A comparison between different models of delivering maternal cash transfers in Myanmar.

As part of a randomized controlled trial conducted in Myanmar between 2016 and 2019, we explore the performance of a maternal cash transfer program across villages assigned to different models of delivery (by government health workers vs loan agents of a non-governmental organization) and identify key factors of success. Measures include enrolment inclusion and exclusion errors, failures in payment delivery to enrolled beneficiaries (whether beneficiaries received any transfer, fraction of benefits received and whether there were delays and underpayment of benefit amounts) and whether beneficiaries remained in the program beyond eligibility. We find that women in villages where government health workers delivered cash transfers received on average two additional monthly transfers, were 19.7% more likely to receive payments on time and in-full and were 14.6% less likely to stay in the program beyond eligibility. With respect to the primary health objective of the program-child nutrition-we find that children whose mother received cash by government health workers were less likely to be chronically malnourished compared to those whose mother received cash by loan agents. Overall, the delivery of cash transfers to mothers of young children by government health workers outperforms the delivery by loan agents in rural Myanmar. Qualitative evidence suggests two key factors of success: (1) trusted presence and past interactions with targeted beneficiaries and complementarities between government health workers' expertise and the program; and (2) performance incentives based on specific health objectives along with top-down monitoring. We cannot exclude that other incentives or intrinsic motivation also played a role.

SAA1-dependent reprogramming of adipocytes by tumor cells is associated with triple negative breast cancer aggressiveness.

Triple negative breast cancers (TNBC) are characterized by a poor prognosis and a lack of targeted treatments. Their progression depends on tumor cell intrinsic factors, the tumor microenvironment and host characteristics. Although adipocytes, the primary stromal cells of the breast, have been determined to be plastic in physiology and cancer, the tumor-derived molecular mediators of tumor-adipocyte crosstalk have not been identified yet. In this study, we report that the crosstalk between TNBC cells and adipocytes in vitro beyond adipocyte dedifferentiation, induces a unique transcriptional profile that is characterized by inflammation and pathways that are related to interaction with the tumor microenvironment. Accordingly, increased cancer stem-like features and recruitment of pro-tumorigenic immune cells are induced by this crosstalk through CXCL5 and IL-8 production. We identified serum amyloid A1 (SAA1) as a regulator of the adipocyte reprogramming through CD36 and P2XR7 signaling. In human TNBC, SAA1 expression was associated with cancer-associated adipocyte infiltration, inflammation, stimulated lipolysis, stem-like properties, and a distinct tumor immune microenvironment. Our findings constitute evidence that the interaction between tumor cells and adipocytes through the release of SAA1 is relevant to the aggressiveness of TNBC.

Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis

Background: The entire population of Mozambique is at risk for malaria, which remains one of the leading causes of death. The 2017-2022 National Malaria Strategic Plan focuses on reducing malaria morbidity and mortality in high- and low-transmission areas. This study aimed to estimate the costs and health benefits of six variations of the World Health Organization's "test-and-treat" strategy among children under five. Methods: A decision tree model was developed that estimates the costs and health outcomes for children under five. Data on probabilities, costs, weights for disability-adjusted life years (DALYs), and quality-adjusted life years (QALYs) were based on peer-reviewed, grey literature, and primary data analysis of the 2018 Malaria Indicator Survey. Six scenarios were compared to the status quo and calculated the incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, DALY averted, and life saved. Deterministic and probabilistic sensitivity analyses were conducted to understand the effect of parameter uncertainty on the findings. Results: In the base case, reaching the target of 100% testing with rapid diagnostic tests (RDTs; Scenario 1) is more cost-effective than improving the testing rate alone by 10% (Scenario 2). Achieving a 100% (Scenario 3) or a 10% increase in treatment rate (Scenario 4) have ICERs that are lower than Scenarios 1 and 2. Both Scenarios 5 and 6, which represent combinations of Scenarios 1-4, have lower ICERs than their constituent strategies on their own, which suggests that improvements in treatment are more cost-effective than improvements in testing alone. These results held when DALYs averted or lives saved were used as health outcomes. Deterministic and probabilistic sensitivity analyses revealed that the cost-effectiveness of Scenarios 1-6 are subject sensitive to parameter uncertainty, though Scenarios 4 and 5 are the optimal choice when DALYs averted or QALYs gained were used as the measure of health outcomes across all cost-effectiveness thresholds. Conclusions: Improving testing rates alone among children at risk for malaria has the potential to improve health but may not be the most efficient use of limited resources. Instead, small or large improvements in treatment, whether alone or in conjunction with improvements in testing, are the most cost-effective strategies for children under five in Mozambique.