Exogenous-Loss Awareness in Queue Management: Toward Global Fairness

For a given TCP flow, exogenous losses are those occurring on links other than the flow's bottleneck link. Exogenous losses are typically viewed as introducing undesirable "noise" into TCP's feedback control loop, leading to inefficient network utilization and potentially severe global unfairness. This has prompted much research on mechanisms for hiding such losses from end-points. In this paper, we show through analysis and simulations that low levels of exogenous losses are surprisingly beneficial in that they improve stability and convergence, without sacrificing efficiency. Based on this, we argue that exogenous loss awareness should be taken into account in any AQM design that aims to achieve global fairness. To that end, we propose an exogenous-loss aware Queue Management (XQM) that actively accounts for and leverages exogenous losses. We use an equation based approach to derive the quiescent loss rate for a connection based on the connection's profile and its global fair share. In contrast to other queue management techniques, XQM ensures that a connection sees its quiescent loss rate, not only by complementing already existing exogenous losses, but also by actively hiding exogenous losses, if necessary, to achieve global fairness. We establish the advantages of exogenous-loss awareness using extensive simulations in which, we contrast the performance of XQM to that of a host of traditional exogenous-loss unaware AQM techniques.

Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study

BACKGROUND:Zambia was the first African country to change national antimalarial treatment policy to artemisinin-based combination therapy - artemether-lumefantrine. An evaluation during the early implementation phase revealed low readiness of health facilities and health workers to deliver artemether-lumefantrine, and worryingly suboptimal treatment practices. Improvements in the case-management of uncomplicated malaria two years after the initial evaluation and three years after the change of policy in Zambia are reported.METHODS:Data collected during the health facility surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission facilities in four Zambian districts were analysed. The surveys were cross-sectional, using a range of quality of care assessment methods. The main outcome measures were changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five years of age presenting with uncomplicated malaria as defined by national guidelines.RESULTS:In 2004, 94 health facilities, 103 health workers and 944 consultations for children with uncomplicated malaria were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were evaluated using the same criteria of selection. Health facility and health worker readiness improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60% (62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75% (78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of in-service training from 25% (26/103) to 41% (55/135). The proportions of children with uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006: from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to 42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22% (441/2020) of children with uncomplicated malaria were not prescribed any antimalarial drug.CONCLUSION:Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment provided at the point of care is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.