Travel medicine updates for the NP.

ABSTRACT: This article provides an overview of the approach to preparing patients for travel, including travel counseling and risk mitigation through vaccination and chemoprophylaxis. Although some patients require referral for consultation with a travel medicine specialist, others can be managed by their primary care provider. In this article, traveler's diarrhea, updated travel-related immunizations, and malaria prophylaxis are discussed.

Adesão ao tratamento da malária e fatores contribuintes / Adherence to malaria treatment and its contributing factors / Adhesión al tratamiento de la malaria y factores contributivos

Estudo exploratório, descritivo, transversal. O objetivo foi estimar a frequência de adesão ao tratamento da malária no distrito de Três Fronteiras, município de Colniza, Mato Grosso, descrevendo os fatores que contribuem para a sua ocorrência. Participaram 27 pacientes selecionados na busca ativa. A coleta de dados foi por meio de entrevista e a medida de adesão ao tratamento deu-se pelo autorrelato e contagem de medicamentos. A frequência de adesão foi de 77,8%. Entre os fatores que contribuíram para a adesão ao tratamento da malária, destacaram-se os relacionados ao paciente, principalmente o desejo de melhorar e a confiança na efetividade dos medicamentos. A frequência de adesão encontrada foi ligeiramente inferior à de outros estudos realizados em regiões endêmicas do país. Concluindo, ações de educação em saúde sobre a necessidade de adesão ao tratamento devem ser enfatizadas e intensificadas para minimizar ou eliminar o abandono de tratamento.

This exploratory, descriptive and cross-sectional study was performed with the objective to estimate the frequency of adherence to malaria treatment in the Brazilian district of Três Fronteiras, belonging to the municipality of Colniza, in the state of Mato Grosso, and describe the contributing factors. Twenty-seven patients were selected by active search. Interviews were conducted for data collection, and treatment adherence was measured considering the patients' self report and by counting medication. The frequency of adherence was 77.8%. Among the factors that contributed to malaria treatment adherence, those related to the patient, particularly regarding the will to get better and the confidence in the effectiveness of the medication were the most prevalent. The identify adherence frequency rate was lower than that reported in previous studies performed in endemic regions of Brazil. In conclusion, health education actions addressing the importance of treatment adherence must be emphasized and intensified to minimize or eliminate treatment abandonment.

Estudio exploratorio, descriptivo, transversal. Se objetivó estimar la frecuencia de adhesión al tratamiento de la malaria en el distrito de Tres Fronteras, municipio de Colniza, Mato Grosso, describiendo los factores que contribuyen al hecho. Participaron 27 pacientes seleccionados en la búsqueda activa. Datos recolectados mediante entrevista, medida de adhesión al tratamiento establecida por autorrelato y recuento de medicamentos. La frecuencia de adhesión fue del 77,8%. Entre los factores que contribuyeron a la adhesión al tratamiento de la malaria, se destacaron los relativos al paciente; en especial, el deseo de mejorar y la confianza en la efectividad de los medicamentos. La frecuencia de adhesión hallada fue ligeramente inferior a la de otros estudios realizados en regiones endémicas del país. Concluyendo, deben enfatizarse e intensificarse las acciones de educación en salud acerca de la necesidad de adhesión al tratamiento, a fin de minimizar o acabar con el abandono del mismo.

Household roles and care-seeking behaviours in response to severe childhood illness in Mali.

Malaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region.

Travel health: safety and preparation strategies for clinicians.

Travel health has become a popular and widely accepted component of the medical community. With the increase in medical travel, NPs must be aware of the guidelines pertaining to health issues and diseases that arise in underdeveloped countries.

Staying power.

A student reflects on how she cared for children with malaria, then contracted the disease herself.

An economic evaluation of home management of malaria in Uganda: an interactive Markov model.

BACKGROUND: Home management of malaria (HMM), promoting presumptive treatment of febrile children in the community, is advocated to improve prompt appropriate treatment of malaria in Africa. The cost-effectiveness of HMM is likely to vary widely in different settings and with the antimalarial drugs used. However, no data on the cost-effectiveness of HMM programmes are available. METHODS/PRINCIPAL FINDINGS: A Markov model was constructed to estimate the cost-effectiveness of HMM as compared to conventional care for febrile illnesses in children without HMM. The model was populated with data from Uganda, but is designed to be interactive, allowing the user to adjust certain parameters, including the antimalarials distributed. The model calculates the cost per disability adjusted life year averted and presents the incremental cost-effectiveness ratio compared to a threshold value. Model output is stratified by level of malaria transmission and the probability that a child would receive appropriate care from a health facility, to indicate the circumstances in which HMM is likely to be cost-effective. The model output suggests that the cost-effectiveness of HMM varies with malaria transmission, the probability of appropriate care, and the drug distributed. Where transmission is high and the probability of appropriate care is limited, HMM is likely to be cost-effective from a provider perspective. Even with the most effective antimalarials, HMM remains an attractive intervention only in areas of high malaria transmission and in medium transmission areas with a lower probability of appropriate care. HMM is generally not cost-effective in low transmission areas, regardless of which antimalarial is distributed. Considering the analysis from the societal perspective decreases the attractiveness of HMM. CONCLUSION: Syndromic HMM for children with fever may be a useful strategy for higher transmission settings with limited health care and diagnosis, but is not appropriate for all settings. HMM may need to be tailored to specific settings, accounting for local malaria transmission intensity and availability of health services.

Home management of malaria by care givers of under-five children in an urban area in Lagos, Nigeria.

BACKGROUND: One of the key interventions proposed under the Roll back malaria initiative is improvement of case management of malaria at the home and community levels to reduce malaria burden. This study was conducted to determine the practice and determinants of Home Management of Malaria (HMM) among care givers of children below 5 years old in an urban community in Lagos State, Nigeria. METHODS: This was a cross-sectional study conducted in 2007. A multi-stage sampling method was used to select the 340 respondents who participated in this study. Data was collected using interviewer administered questionnaires and analysed with Epi-info software. A care giver was included in the study if he/she takes care of a child/children less than 5 years old. RESULTS: The commonest treatment practice by caregivers for their young children with malaria was home treatment with antimalarial drugs [51.5%]. HMM was not significantly determined by care givers' age nor educational level. Most children were treated with chloroquine and only a few [4.2%] of the children were treated with the recommended drug [ACT]. Overall, only 1.24% received adequate treatment. CONCLUSION: Few respondents correctly practice HMM. There is need to educate care givers of young children on the proper management of malaria at home.

A modern African perspective on the role of the clinical nurse specialist.

In Africa, there is an overwhelming and increasing prevalence of illnesses such as HIV and AIDS, tuberculosis, and malaria. This constitutes a "burden of disease" facing Africa. Nursing must evolve accordingly to the changing needs of clients, many of whom have chronic illnesses. In achieving desirable outcomes, it is essential to adopt and adapt the clinical nurse specialist (CNS) role so that expert and specialist practice is available to clients in a cost-effective manner. The role of the CNS singles out clinical responsibilities in a hospital setting so that nurse administrators can concentrate on the provision of resources. A CNS position in the hospital structure would offer a clinical career pathway for advanced practice nurses who wish to remain "by-the-bedside." Regional initiatives are already beginning to show a need for master's-prepared, advanced practice nurses in the clinical areas so as to reduce maternal mortality.

Power to the people.

ICROSS is a small but effective organisation tackling issues by working with the resources and capacities of poor communities.

Caregivers' child malaria treatment practice in Gilgel Gibe field research center, south west Ethiopia.

BACKGROUND: Reduction of malarial morbidity and mortality in children greatly depends on caregivers' response to childhood malaria. OBJECTIVE: The study was conducted to assess caregivers'practice related to the treatment of childhood malaria. METHODS: The study was conducted in 9 Kebeles surrounding Gilgel Gibe Dam from November to December 2005 employing a cross-sectional design. A sample of 588 households in which children between the age of 2 months and 59 months resided were randomly selected from urban, semi urban and rural strata. The primary caregivers in each sampled households were interviewed using structured questionnaire. FINDINGS: Most (79.2%) of the caregivers reported that their under five child has been affected by malaria at least once in their lifetime. The common first modalities of treatment for the child's last malarial episode were home treatment (52.3%) and treatment seeking from formal sectors (43.7%). The commonest type of home care was treatment with antimalarials (71.3%). Early treatment seeking was higher among those who started home antimalarial treatment (30%) as compared to those who sought treatment from formal sectors (19.7%). Higher socioeconomic status was found to be associated with early treatment seeking. CONCLUSION: The study has identified high prevalence of home treatment with antimalarials and late onset of treatment seeking by caregivers for children with malaria. This lays a good ground and calls for implementation of home malaria management strategy.

Delivering new malaria drugs through grassroots private sector.

OBJECTIVE: To demonstrate that micro-franchising system is an effective way of improving access to effective health care such as the introduction of first line antimalarias in populations living in underserved rural areas in Kenya. DESIGN: A descriptive study. SETTING: Child and family wellness (CFW) micro-franchised nurse run clinics in Kenya. RESULTS: In 2007, 39.3% of RDTs carried out were positive for malaria. All malaria positive (RDTs and microscopy) patients received artemether lumefantrine (AL) according to their weight in accordance with the Government approved treatment guidelines. During the same period a total of 3,248 community members were reached with malaria information, however, community expectations took longer to change as patients demanded AL even when the malaria diagnosis was negative. Initially, this led to the dispensing of other antimalarials to patients with malaria like symptoms even with a negative test. This demand decreased with more community education on the importance of the tests. Engaging the private sector though with challenges proved feasible and appropriate in accessing malaria treatment based on clinical diagnosis supported by RDTs to confirm the diagnosis instead of presumptive treatment based on fever. This led to a reduction of antimalarial prescriptions by more than 50%, implying better patient care, rational drug use as well as cost savings on malaria treatment. CONCLUSION: A micro-franchising system is an effective and sustainable way of improving access to effective health care by populations living in underserved rural areas of Africa. With appropriate supportive training and supervision, the system can adapt to changes in treatment guidelines and to new regimens.