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  • However despite the strength of the research

    2019-06-12

    However, despite the strength of the research by Shawar and colleagues, any given process tracing case study can always be improved. In relation to this Article, the empirical tracing of causal processes could be strengthened further in future research, in particular by telling us more explicitly what empirical material we should expect to find if each part of the causal process purchase NCT-501 was present in the case. For instance, how should we recognise a cohesive policy purchase NCT-501 empirically when we see it in a case?
    Malaria in pregnancy has a devastating effect on the health of mothers and their babies, and is an important cause of maternal and infant mortality and morbidity. The greatest effect of malaria in pregnancy is concentrated in sub-Saharan Africa and is associated with infection. However, pregnant women are also at risk of malaria. Although its burden seems to be lower than that of malaria is still associated with harmful consequences for maternal and infant health. WHO promotes three strategies for the control of infection in pregnancy in Africa, which include provision of intermittent preventive treatment for malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), use of insecticide-treated nets (ITNs), and prompt diagnosis and treatment of confirmed infections. Unlike in stable transmission areas, no global recommendations currently exist for the prevention of malaria in pregnancy in low-transmission areas or those predominates. In 2000, under the Roll Back Malaria Partnership, Abuja targets were set for at least 60% of pregnant women who are at risk of malaria to have access to antimalarial chemoprophylaxis or IPTp-SP by 2005, and at least 80% use of ITNs by 2010. These targets were subsequently reset with even more ambition to 100% use of both interventions by 2015. However, coverage estimates for IPTp-SP and long-lasting ITNs in the sub-Saharan region have increased only modestly in past years, reaching about 21% coverage for two doses of IPTp-SP and 41% for ITNs on average in 2010. Problems with the delivery of control interventions for malaria in pregnancy are linked to weaknesses within the health system, such as insufficient resources, inadequate or poorly trained staff, and ineffective procurement and supply chain management of SP and ITNs. In 2012, WHO updated its policy for IPTp-SP, recommending an increase in the number of doses of SP to be administered at each scheduled antenatal care visit, starting as early as possible in the second trimester. Countries currently face many obstacles in the scale-up of the provision of IPTp-SP, including inconsistencies between the WHO guidelines and national policies, which have increased the number of missed opportunities for control of malaria in pregnancy.
    In April, 2015, the World Bank announced US$650 million to help Guinea, Liberia, and Sierra Leone recover from the Ebola epidemic, including building their health systems. Although there is consensus on the need for more resilient systems with greater surveillance capabilities, there is less clarity on how countries should pragmatically go about this undertaking. In view of the currently severe gaps in health systems whereby almost everything is a need, countries will have to set priorities for initiating this process.
    The recent outbreak of Ebola in West Africa will leave a legacy significantly deeper than the morbidity and mortality caused directly by the disease. Ebola deaths have been disproportionately concentrated among health personnel. By May, 2015, 0·02% of Guinea\'s population had died due to Ebola, compared with 1·45% of the country\'s doctors, nurses, and midwives. In Liberia and Sierra Leone, the differences are more dramatic, with 0·11% and 0·06% of the general population killed by Ebola versus 8·07% of the health-care workers in Liberia, and 6·85% in Sierra Leone. The fact that health-care workers are at greater risk of contracting Ebola will exacerbate existing skill shortages in countries that had few health personnel to begin with.