Malaria prevention in north-eastern Tanzania: patterns of expenditure and determinants of demand at the household level.

Objective. This study aims to provide a better understanding of the amounts spent on different malaria prevention products and the determinants of these expenditures. Methods. 1,601 households were interviewed about their expenditure on malaria mosquito nets in the past five years, net re-treatments in the past six months and other expenditures prevention in the past two weeks. Simple random sampling was used to select villages and streets while convenience sampling was used to select households. Expenditure was compared across bed nets, aerosols, coils, indoor spraying, using smoke, drinking herbs and cleaning outside environment. Findings. 68% of households owned at least one bed net and 27% had treated their nets in the past six months. 29% were unable to afford a net. Every fortnight, households spent an average of US $0.18 on nets and their treatment, constituting about 47% of total prevention expenditure. Sprays, repellents and coils made up 50% of total fortnightly expenditure (US$0.21). Factors positively related to expenditure were household wealth, years of education of household head, household head being married and rainy season. Poor quality roads and living in a rural area had a negative impact on expenditure. Conclusion. Expenditure on bed nets and on alternative malaria prevention products was comparable. Poor households living in rural areas spend significantly less on all forms of malaria prevention compared to their richer counterparts. Breaking the cycle between malaria and poverty is one of the biggest challenges facing malaria control programmes in Africa.

Landscape and planning: strengthening discussions in the decision-making process

Since the emergence of the European Landscape Convention (ELC) in 2000, the important link between landscape and planning has greatly intensified. Now, more than ever, the fundamental role of the planning system in delivering the ELC’s requirements is recognised. This has been further substantiated within Ireland’s recently published National Landscape Strategy. However it has continually been suggested that decision-making processes need to adapt better to the holistic, valueladen and multidimensional approaches underpinning the ELC. In light of these milestones for the preservation, management and planning of landscape, this research sets out to establish synergies and disparities in the existing relationship between landscape and planning. It investigates detailed evidence of the presence and manifestations of landscape in key processes of day-to-day planning practice in Ireland, from individual planning appeals and ‘special’ cases, to the major strategic instruments that inform the making of landscape policies within development plans. This is set within wider theoretical and policy contexts where the compatibility of landscape and planning is subjected to critical scrutiny and then explored through these practical case studies. Driving this research is the intention to make a case for the planning domain to be an ideal ‘home’ for landscape – in all its deep, multidimensional meaning – and for enhancing landscape arguments and objectives in the face of conflict, competing values and power-plays in the real world. Emerging out of this research is a set of recommendations for how, at a national level, new approaches for decision making for and about landscape can be more effective and meaningful.

Diagnosing primary ciliary dyskinesia: an international patient perspective

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by progressive sinopulmonary disease, with symptoms starting soon after birth. A European Respiratory Society (ERS) Task Force aims to address disparities in diagnostics across Europe by providing evidence-based clinical practice guidelines. We aimed to identify challenges faced by patients when referred for PCD diagnostic testing. A patient survey was developed by patient representatives and healthcare specialists to capture experience. Online versions of the survey were translated into nine languages and completed in 25 countries. Of the respondents (n=365), 74% were PCD-positive, 5% PCD-negative and 21% PCD-uncertain/inconclusive. We then interviewed 20 parents/patients. Transcripts were analysed thematically. 35% of respondents visited their doctor more than 40 times with PCD-related symptoms prior to diagnostic referral. Furthermore, the most prominent theme among interviewees was a lack of PCD awareness among medical practitioners and failure to take past history into account, leading to delayed diagnosis. Patients also highlighted the need for improved reporting of results and a solution to the “inconclusive” diagnostic status. These findings will be used to advise the ERS Task Force guidelines for diagnosing PCD, and should help stakeholders responsible for improving existing services and expanding provision for diagnosis of this rare disease.