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  • Through analyses of data from surveys that

    2019-06-17

    Through analyses of data from surveys that used similar measures, methods, and ethical standards across 44 countries, Heise and Kotsadam have taken an important step towards an improved understanding of intimate partner violence and informing interventions. However, much work remains to be done. In view of the existing gaps in evidence, a need for significant investment to test interventions that address this Liproxstatin-1 HCl cost crucial public health issue exists. We also know that evidence alone is insufficient. Within these efforts, intimate partner violence must be recognised as an urgent public health priority in and of itself, rather than merely as a contributing factor to other public health issues. Donors and governments must work alongside civil society and grassroots efforts to recommit to gender equality in both stable and fragile states to reduce violence against women.
    During recent years, malaria morbidity and mortality have substantially decreased. However, concurrently, resistance to artemisinin-based combination therapy and proliferation of substandard and counterfeit antimalarial drugs have continued to increase and subsequently threaten effective malaria control. Here we suggest that bundling of rapid diagnostic tests with artemisinin-based combination treatment could address these two closely related problems. The global strategy to combat uncomplicated malaria relies on the widespread adoption of rapid diagnostic tests and the use of artemisinin-based combination treatment. Rapid diagnostic tests for malaria help with early and accurate diagnosis of infection (typically within 20 min) and are effective, with high sensitivity (80–95%) and specificity (85%) in malaria-endemic countries. The cost of a rapid diagnostic test ranges from US$0·45 for a test to $1·40 for an all-species test. Therefore, WHO guidelines recommend the use of these tests in these settings for the management of fever-like illness in children and adults. Antimalarials have large (although not well quantified) selection pressures on malaria parasites, and evolving resistance to artemisinin has been reported in southeast Asia with growing concern that resistance might spread. Additionally, the common practice of presumptive use of artemisinin-based combination treatment to treat fevers in many clinical settings inevitably leads to overuse. With few alternative treatment options available, the conservation of vaccine treatment is important and thus improved stewardship is key to slowing down resistance. Bundling of medical products has been used successfully to improve health intervention delivery, as with the joint WHO-UNICEF policy statement on mass immunisation. The statement recommended the combination of vaccines, autodisposal syringes, and safety disposal boxes into one theoretical bundle for use in all mass-immunisation campaigns. A similar approach could conceivably be adapted for better antimalarial stewardship and include physical bundling of the two approaches for delivery to national control programmes.
    Rwanda has achieved remarkable progress in health. Since 1990, under-5 mortality has decreased by two-thirds and maternal mortality by three-quarters while life expectancy has nearly doubled. Rwanda has also become a pioneer in tackling cancer and non-communicable diseases that most low-income countries are only beginning to take on. The health achievements of this country surpass those of its peers and even countries with higher levels of economic development (). This success has been attributed to innovative policy making and the alignment of vertical donor funding with horizontal government-driven priorities. Although these factors have been important, several countries have pursued similar strategies but have not achieved the same results. Rwanda, on the other hand, has achieved gains across service delivery sectors such as law and order and education, suggesting that general state capability—the government\'s ability to translate intended policy into reliable day-to-day implementation—has been a distinguishing factor in its health advances.