Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

Abstract Background In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. Method The cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters. Results In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy. Conclusion Microscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

Manual pumping test method for characterizing the productivity of drilled wells equipped with rope pumps

Since the introduction of the rope-pump in Nicaragua in the 1990s, the dependence on wells in rural areas has grown steadily. However, little or no attention is paid to rope-pump well performance after installation. Due to financial restraints, groundwater resource monitoring using conventional testing methods is too costly and out of reach of rural municipalities. Nonetheless, there is widespread agreement that without a way to quantify the changes in well performance over time, prioritizing regulatory actions is impossible. A manual pumping test method is presented, which at a fraction of the cost of a conventional pumping test, measures the specific capacity of rope-pump wells. The method requires only sight modifcations to the well and reasonable limitations on well useage prior to testing. The pumping test was performed a minimum of 33 times in three wells over an eight-month period in a small rural community in Chontales, Nicaragua. Data was used to measure seasonal variations in specific well capacity for three rope-pump wells completed in fractured crystalline basalt. Data collected from the tests were analyzed using four methods (equilibrium approximation, time-drawdown during pumping, time-drawdown during recovery, and time-drawdown during late-time recovery) to determine the best data-analyzing method. One conventional pumping test was performed to aid in evaluating the manual method. The equilibrim approximation can be performed while in the field with only a calculator and is the most technologically appropriate method for analyzing data. Results from this method overestimate specific capacity by 41% when compared to results from the conventional pumping test. The other analyes methods, requiring more sophisticated tools and higher-level interpretation skills, yielded results that agree to within 14% (pumping phase), 31% (recovery phase) and 133% (late-time recovery) of the conventional test productivity value. The wide variability in accuracy results principally from difficulties in achieving equilibrated pumping level and casing storage effects in the puping/recovery data. Decreases in well productivity resulting from naturally occuring seasonal water-table drops varied from insignificant in two wells to 80% in the third. Despite practical and theoretical limitations on the method, the collected data may be useful for municipal institutions to track changes in well behavior, eventually developing a database for planning future ground water development projects. Furthermore, the data could improve well-users’ abilities to self regulate well usage without expensive aquifer characterization.

(Table 1) Isotopic composition of Sm and Nd in mantle restites of the Central Atlantic and in associated plutonic and volcanic rocks

Ultrabasic rock samples collected from two areas of the crustal zone of the Mid-Atlantic Ridge (MAR): (1) 13-17°N (near the intersection of the ridge axis with the 15°20'N prime fracture zone), and (2) 33°40'N prime (the western intersection of the MAR crest with the Heis fracture zone) were objects of this study. Samples of peridotite and of plutonic and volcanic rocks associated with it were used to measure their Sm/Nd, 143Nd/144Nd, and 147Sm/144Nd ratios, which allowed to test time and genetic relationships between evolution of mantle material under the ridge crest and products of its magmatic activity. Results of this work proved ubiquitous discrepancy between melting degree values of extremely depleted mantle peridotites in the MAR area between 14°N and 16°N, obtained using petrologic and geochemical methods. This discrepancy suggests large-scale interaction between mantle material and magmatic melts and fluids enriched in incompatible elements or fluids. The results obtained suggest that repeated melting of the mantle under the axial MAR zone is an universal characteristic of magmatism in low-velocity spreading centers. The results of this study also proved the crestal MAR zone in the Central Atlantic region show distinct indications of isotope-geochemical segmentation of the mantle. It is suggested that the geochemically anomalous MAR mantle peridotite in the zone of the MAR intersection with the 15°20'N prime fracture zone can be interpreted as fragments of mantle substrate, foreign for the Atlantic mantle north of the equator.

(Table 1) Magnetic properties for individual samples from ODP Hole 136-843B

We present rock magnetic data on 10 samples recovered from ODP Hole 843B. The 95-m.y.-old basalts have moderately high magnetization values, and Curie temperature measurements show that these basalts have undergone systematic low-temperature oxidation. High values for bulk coercivity indicate that the remanent magnetization is likely to be stable over geological time, and low viscous remanent magnetization coefficients measured for these samples argue that acquisition of viscous remanent magnetization is not likely to be geologically important in these samples. Unfortunately, formation of the Hole 843B crustal section at the beginning of the Cretaceous Normal Magnetic Superchron does not allow any simple test of the hypothesis that a substantial component of chemical remanent magnetization, in the direction of the field present during oxidation, is added soon after formation (Raymond and LaBrecque, 1987, doi:10.1029/JB092iB08p08077).

(Table 3) Concentrations of polybrominated diphenyl ether and congeners in blubber samples from whales, seals and porpoises between 1986-2009

A selection of PBDE congeners was analyzed in pooled blubber samples of pilot whale (Globicephala melas), ringed seal (Phoca hispida), minke whale (Balaenoptera acutorostrata), fin whale (Balaenoptera physalus), harbor porpoise (Phocoena phocoena), hooded seal (Cystophora cristata) and Atlantic white-sided dolphin (Lagenorhynchus acutus), covering a time period of more than 20 years (1986-2009). The analytes were extracted and cleaned-up using open column extraction and multi-layer silica gel column chromatography, and the analysis was performed on a GC-MS system operating in the NCI mode. The highest PBDE levels were found in the toothed whale species pilot whale and white-sided dolphin, and the lowest levels in fin whales and ringed seals. One-sided analyses of variance (ANOVA) followed by Tukey comparisons of means were applied to test for differences between years and sampling areas. Due to inter-year sampling variability, only general comparisons of PBDE concentrations between different sampling areas could be made. Differences in PBDE concentrations between three sampling periods, from 1986 to 2007, were evaluated in samples of pilot whales, ringed seals, white-sided dolphins and hooded seals. The highest PBDE levels were found in samples from the late 1990s or beginning of 2000, possibly reflecting the increase in the global production of technical PBDE mixtures in the 1990s. The levels of BDE #153 and #154 increased relative to the total PBDE concentration in some of the species in recent years, which may indicate an increased relative exposure to higher brominated congeners. In order to assess the effect of measures taken in legally binding international agreements, it is important to continuously monitor POPs such as PBDEs in sub-Arctic and Arctic environments.

(Table 2) Weight percent organic carbon from ODP Site 138-847

As the length of marine cores increases and sampling intervals decrease, the need for rapid and inexpensive means of determining sediment composition has become apparent. In this study we examine one potentially useful technique for assessing compositional changes in marine cores, diffuse reflectance spectrophotometry. We examined near-ultraviolet, visible, and near-infrared reflectance spectra from five data sets. Each data set consists of calibration samples and test samples. The calibration samples' spectra were related to a sediment component using multiple linear regression. The resulting regression or calibration equations were then evaluated using the test samples. Calibration equations were written relating spectra to several sediment components incduding carbonate (Atlantic and east Pacific Rise ODP Site 847), organic carbon content (Atlantic and east Pacific Rise), and opal content (east Pacific Rise). The correlation coefficients for the regression equations ranged from a high of 0.99 for carbonate and opal at ODP Site 847 to a low of 0.97 for Atlantic carbonate indicating that spectral variations are highly correlated to sediment composition. All of the equations include a substantial number of variables from shorter visible and longer near ultraviolet wavelengths suggesting that these wavelengths are especially important for devices designed specifically to scan marine cores. Although equations for estimating organic and carbonate content appear independent of other sediment components, the opal equation is strongly dependent on carbonate content indicating that opal concentration is correlated to carbonate content. Tests of the calibration equations indicated that all our equations reasonably estimate the pattern of changes, either down core or in surface sediments. Where our spectral estimates have difficulty is with absolute values, frequently over or underestimating observed values by a substantial amount. Within these limitations diffuse reflectance spectrophotometry can be a useful tool for characterizing marine cores and as our understanding of the relationship between spectra and mineralogy improves so will estimates of absolute values.