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.

Linking brain to mind in normal behavior and schizophrenia

In order to understand schizophrenia, a linking hypothesis is needed that shows how brain mechanisms lead to behavioral functions in normals, and also how breakdown in these mechanisms lead to behavioral symptoms in schizophrenia. Such a linking hypothesis is now available that complements the discussion offered by Phillips and Silverstein.

Linking Visual Development and Learning to Information Processing: Preattentive and Attentive Brain Dynamics

National Science Foundation (SBE-0354378); Office of Naval Research (N00014-95-1-0657)

Brain Learning and Recognition: The Large and the Small of It in Inferotemporal Cortex

Anterior inferotemporal cortex (ITa) plays a key role in visual object recognition. Recognition is tolerant to object position, size, and view changes, yet recent neurophysiological data show ITa cells with high object selectivity often have low position tolerance, and vice versa. A neural model learns to simulate both this tradeoff and ITa responses to image morphs using large-scale and small-scale IT cells whose population properties may support invariant recognition.

From Stereograms to Surface: How the Brain Sees the World in Depth

When we look at a scene, how do we consciously see surfaces infused with lightness and color at the correct depths? Random Dot Stereograms (RDS) probe how binocular disparity between the two eyes can generate such conscious surface percepts. Dense RDS do so despite the fact that they include multiple false binocular matches. Sparse stereograms do so even across large contrast-free regions with no binocular matches. Stereograms that define occluding and occluded surfaces lead to surface percepts wherein partially occluded textured surfaces are completed behind occluding textured surfaces at a spatial scale much larger than that of the texture elements themselves. Earlier models suggest how the brain detects binocular disparity, but not how RDS generate conscious percepts of 3D surfaces. A neural model predicts how the layered circuits of visual cortex generate these 3D surface percepts using interactions between visual boundary and surface representations that obey complementary computational rules.

Distributed Hypothesis Testing, Attention Shifts and Transmitter Dynatmics During the Self-Organization of Brain Recognition Codes

BP (89-A-1204); Defense Advanced Research Projects Agency (90-0083); National Science Foundation (IRI-90-00530); Air Force Office of Scientific Research (90-0175, 90-0128); Army Research Office (DAAL-03-88-K0088)

A Recurrent Cooperative/Competitive Field for Segmentation of Magnetic Resonance Brain Imagery

The Grey-White Decision Network is introduced as an application of an on-center, off-surround recurrent cooperative/competitive network for segmentation of magnetic resonance imaging (MRI) brain images. The three layer dynamical system relaxes into a solution where each pixel is labeled as either grey matter, white matter, or "other" matter by considering raw input intensity, edge information, and neighbor interactions. This network is presented as an example of applying a recurrent cooperative/competitive field (RCCF) to a problem with multiple conflicting constraints. Simulations of the network and its phase plane analysis are presented.