Friday, April 24, 2009

[EQ] Lifting the Burden of Malaria

Affordable Medicines Facility - malaria (AMFm)

The Global Fund: http://www.theglobalfund.org/en/amfm/?lang=en

An innovative financing mechanism, the Affordable Medicines Facility for malaria ( AMFm), was officially launched. The AMFm will make the most effective treatment for malaria, artemisinin combination therapies (ACTs), more affordable and so has the potential to save thousands of lives. The Global Fund to Fight AIDS, Tuberculosis and Malaria will manage the new scheme.

The Lancet, Volume 373, Issue 9673, Pages 1447 - 1454, 25 April 2009

World Malaria Day (April 25) is a time to assess key achievements and future goals in malaria control and elimination. In a Comment, Sir Richard Feachem and Allison Phillips discuss the rapid progress made in malaria control and elimination in the past two years, and discuss their optimism for the future. A second Comment outlines in detail the progress towards a malaria vaccine.

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Evaluation of malaria diagnostic tests by WHO and partners finds variation in test performance

News Release WHO/12 • 24 April 2009

WHO, 24 April 2009

· Press release [PDF: 324Kb, 2 pages] | French | Spanish

· Full report [PDF: 2.8Mb, 110 pages]

· Executive summary [PDF: 131Kb, 3 pages]

GENEVA–The largest-ever independent, laboratory-based evaluation of rapid diagnostic tests (RDTs) for malaria has shown that some tests on the market perform exceptionally well in tropical temperatures and can detect even low parasite densities in blood samples, while other tests were only able to detect the parasite at high parasite densities.

The evaluation was co-sponsored by the WHO Regional Office for the Western Pacific (WPRO), WHO-based Special Programme for Research and Training in Tropical Diseases (TDR) and the Foundation for Innovative New Diagnostics (FIND). Testing was performed at the US Centers for Disease Control and Prevention (CDC). Forty-one commercially available RDTs went through a blinded laboratory evaluation.

The findings will serve as a tool for countries to make informed choices, from among the dozens of tests commercially available, on the purchase and use of rapid diagnostics that are best suited to local conditions.

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The Center for High Impact Philanthropy at the University of Pennsylvania's School of Social Policy & Practice has published a document intended to help donors make the most useful contributions to the fight against malaria. Lifting the Burden of Malaria: An Investment Guide for Impact-Driven Philanthropy describes examples of promising models, provides cost-per-impact estimates and offers advice on setting a strategy.
www.impact.upenn.edu

Lifting the Burden of Malaria:

An Investment Guide for Impact-Driven Philanthropy

Carol McLaughlin, Jennifer Levy, Kathleen Noonan, Katherina Rosqueta

February 2009

Summary: http://www.impact.upenn.edu/documents/UPenn_CHIP_MalariaExecSumm_Feb09.pdf

Every thirty seconds a young child dies of malaria.1 Each of those deaths is avoidable.

There now exists a window of opportunity for you, as an individual philanthropist, to help lift the burden of malaria due to the emergence of three pivotal developments. First, effective, low-cost tools now exist for malaria’s prevention and treatment. Second, a consensus is emerging on a global strategy to combat the disease and overcome delivery obstacles to reaching affected communities. Third, this global strategy is receiving increasing attention from an array of global players and donors. Your challenge is to figure out how you can best leverage the current momentum to make the biggest difference.

TABLE OF CONTENTS

I . THE NEED FOR PHILANTHROPIC INVESTMENT IN MALARIA CONTROL (pp 1 - 9)

Malaria is a global priority for health and development
The global strategy to combat malaria
How philanthropists can help
Why invest now
What are the best investments in malaria control

II . TREAT AND PREVENT NOW (pp 10 - 31)

Overview of malaria tools
Malaria tools are both inexpensive and cost-effective
Philanthropists can address the current gaps in the coverage of tools
Effective tool-delivery strategies

Addressing current constraints to delivery

§ Strategy 1: Extend the existing health system capacity through community health workers

§ Strategy 2: Enlist family members and community volunteers to educate communities

§ Strategy 3: Piggyback on existing systems for delivery of bednets

§ Strategy 4: Scale-up community and household access to new ACTs

Helping especially vulnerable populations

§ Strategy 5: Build training networks to prevent malaria in pregnancy

§ Strategy 6: Assist the most vulnerable in areas of conflict or natural disaster

III . BUILD SYSTEMS FOR THE LONG TERM (pp 32 - 41)

Strategy 7: Strengthen health system capacity through effective partnerships
Strategy 8: Leverage existing financing resources for system-wide change
Strategy 9: Create information networks to track outcomes, monitor resistance, and predict epidemics
Strategy 10: Prepare future health leaders from
malaria-affected countries

IV. INNOVATE FOR THE FUTURE (pp 42 - 50)

Strategy 11: Support innovation for new tools
Strategy 12: Innovate by harnessing the potential of the private sector or applying new technology

In-depth case study included in this section

V. TRANSLATING GOOD INTENTIONS INTO HIGH IMPACT PHILANTHROPY (pp 51 - 64)

1. Select your entry point supporting the global malaria strategy
2. Consider what region you want to target
3. Evaluate potential investments
4. Measure what matters after you have written the check
5. Incorporate proven strategies for successful public health efforts

RESOURCES AND REFERENCES (pp 65 - 82)

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[EQ] Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme

Seguro Popular in Mexico: is premature evaluation healthy?

Cesar G Victora, David H Peters

The Lancet, Volume 373, Issue 9673, Pages 1447 - 1454, 25 April 2009

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60564-X/fulltext

‘….Rigorous research on health-systems issues is much needed, 2 and the investigators break new ground with one of the largest randomised health-policy experiments ever. The main finding was a reduction in catastrophic expenditures on health of 1·9%. Such expenditures were defined as health-spending share of a household's spending capacity after a minimum food budget…”

Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme

Prof Gary King PhD a Emmanuela Gakidou PhD b, Kosuke Imai PhD c, Jason Lakin PhD d, Ryan T Moore PhD h, Clayton Nall MA d, Nirmala Ravishankar PhD b, Manett Vargas MPA e, Martha María Téllez-Rojo PhD f, Juan Eugenio Hernández Ávila MSc f, Mauricio Hernández Ávila MD e f, Héctor Hernández Llamas PhD g

The Lancet, Volume 373, Issue 9673, Pages 1447 - 1454, 25 April 2009

Abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60239-7/abstract

We assessed aspects of Seguro Popular, a programme aimed to deliver health insurance, regular and preventive medical care, medicines, and health facilities to 50 million uninsured Mexicans.

Methods
We randomly assigned treatment within 74 matched pairs of health clusters—ie, health facility catchment areas—representing 118 569 households in seven Mexican states, and measured outcomes in a 2005 baseline survey (August, 2005, to September, 2005) and follow-up survey 10 months later (July, 2006, to August, 2006) in 50 pairs (n=32 515). The treatment consisted of encouragement to enrol in a health-insurance programme and upgraded medical facilities. Participant states also received funds to improve health facilities and to provide medications for services in treated clusters. We estimated intention to treat and complier average causal effects non-parametrically.

Findings
Intention-to-treat estimates indicated a 23% reduction from baseline in catastrophic expenditures (1·9% points; 95% CI 0·14—3·66). The effect in poor households was 3·0% points (0·46—5·54) and in experimental compliers was 6·5% points (1·65—11·28), 30% and 59% reductions, respectively. The intention-to-treat effect on health spending in poor households was 426 pesos (39—812), and the complier average causal effect was 915 pesos (147—1684). Contrary to expectations and previous observational research, we found no effects on medication spending, health outcomes, or utilisation.

Interpretation
Programme resources reached the poor. However, the programme did not show some other effects, possibly due to the short duration of treatment (10 months). Although Seguro Popular seems to be successful at this early stage, further experiments and follow-up studies, with longer assessment periods, are needed to ascertain the long-term effects of the programme.

Funding

Mexican Ministry of Health, the National Institute of Public Health of Mexico, and Harvard University Institute for Quantitative Social Science.

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[EQ] Association of Maternal Height With Child Mortality, Anthropometric Failure, and Anemia in India

Association of Maternal Height With Child Mortality, Anthropometric Failure, and Anemia in India

S. V. Subramanian, PhD; Leland K. Ackerson, ScD; George Davey Smith, MD, DSc; Neetu A. John, ScM

JAMA. 2009;301(16):1691-1701. - Vol. 301 No. 16, April 22/29, 2009

Website: http://jama.ama-assn.org/cgi/content/short/301/16/1691

“………..Most investigations of child health determinants have focusedon contemporaneous factors such as maternal behaviors, nutrition,and environmental conditions, with little attention given tointergenerational factors. In an analysis of data from India'sNational Family Health Survey, Subramanian and colleagues examinedthe association between maternal adult height—a reflectionof the mother's social and nutritional health in childhood—andchild mortality, anthropometric failure (eg, underweight, stunting,and wasting), and anemia. In analyses that adjusted for demographicand socioeconomic variables, the authors found that maternalheight was inversely associated with mortality and anthropometricfailure among children aged 0 to 59 months…..” S. V. Subramanian

Context Prior research on the determinants of child healthhas focused on contemporaneous risk factors such as maternalbehaviors, dietary factors, and immediate environmental conditions.Research on intergenerational factors that might also predisposea child to increased health adversity remains limited.

Objective To examine the association between maternalheight and child mortality, anthropometric failure, and anemia.

Design, Setting, and Population We retrieved data fromthe 2005-2006 National Family Health Survey in India (releasedin 2008). The study population constitutes a nationally representativecross-sectional sample of singleton children aged 0 to 59 monthsand born after January 2000 or January 2001 (n = 50 750)to mothers aged 15 to 49 years from all 29 states of India.Information on children was obtained by a face-to-face interviewwith mothers, with a response rate of 94.5%. Height was measuredwith an adjustable measuring board calibrated in millimeters.Demographic and socioeconomic variables were considered as covariates.Modified Poisson regression models that account for multistagesurvey design and sampling weights were estimated.

Main Outcome Measures Mortality was the primary end point;underweight, stunting, wasting, and anemia were included assecondary outcomes.

Results In adjusted models, a 1-cm increase in maternalheight was associated with a decreased risk of child mortality(relative risk [RR], 0.978; 95% confidence interval [CI], 0.970-0.987;P < .001), underweight (RR, 0.971; 95% CI, 0.968-0.974;P < .001), stunting (RR, 0.971; 95% CI, 0.968-0.0973;P < .001), wasting (RR, 0.989; 95% CI, 0.984-0.994;P < .001), and anemia (RR, 0.998; 95% CI, 0.997-0.999;P = .02). Children born to mothers who were less than145 cm in height were 1.71 times more likely to die (95% CI,1.37-2.13) (absolute probability, 0.09; 95% CI, 0.07-0.12) comparedwith mothers who were at least 160 cm in height (absolute probability,0.05; 95% CI, 0.04-0.07). Similar patterns were observed foranthropometric failure related to underweight and stunting.Paternal height was not associated with child mortality or anemiabut was associated with child anthropometric failure.

Conclusion In a nationally representative sample of householdsin India, maternal height was inversely associated with childmortality and anthropometric failure.

Author Affiliations: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts (Dr Subramanian and Ms John); Department of Community Health and Sustainability, School of Health and Environment, University of Massachusetts, Lowell (Dr Ackerson); and MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, England (Dr Davey Smith).

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