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.

On the Size Distribution of Autonomous Systems

This paper explores reasons for the high degree of variability in the sizes of ASes that have recently been observed, and the processes by which this variable distribution develops. AS size distribution is important for a number of reasons. First, when modeling network topologies, an AS size distribution assists in labeling routers with an associated AS. Second, AS size has been found to be positively correlated with the degree of the AS (number of peering links), so understanding the distribution of AS sizes has implications for AS connectivity properties. Our model accounts for AS births, growth, and mergers. We analyze two models: one incorporates only the growth of hosts and ASes, and a second extends that model to include mergers of ASes. We show analytically that, given reasonable assumptions about the nature of mergers, the resulting size distribution exhibits a power law tail with the exponent independent of the details of the merging process. We estimate parameters of the models from measurements obtained from Internet registries and from BGP tables. We then compare the models solutions to empirical AS size distribution taken from Mercator and Skitter datasets, and find that the simple growth-based model yields general agreement with empirical data. Our analysis of the model in which mergers occur in a manner independent of the size of the merging ASes suggests that more detailed analysis of merger processes is needed.

Safe Compositional Specification of Networking Systems

The Science of Network Service Composition has clearly emerged as one of the grand themes driving many of our research questions in the networking field today [NeXtworking 2003]. This driving force stems from the rise of sophisticated applications and new networking paradigms. By "service composition" we mean that the performance and correctness properties local to the various constituent components of a service can be readily composed into global (end-to-end) properties without re-analyzing any of the constituent components in isolation, or as part of the whole composite service. The set of laws that would govern such composition is what will constitute that new science of composition. The combined heterogeneity and dynamic open nature of network systems makes composition quite challenging, and thus programming network services has been largely inaccessible to the average user. We identify (and outline) a research agenda in which we aim to develop a specification language that is expressive enough to describe different components of a network service, and that will include type hierarchies inspired by type systems in general programming languages that enable the safe composition of software components. We envision this new science of composition to be built upon several theories (e.g., control theory, game theory, network calculus, percolation theory, economics, queuing theory). In essence, different theories may provide different languages by which certain properties of system components can be expressed and composed into larger systems. We then seek to lift these lower-level specifications to a higher level by abstracting away details that are irrelevant for safe composition at the higher level, thus making theories scalable and useful to the average user. In this paper we focus on services built upon an overlay management architecture, and we use control theory and QoS theory as example theories from which we lift up compositional specifications.

Safe Compositional Specification of Networking Systems: TRAFFIC The Language and Its Type Checking

This paper formally defines the operational semantic for TRAFFIC, a specification language for flow composition applications proposed in BUCS-TR-2005-014, and presents a type system based on desired safety assurance. We provide proofs on reduction (weak-confluence, strong-normalization and unique normal form), on soundness and completeness of type system with respect to reduction, and on equivalence classes of flow specifications. Finally, we provide a pseudo-code listing of a syntax-directed type checking algorithm implementing rules of the type system capable of inferring the type of a closed flow specification.

Safe Compositional Specification of Networking Systems: A Compositional Analysis Approach

We present a type inference algorithm, in the style of compositional analysis, for the language TRAFFIC—a specification language for flow composition applications proposed in [2]—and prove that this algorithm is correct: the typings it infers are principal typings, and the typings agree with syntax-directed type checking on closed flow specifications. This algorithm is capable of verifying partial flow specifications, which is a significant improvement over syntax-directed type checking algorithm presented in [3]. We also show that this algorithm runs efficiently, i.e., in low-degree polynomial time.

Safe Compositional Specification of Network Systems With Polymorphic, Constrained Types

In the framework of iBench research project, our previous work created a domain specific language TRAFFIC [6] that facilitates specification, programming, and maintenance of distributed applications over a network. It allows safety property to be formalized in terms of types and subtyping relations. Extending upon our previous work, we add Hindley-Milner style polymorphism [8] with constraints [9] to the type system of TRAFFIC. This allows a programmer to use for-all quantifier to describe types of network components, escalating power and expressiveness of types to a new level that was not possible before with propositional subtyping relations. Furthermore, we design our type system with a pluggable constraint system, so it can adapt to different application needs while maintaining soundness. In this paper, we show the soundness of the type system, which is not syntax-directed but is easier to do typing derivation. We show that there is an equivalent syntax-directed type system, which is what a type checker program would implement to verify the safety of a network flow. This is followed by discussion on several constraint systems: polymorphism with subtyping constraints, Linear Programming, and Constraint Handling Rules (CHR) [3]. Finally, we provide some examples to illustrate workings of these constraint systems.