transitions. In particular, we find that in the transition from negative to positive values the heat capacities $C_{JQ}$, $C_{\Omega Q}$ and $C_{J\Phi}$ give rise to critical exponents satisfying the scaling laws. The three transitions have the same critical exponents as predicted by the universality Hypothesis. We also briefly discuss the implications of this result with regards to the connections among gravitation, quantum mechanics and statistical physics.Comment: 19 pages (two figures), Plain Tex. Preprint KONS-RGKU-93-11. To appear in Nucl. Phys. B (1993

Knowledge, attitude and perception on antimicrobial use and antimicrobial resistance among final year medical students in the College of Medicine, Malawi

BackgroundMedical curricula need to provide adequate knowledge on antimicrobial medicine use and antimicrobial resistance (AMR). Such knowledge is critical in shaping correct attitudes and perceptions among future prescribers. However, the extent of preparation provided by medical curricula remains unknown.AimThe current study sought to determine knowledge, attitude and perception on antimicrobial use and AMR among final year medical students in Malawi.MethodsA descriptive cross-sectional study was undertaken among all final year medical students at the College of Medicine, University of Malawi in 2016. Total population sampling and self-administered questionnaires were used. Data were entered using Microsoft Excel and analysed with Epi info. Descriptive analysis for categorical data was done using frequencies and proportions, and for continuous data using measures of central tendency.ResultsThe response rate in this study was 95%. The mean and median aggregated scores were 7.2 and 7, respectively, for the 11 knowledge questions. Over 88% of the respondents answered more than half of the knowledge questions correctly. Respondents agreed that antimicrobials are overused both at national (50; 69%) and at hospital (52; 72%) levels.ConclusionThis study reports high aggregated knowledge scores on antimicrobial use and resistance with wide variations on correct knowledge scores per question. The study further shows varying level in attitudes and perceptions among medical students. Overall, there were gaps on antimicrobial use and knowledge of AMR which the medical curriculum should addresses

A Retrospective Survey of HIV Drug Resistance Among Patients 1 Year After Initiation of Antiretroviral Therapy at 4 Clinics in Malawi

In 2004, Malawi began scaling up its national antiretroviral therapy (ART) program. Because of limited treatment options, population-level surveillance of acquired human immunodeficiency virus drug resistance (HIVDR) is critical to ensuring long-term treatment success. The World Health Organization target for clinic-level HIVDR prevention at 12 months after ART initiation is ≥ 70%. In 2007, viral load and HIVDR genotyping was performed in a retrospective cohort of 596 patients at 4 ART clinics. Overall, HIVDR prevention (using viral load ≤ 400 copies/mL) was 72% (95% confidence interval [CI], 67%-77%; range by site, 60%-83%) and detected HIVDR was 3.4% (95% CI, 1.8%-5.8%; range by site, 2.5%-4.7%). Results demonstrate virological suppression and HIVDR consistent with previous reports from sub-Saharan Africa. High rates of attrition because of loss to follow-up were noted and merit attention

Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.

Despite the enormous progress made in scaling up antiretroviral therapy (ART) in sub-Saharan Africa, many challenges remain, not least of which are the identification and management of patients who have failed first-line therapy. Less than 3% of patients are receiving second-line treatment at present, whereas 15-25% of patients have detectable viral loads 12 months or more into treatment, of whom a substantial proportion might have virological failure. We discuss the reasons why virological ART failure is likely to be under-diagnosed in the routine health system, and address the current difficulties with standard recommended second-line ART regimens. The development of new diagnostic tools for ART failure, in particular a point-of-care HIV viral-load test, combined with simple and inexpensive second-line therapy, such as boosted protease-inhibitor monotherapy, could revolutionise the management of ART failure in resource-limited settings

The Impact of Macroeconomic Variables on Industrial Shares Listed on the JSE

This study investigates the causal relationships, both long run and short run between the Industrial Index 25 and some macroeconomic variables in South Africa. Quarterly data from all the variables was collected from 1995 Q3 (September) to 2015 Q2 (June). Included in the set of macroeconomic variables used in this study are gross domestic product (GDP), inflation (CPI), prime rates and exchange rates. Statistical techniques applied in order to analyse the relationship between stock returns and macroeconomic variables include Augmented Dickey Fuller (ADF) unit root tests, correlation analysis, Johansen cointegration test, Vector error correction (VECM) and Granger causality tests in a multivariate framework. Results show that inflation significantly increases stock prices, hence investors get some inflationary compensation. Interest rates are shown to have a negative relationship between, suggestive of the substitution between stocks and interest bearing securities when interest rates increase. On the other hand, exchange rates have a positive effect on the INDI25, whilst there is no relationship between INDI 25 and GDP. Two error correction terms were obtained from the VECM. Whilst the first one was insignificant and failed to indicate any long -run relationship, the other term was significant, indicating short term adjustments and the presence of a long run relationship from GDP, CPI, prime rates and exchange rates to INDI 25. Results from Granger causality showed only univariate causality from INDI 25 to prime rates.Dissertation (MCom)--University of Pretoria, 2017.Financial ManagementMComUnrestricte

PER3 polymorphisms and their association with prostate cancer risk in Japanese men

Introduction: Prostate cancer (PCa) is one of the most common cancers affecting men globally. Although PER3 has been suggested as a risk factor for cancer development, there are few reports elucidating the relationship between PER3 and PCa. We investigated the association between PER3 polymorphisms (rs2640908 and VNTR) and susceptibility to PCa in the Japanese population. Methods: Eighty three patients with PCa and 122 controls participated in this study. We analyzed rs2640908 and VNTR polymorphisms by using PCR–Restriction Fragment Length Polymorphism (PCR–RFLP). Results: Compared to the C/C genotype with the rs2640908 polymorphism, the T/T (OR: 0.35, 95% CI: 0.15–0.81, P = 0.02) and C/T + T/T (OR: 0.46, 95% CI: 0.24–0.88, P = 0.02) genotypes had a significantly lower risk of PCa. TT (OR: 0.29, 95% CI: 0.10–0.77, P = 0.02) and CT + TT (OR: 0.47, 95% CI: 0.23–0.97, P = 0.04) also had significant protection against PCa in the smoker group. Significantly, we observed an association between smoking and rs2640908 polymorphism in this study. However, no association between the VNTR polymorphisms and PCa was detected. Conclusions: Our results suggest that PER3 rs2640908 polymorphisms influence an individual’s susceptibility to PCa