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      Free treatment, rapid malaria diagnostic tests and malaria village workers can hasten progress toward achieving the malaria related millennium development goals: the Médecins Sans Frontières experience from Chad, Sierra-Leone and Mali

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          Halving the burden of malaria by 2015 and ensuring that 80% of people with malaria receive treatment is among the health related targets of the Millennium Development Goals (MDGs). Despite political momentum toward achieving this target, progress is slow and many with malaria (particularly in poor and rural communities in Africa) are still without access to effective treatment. Finding ways to improve access to anti-malarial treatment in Africa is essential to achieve the malaria related and other MDG targets. During its work in Chad, Sierra Leone and Mali in the period 2004 to 2008, Médecins Sans Frontières showed that it was possible to significantly improve access to effective malaria treatment through: i) the removal of health centre level user fees for essential healthcare for vulnerable population groups, ii) the introduction of free community based treatment for children using malaria village workers to diagnose and treat simple malaria in communities where geographical and financial barriers limited access to effective malaria care, iii) the improved diagnosis and treatment of malaria using rapid diagnosis tests and artemisinin based combination therapy, at both health facilities and in the community. This paper describes and discusses these strategies and their related impact.

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          How many child deaths can we prevent this year?

          This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.
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            Evidence-based, cost-effective interventions: how many newborn babies can we save?

            In this second article of the neonatal survival series, we identify 16 interventions with proven efficacy (implementation under ideal conditions) for neonatal survival and combine them into packages for scaling up in health systems, according to three service delivery modes (outreach, family-community, and facility-based clinical care). All the packages of care are cost effective compared with single interventions. Universal (99%) coverage of these interventions could avert an estimated 41-72% of neonatal deaths worldwide. At 90% coverage, intrapartum and postnatal packages have similar effects on neonatal mortality--two-fold to three-fold greater than that of antenatal care. However, running costs are two-fold higher for intrapartum than for postnatal care. A combination of universal--ie, for all settings--outreach and family-community care at 90% coverage averts 18-37% of neonatal deaths. Most of this benefit is derived from family-community care, and greater effect is seen in settings with very high neonatal mortality. Reductions in neonatal mortality that exceed 50% can be achieved with an integrated, high-coverage programme of universal outreach and family-community care, consisting of 12% and 26%, respectively, of total running costs, plus universal facility-based clinical services, which make up 62% of the total cost. Early success in averting neonatal deaths is possible in settings with high mortality and weak health systems through outreach and family-community care, including health education to improve home-care practices, to create demand for skilled care, and to improve care seeking. Simultaneous expansion of clinical care for babies and mothers is essential to achieve the reduction in neonatal deaths needed to meet the Millennium Development Goal for child survival.
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              Guidelines for the Treatment of Malaria

               Y-W Ho (2010)

                Author and article information

                J Public Health Africa
                Journal of Public Health in Africa
                PAGEPress Publications (Pavia, Italy )
                11 February 2011
                01 March 2011
                : 2
                : 1
                [1 ]Médecins Sans Frontières, Operational Research Unit, Medical Department, Brussels Operational Centre, Brussels, Belgium;
                [2 ]Médecins Sans Frontières, London UK;
                [3 ]Médecins Sans Frontières, Analysis and Advocacy Unit, Brussels Operational Centre, Brussels, Belgium
                Author notes
                Correspondence: Katie Tayler-Smith, Médecins Sans Frontières (Brussels Operational Centre), Operational Research Unit, Rue Dupré 94, 1090 Brussels, Belgium. E-mail: katie_harries@

                Ethical clearance: the MSF projects in Sierra Leone, Chad and Mali function under the framework of formal collaborative agreements with each of the different National Ministries of Health. The activities were conducted within the framework of existing Ministry of Health facilities. The data pertaining to this study did not include patient identifiers and constituted what was routinely collected as part of programme evaluation in each of the project settings, with local and national health authority approval.

                Contributions: MP, FP, SG, ND were involved in the collection, analysis and interpretation of the data used in this article; AK, KTS, RZ, SG in drafting the first version of the manuscript. All authors contributed to subsequent and final drafts of the manuscript and read and approved the final version. SG is guarantor of the paper.

                Conflict of interest: the authors report no conflicts of interest.

                ©Copyright K. Tayler-Smith et al., 2011

                This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).

                Licensee PAGEPress, Italy

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