Fred Arnold

Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.

BACKGROUND Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). METHODS We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Funds quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. FINDINGS In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US

Measuring Coverage in MNCH: New Findings, New Strategies, and Recommendations for Action

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Measuring Coverage in MNCH: Tracking Progress in Health for Women and Children Using DHS and MICS Household Surveys

4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. INTERPRETATION Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. FUNDING The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.

Viewpoint: evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa.

Measuring Coverage in Maternal and Child Health: New Findings, New Strategies and Recommendations for Action In this overview of the PLOS Medicine Collection on “Measuring Coverage in Maternal and Child Health, Jennifer Bryce and colleagues discuss how and why some of the indicators now being used to track intervention coverage may not provide fully reliable measurements, draw together strategies proposed across the Collection for improving these measurements and make recommendations for action.

Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys.

In a PLOS Medicine Review, Attila Hancioglu and Fred Arnold describe the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) and highlight the methodological principles and challenges involved in using household survey data to measure reproductive, maternal, newborn, and child health intervention coverage.

Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys

Objective  To describe an approach for evaluating the impact of malaria control efforts on malaria‐associated mortality in sub‐Saharan Africa, where disease‐specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children.

Success in reducing maternal and child mortality in Afghanistan

In a PLOS Medicine Review, Thomas Eisele and colleagues discuss the importance of considering sampling and non-sampling errors when interpreting estimates of coverage of maternal, newborn, and child health interventions based on data from household surveys.

Sex ratio unaffected by parental age gap.

To describe the state of the public and private malaria diagnostics market shortly after WHO updated its guidelines for testing all suspected malaria cases prior to treatment.

Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.

After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the countrys economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260–394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

Improving estimates of insecticide-treated mosquito net coverage from household surveys: using geographic coordinates to account for endemicity

Sex ratios based on a small sample of births tend to be very unstable. It is therefore not surprising that Manning et al. found a relationship between spousal age differences and the sex ratios at birth for a very small sample from a restricted population. Their findings do not stand up to scrutiny when tested with larger, representative samples of births.