Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania : an open label prospective study

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results: A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p <= 0.046). Conclusions: Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.

Kroppsideal via Instagram

Syfte Dagens teknik har medfört en explosion av nätbaserade sociala medier där bilder av träning och kroppar är ett tydligt fenomen. Syftet med detta arbete har varit att undersöka hur kroppsideal skapas och framställs på internet och framförallt sociala medier. Till hjälp användes frågeställningarna: Hur gestaltar manliga fitness-profiler sig själv och sina kroppar på den nätbaserade tjänsten Instagram? Finns det kopplingar mellan dessa profilers kroppsgestaltningar och specifika kroppsideologier? (Rosenmann & Kaplan, 2014) Metod Arbetet utfördes med netnografisk metod i grunden, en metod specifikt fokuserad på kvalitativ forskning av internet. Tre manliga fitnessprofiler samt fem av varje profils bilder valdes utifrån popularitet på Instagram för att granskas och analyseras i relation till kroppsideal. Resultat Bilderna hade gemensamma egenskaper då dessa, ofta i gymmiljö, visade avklädda, extremt muskulösa kroppar med fokus på framsidan av överkroppen. Skilda egenskaper förekom, dock inte i någon signifikant bemärkelse. Kroppsideologin metrosexuella-och konsumentmaskuliniteten (Rosenmann & Kaplan, 2014) präglade profilerna. Slutsatser Dessa fitnessprofilers framställning av sina kroppar stämde väl överens med dagens rådande muskulära kroppsideal som innefattar en slimmad, muskulös, väldefinierad kropp. Tydliga kopplingar kunde också göras till Rosenmann’s och Kaplan’s (2014) kroppsideologi; metrosexuella-och konsumentmaskuliniteten.