Sustained Coverage Research Articles

Untangling the Debate Surrounding Strategies for Achieving Sustainable High Coverage of Insecticide-Treated Nets

On the question of how to achieve the goal of long-term high utilisation of insecticide-treated nets (ITNs), most protagonists fall into one of two camps: free distribution or market development. The 'free distribution' camp argue that given the health benefit to be gained and lives saved, not to mention the relative cost effectiveness of ITNs, such an intervention should be provided free and paid for by governments or donors. In addition, they argue that it is unrealistic to ask the poorest of the population, who are often the ones at most risk, to pay for an ITN, and this risks producing greater inequalities in health. The market advocates counter that free distribution compromises sustainability, both in terms of demand and supply. Firstly they argue that, without a price, people will be less inclined to value ITNs. In turn this could mean lower utilisation, and a lower inclination to replace such an asset at the end of its useful life. In addition, on the supply side, without a price there is little chance of a local market developing for ITNs, although this would be the surest way to ensure a sustainable supply. It is hard to argue with either viewpoint, as both have merit. This article considers three major issues in the debate, and attempts to draw policy conclusions.

ZIMBABWE: BEYOND THE DEMOCRATIC IMPASSE

Extracted from text ... COMMENTARY ZIMBABWE: BEYOND THE DEMOCRATIC IMPASSE CHERYL HENDRICKS Few countries in Africa attract sustained international media coverage without the presence of a civil war. Countries beyond the Limpopo rarely attract close scrutiny by the South African citizenry either, and their policies and practices seldom evoke domestic outbursts or mobilisation. Zimbabwe, since its 2000 general elections, has achieved this feat. Unfortunately, this particularity is derived from many of the factors that led to the disintegration of other post-colonial African states. The Zimbabwean government's resistance to democratisation, its reassertion of a narrow African nationalism, the government's repressive tactics, and ..

Management systems response to improving immunization coverage in developing countries: a case study from Cambodia

In contrast to the initial success following the establishment of the National Immunization Program (NIP) in Cambodia in 1986, infant vaccination coverage rates against the six expanded program immunization diseases have not improved since 1995. In response, the NIP of the Ministry of Health has undertaken a series of institutional initiatives to address the problem of static or declining rates of coverage. The aim of this paper is to describe and assess management strategies undertaken by the NIP in Cambodia in support of improved immunization coverage. Sources of information used in preparing this report include international literature, national coverage and surveillance data, government policy documentation, information generated by national strategic planning and health centre microplanning processes, a functional analysis of human resources, and data quality audits. The NIP has implemented planning, organizational development and human resource development responses to the problem of low coverage. These have included: integration of the nip strategic and operational plans into the health sector plan; strengthening of needs-based microplanning; establishment of a national monitoring and management support strategy; and the introduction of performance-based agreements between levels of government for improved immunization coverage. Our analysis of these findings, in particular of the international literature, suggests that NIP's responses have been appropriate, and that the development of NIP management systems and capacity will increase the likelihood for sustained immunization coverage gains within a reform environment of health system decentralization. In 2003, there are early signs that the reform processes undertaken by the NIP have resulted in improved immunization coverage in targeted areas, and this should place the national program in a stronger position to lift immunization coverage in 2004.

Modelling measles re-emergence as a result of waning of immunity in vaccinated populations

An age-structured mathematical model of measles transmission in a vaccinated population is used to simulate the shift from a population whose immunity is derived from natural infection to a population whose immunity is vaccine-induced. The model incorporates waning of immunity in a population of vaccinees that eventually will become susceptible to a milder form of vaccine-modified measles with a lower transmission potential than unvaccinated classical measles. Using current estimates of duration of vaccine-derived protection, measles would not be expected to re-emerge quickly in countries with sustained high routine vaccine coverage. However, re-emergence is possible to occur several decades after introduction of high levels of vaccination. Time until re-emergence depends primarily on the contagiousness of vaccine-modified measles cases in comparison to classical measles. Interestingly, in a population with a high proportion of vaccinees, vaccine-modified measles and classical measles would occur essentially in the same age groups. Although waning of humoral immunity in vaccinees is widely observed, re-emergence of measles in highly vaccinated populations depends on parameters for which better estimates are needed.

Controversies in chicken-pox immunization.

Chicken-pox is one more newer vaccine in our armamentarium against infectious diseases. Due to its extremely contagious nature, varicella is experienced by almost every child or young adult in the world. Each year from 1990 to 1994, prior to availability of varicella vaccine, about 4 million cases of varicella occurred in the United States. Of these cases approximately 10,000 required hospitalization and 100 died. Although varicella is not commonly perceived as an important public health problem, the socioeconomic consequences in industrialized countries of a disease that affects practically every child and causes the carrier absence from work should not be underestimated. The varicella vaccines available in the market are safe and effective. A recent cost-benefit analysis in USA showed that routine chicken-pox vaccination is likely to save five times the investment. Even when only direct costs were considered, benefits almost balanced the costs. At present similar studies from developing countries are not available. The public health impact of varicella and zoster may be increasing in regions with high endemic rates of HIV infection. Varicella vaccine may be used either at an individual level to protect susceptible adolescents and adults, or at a population level, to cover all children as part of a national immunization programme. Vaccination of adolescents and adults will protect at-risk individuals, but will not have a significant impact on the epidemiology of the disease on a population basis. On the other hand, extensive use as a routine vaccine in children will have a significant impact on the epidemiology of the disease. If sustained high coverage can be achieved, the disease may virtually disappear. If only partial coverage can be obtained, the epidemiology may shift, leading to an increase in the number of cases in older children and adults. Hence, routine childhood varicella immunization programmes should emphasize high, sustained coverage. At present, this vaccine will have a lower priority in the National Immunization Schedule that does not have MMR and typhoid, which have a greater socioeconomic impact. Hence, at the present time WHO does not recommend the inclusion of varicella vaccination into the routine immunization programmes of developing countries.

Schwarzenegger in Transition: Time to Govern

Elizabeth Capell, a political scientist and veteran of California politics, marks off a range of key executive decisions facing governor-elect Arnold Schwarzenegger, as well as the constitutional, structural and budgetary obstacles he confronts. While Schwarzenegger’s celebrity may help him in battles with political foes, she doubts he can count on mobilizing public opinion behind policies that tend to be too complicated and dry for sustained and widespread media coverage.

Developing external quality assessment programmes for primary health: care level in resource limited countries

Laboratory services are an essential component of health care delivery in tropical countries and play a vital role in improving the accuracy of clinical diagnosis and the investigation of disease outbreaks. In developing countries, laboratories face numerous constraints to providing quality services, including poor selection of techniques, difficulties in equipment availability and maintenance, and shortages of supplies, staffing and supervision. Currently in the eastern African countries (Kenya, Tanzania and Uganda), internal quality control procedures are inconsistently carried out in most laboratories. National External Quality Assessment Schemes (EQAS) have been established in all countries addressing a limited number of tests, but are constrained by difficulties of sustainability and poor coverage. The Laboratory Programme of the African Medical and Research Foundation (AMREF) has been operating a simple EQAS for primary heath care laboratories since 1993. Tests addressed are those carried out in primary health care laboratories in eastern Africa. A total of 81 laboratories from 5 countries in the eastern African region have participated in the scheme since 1993 and 9 distributions were submitted since the start of the scheme. No laboratory participated in all distributions; 24 (30%) laboratories participated in 4 or more distributions. Of these, the hospital laboratories in Kenya and Tanzania showed improved average mean scores between the first two and subsequent distributions. The educational benefit of participation in the scheme is emphasised. There was an overall low rate of participation of laboratories (35%) once the scheme was expanded to include laboratories outside direct AMREF project activities. Contributing factors include shortages of staff and lack of time in busy rural laboratories, together with difficulties in communication; however, the voluntary nature and lack of appreciation of the benefits of participation may also play a role. To increase participation in the scheme and to address the quality of laboratory services throughout the region, AMREF is currently developing a Regional EQAS in collaboration with the Ministries of Health of Kenya, Tanzania and Uganda, in affiliation with the World Health Organisation (WHO). The approaches used to establish reference values for haemoglobin samples are discussed. The scheme has also been utilised to examine the performance of different techniques for haemoglobin estimation, demonstrating the inaccuracy of the visual comparator methods.

The saga of the Crown Pilot: framing, reframing, and reconsideration

In 1996, Nabisco discontinued production of its longest running product, the Crown Pilot cracker. This move prompted public protest and subsequently garnered widespread media attention. Based on the sustained news coverage and a barrage of telephone calls, e-mails, and letters, Nabisco eventually relented and resumed production of the Crown Pilot. This case study focuses upon the “frames” used in the media coverage to help audiences interpret news stories about the Crown Pilot situation. The research attempts to explain how the public relations efforts of both the protesters and Nabisco influenced the framing. Because framing choices are among the most critical strategic decisions in the public relations process, the study has ramifications for public relations researchers interested in the concept and practitioners concerned with publicizing a variety of issues.

UK and Global Insurance Responses to Flood Hazard

This paper explores the question of whether it is possible to arrange sustainable flood insurance coverage for domestic properties in Canada and elsewhere and whether it should be public or private insurance. It considers the essential requirements for a sustainable insurance market, including the importance of adverse selection and the vicious circle, with particular regard to flood risks. Based on a critical overview of the different private and public insurance solutions to flood risks around the world, the conclusion is drawn that the “bundled” system of private insurance would have the best prospects of success and would provide the best value for money for the community. However, for private flood insurance to be sustainable, the State would need to make a conscious decision not to provide any further compensation to flood victims. Instead it should concentrate on renewing infrastructure and working in partnership with insurers on issues such as building codes and planning matters. Some suggestions are made about how such a private insurance system might be established. Support for a private insurance system could be a potentially sensitive political risk for the government, if its citizens regard the provision of flood compensation as a social duty. Some consideration is therefore given to ways in which the insurance industry has demonstrated social responsibility in connection with other issues, such as climate change and the United Nations Environment Program. Insurers can bring data, expertise on risk management, risk transfer, and claims handling expertise to the table. The State can establish the conditions for a sustainable market in the face of a growing risk. The key to success is partnerships.

Factors associated with coverage in community-directed treatment with ivermectin for onchocerciasis control in Oyo State, Nigeria.

Community-directed distribution with ivermectin (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) as its main strategy for achieving sustained high coverage in endemic communities. This article describes the coverage results achieved when CDTI was introduced in four local government areas of Oyo State, Nigeria. Using a household survey after the second distribution, researchers documented that 68.6% of the community overall received the drug, and as did 85.0% of those who were eligible (not pregnant, not sick and at least 5 years of age). Six factors were associated with having received ivermectin. Four were personal characteristics: being male, being at least 35 years of age, belonging to the Fulani ethnic minority, having taken the drug at a previous distribution. Two village characteristics were smaller size, as measured by number of houses, and use of the central place mode of distribution as opposed to house-to-house. In-depth interviews with village leaders and volunteer community-directed distributors (CDDs) and focus group discussions among villagers provided qualitative data to help interpret the findings. Women in many villages felt excluded from decision making. The concerns of migrant farm workers living in Yoruba farm settlements were not well understood by health staff or the majority population. The main factor associated with receiving the ivermectin was having received it before, and qualitative comments about side-effects and beliefs about orthodox drugs indicated that issues of personal preferences, not addressed in a household coverage survey, need to be explored further. The findings can provide guidance in re-orienting health workers to the importance of fostering participation and cohesion among all segments of the community, especially the inclusion of women and minority groups.

The Riot in Westport: George A. Birmingham at Home

On Wednesday, February 4,1914, the performance of George A. Birmingham's General John Regan, in Westport, County Mayo, punctuated by catcalls throughout the first act, was stopped during the second act when angry pro testers stormed the stage. Members of the audience who were not part of the planned action, triggered by the cry Now boys!, fled the theater. Although alerted to the likelihood of trouble by posters calling for the protest, the police were unable to restore order in the theater to allow the performance to contin ue. Chairs were hurled, stage properties and scenery destroyed, the theater itself badly damaged. The actor playing the Catholic parish priest was the focus of the attack. Rioters ripped off his Roman collar and, after leaving the theater, burned it in the Octagon (Westport's town center). Police accounts report that the crowd had swelled to 700. The windows of the box office, theater, and hotel accommodating the actors were broken. In the course of what the police called a riot, a constable was badly injured and five baton charges were made against the crowd. The riot was quelled only after the intervention of the parish priest, Father Canavan, who pleaded for order. Twenty young men described as stu dents were arrested. This now obscure incident in Irish stage history was anomalous in that it occurred not in Dublin but in Westport; yet in other respects it was entirely characteristic of the disorders associated with stage protests in Ireland through out the twentieth century. It was not a spontaneous, but an orchestrated demonstration. It presumed the audience's right to express its displeasure by interrupting a performance. The protest was rooted in publicity that the play had received in the press and triggered its own sustained press coverage, although not on a scale to rival that of The Playboy of the Western World in 1907 or The Plough and the Stars in 1926. The Westport riot, like other riots, direct ed its violence against the actors in a confrontation that pitted Catholic demon strators against a Protestant playwright. The riot over Birmingham's General John Regan was the most violent Irish theatrical confrontation of the century and raised many of the same questions about an audience's prerogatives as well as the play's realism, sources, and politics that arose in regard to both The Play boy and The Plough and the Stars.

The Critical Role of Advertising Media Planning in Federal Rule 23 Class Action Notice

Federal judges frequently must use mass media advertising to provide legal notice in class actions to meet requirements of court rules and constitutional due process. Unlike most marketing situations, in which relatively low but sustained target audience coverage by advertising can help support long-term sales and profits, court rules and constitutional due process demand high class coverage within a relatively short time frame, often spanning 30 to 90 days. Yet judges and attorneys typically lack the expertise to determine the number of class members who are exposed to and read a mass media notice, and case law and official judicial guidelines provide minimal and thus inadequate information. The use of mass media notice without sufficient analyses of likely notice coverage among class members can jeopardize the rights of class members and the legal integrity of the proceedings. Therefore, courts should demand the use of state-of-the-art media planning procedures, as demonstrated in this study, to forecast due process performance of alternative notice plans.

Breaking the silence surrounding rape

Nov 25 was International Day Against Violence Against Women. It was marked by various activities worldwide, and was the first day of the “Take a Stand” movement in South Africa. Take a Stand, which involves peaceful protests and poster campaigns, was launched by a coalition of organisations, including women's groups, churches, businesses, and trades unions, that are speaking out against all forms of sexual violence. The campaign follows months of sustained news coverage of rape, after the conference of South African editors made a commitment to ensure that sexual violence is covered prominently in all types of media.

Vitamin A deficiency in Latin America and the Caribbean: an overview.

Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960s; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implications of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude of VAD in countries of the Region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the Region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol < 20 micrograms/dl) in children under 5 years of age ranges between 6% in Panama and 36% in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25% of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation, with sustained high coverage rates through national immunization days in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala, and Honduras (a significant effect has been documented in Guatemala and Honduras) and is under negotiation in Bolivia, Colombia, Costa Rica (to be resumed), Ecuador, Nicaragua, and Peru; and (c) limited dietary diversification activities.

Gender and mediatized political discourse: a case study of press coverage of Margaret Beckett's campaign for the Labour leadership in 1994

Drawing upon the work of the philosopher Carole Pateman and the critical discourse analyst Norman Fairclough, this article will argue that fraternal networks operate within and between the institutional order of masculinist political discourse and the equally masculinist discourse of the print media, marginalizing female political actors. It will be argued further that the colonization of mediatized political discourse by market values has had a particularly detrimental effect on the representation of female politicians. A comparative analysis of press coverage of the three candidates in the 1994 British Labour leadership campaign reveals a distinct gender bias in the way in which they were treated. This is evident at the metadiscursive level in terms of patterns of discourse representation which suggest that the fraternity of media workers address an ideal reader who is gendered as male. The dominant metaphors and collocations used to describe Margaret Beckett's qualities as a potential party leader in both the national tabloids and broadsheets reveal the extent to which the genre of the political interview in particular, and news narratives in general, are premised on masculinist assumptions. There are, however, contradictory tendencies. For instance, much of the coverage addresses the issue of overt gender bias, while at the same time reproducing it in more covert forms. The case study needs to be seen in the broader context of systematic and sustained negative coverage in the media of feminist strategies aimed at challenging patriarchal practices in British party politics.

Race, Class, Citizenship, and Extraterritoriality: Asian Americans and the 1996 Campaign Finance Scandal

Not since the protracted national debate over whether the Chinese should be excluded from the U.S. in the 1870s and early 1880s have we seen more sustained media coverage and acrimonious debate on the so-called Asian connection in the campaign finance scandal of 1996. Based on my own collection and estimate, no less than 4,000 articles have been published on the subject (newspapers and magazines) between September 1996 and February 1998. As of this writing, no end is in sight for this long-running media obsession and partisan brawl among the political elite.

Increasing rabies vaccination coverage in urban dog populations of high human population density suburbs: a case study in Nairobi, Kenya

The incidence of rabies in dogs is increasing in many regions of Africa, despite the commercial availability of effective vaccines for dogs. The major constraints to effective dog vaccination programmes are poor accessibility of dogs for vaccination, inadequate availability of vaccines in some countries and the relative high cost of vaccines. A study was carried out in a suburb of Nairobi, Kenya, with a high human population density, to evaluate levels of dog vaccination coverage that could be achieved through better vaccine delivery techniques. Using more vaccination teams, extended times and door-to-door vaccination, and timing vaccination to coincide with school holidays, an estimated vaccination coverage of 68–75% was achieved in the study area over a 5 day period. This compared very favourably with the low vaccination coverage levels, estimated to be less than 4%, achieved in the 2 years prior to the study in Nairobi as a whole. The need for a better understanding of dog ecology in such urban communities, as well as ways of improving vaccination delivery and sustainability coverage, are discussed.

A System Approach to Pharmacodynamics. Plasma Iron Mobilization by Endogenous Erythropoietin in the Sheep Fetus; Evidence of Threshold Response in Spontaneous Hypoxemia

At present, nearly all Infants with birth weights of <1kg receive blood transfusions for treatment of clinical signs of tissue hypoxia resulting from anemia of prematurity. In contrast to the successful use of recombinant human erythropoietin (rhEp) in adults, treatment of anemic neonates with rhEp to stimulate red cell production and reduce the need for transfusions that pose serious infectious and immunologic risk has not been effective. The present study investigates the pharmacodynamics (PD) of endogenous erythropoietin (Ep) in sheep fetuses to determine possible causes for the poor rhEp response in early development. The dynamic relationship between plasma Ep and plasma iron resulting from spontaneous hypoxemic episodes is investigated by PD system analysis. The erythropoietic effect of Ep is measured in terms of the mobilization of plasma Iron needed in the production on new erythrocytes. A hysteresis minimization approach is employed to determine the intrinsic PD dose-response relationship (transduction) of Ep. The dose—response relationship shows a well-defined threshold level that has to be exceeded before Ep begins to show a significant effect on plasma iron. It is postulated that the threshold mechanism may serve a useful purpose during early development by reducing the risk of the fetus developing a pathological degree of polycythemia and hyperviscosity in the relatively hypoxemic fetal environment. At the same time, the threshold serves the purpose of providing a needed response to more severe pathologic hypoxemic episodes. The occurrence of anemia during subsequent postnatal life when Pa02 levels increase markedly may be the inevitable, but unfortunate corollary of a continuation of this mechanism. If the poor response to rhEp in early neonatal life is due to a threshold mechanism, then it will be necessary to administer Ep at significantly larger dosing rates to ensure a sufficient and sustained coverage above the threshold level.

Extracorporeal shock wave lithotripsy. Use of antibiotics to avoid postprocedural infection.

Extracorporeal shock wave lithotripsy (ESWL) has the potential to revolutionize the treatment of urolithiasis, but its success depends in part upon minimizing potential sequelae. Although ESWL is safe, effective, and relatively economical, one complication can be urosepsis, resulting from liberation of bacteria when the stones disintegrate. Patients who are at increased risk of infection are those who have existing urinary tract infection; perioperative urologic manipulation; infected stones; predisposition for infectious endocarditis; or multiple, large, or complex stones. If urosepsis occurs, it usually requires prolonged hospitalization, which obviates any cost-benefits that can be accrued from ESWL. Prophylactic use of an antibiotic before ESWL is rational and cost-effective. Ideally, the antibiotic should possess a spectrum of activity against the most likely bacteria to be encountered, require a limited number of doses, and offer the flexibility of sustained coverage in the event that the procedure is delayed. Our experience at Presbyterian Hospital of Dallas supports the use of a long-acting cephalosporin for the prevention of infections following ESWL.

Fair and impartial railroad: The jury, the media, and political trials

The clash between social movements and political authority is often played out in the court rooms in criminal cases which are loosely described as “political trials.” While prosecutors, judges, and defendants rarely agree as to the “political” nature of a particular case, all parties usually regard the jury as the pivotal factor. The jury, of course, is enshrined in Anglo-American legal theory as the final check against suppression of liberty by the state. Plea bargaining is out of the question when the very legitimacy of the state is challenged and when dissident defendants are determined to use the trial process as a means of political expression. The crucial question is whether the jury has in fact lived up to its Constitutional role. The article attempts to answer this question at two levels. First, the history of political trials in the United States is reviewed with the general finding that radicals have faced juries which were both grossly unrepresentative of the general population and typically hostile to the ideas, life styles, and social origins of the defendants. Second, the article considers in some detail the impact of media coverage on potential jurors on one particular recent political case, the 1977–1978 trial of accused “guerrilla-bombers” Richard Picariello and Eduard Guilion in the Federal District Court of Southern Maine. The survey opinion data presented for this case strongly indicate that any chance of a fair trial for the defendants was compromised by effects of sustained hostile media coverage before the onset of the trial. Finally, the article considers available remedies in the form of either legislative reforms designed to ensure representative juries, or voir dire procedures aimed at eliminating biased jurors. A review of these remedies offers little hope that future political trials will be substantially fairer than in the past. Moreover, the direction of current criminal justice reforms, as in the proposed S-1722 Federal Criminal Code, promise to criminalize further important forms of political expression. The conclusion is not that jury trials should be avoided or minimized, since judges are apt to be even more predisposed against dissidents. Rather, the point is that the social and ideological biases which intrude especially in political trials are rooted in the political economy of capitalism which underlies the legal system itself. The jury system remains the best available defense against legal repression, but “justice” must ultimately await the outcome of continued social struggle, rather than further refinements of legal process.