No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Okere and Diaby. Ezendu took the lead in data collection, along with Okere. Data interpretation was performed by all the authors. The manuscript was written by Okere, Diaby, and Berthe and revised by Okere and Diaby.
Background
: Hydroxychloroquine, an antimalarial drug, combined with azithromycin has been considered a potential treatment for COVID-19. However, these drugs may cause electrocardiogram QT prolongation (QTp) and torsade de Pointes (TdP). We examined potential safety signals for these cardiac arrhythmias.
Methods
: Using the OpenVigil 2.1 MedDRA platform, we mined data from the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) from December 2019 to June 2020. We extracted individual case safety reports based on exposures of seven antimalarial drugs, azithromycin, and combinations. All other drugs in FAERS served as controls. Events of interest included QTp and TdP, with associations between drug exposures and events expressed as adjusted Reporting-Odds-Ratios (aRORs) and confidence intervals. The lower end of aROR 95% confidence interval >1 was used as the statistically significant signal detection threshold.
Results
: QTp safety signals were found for hydroxychloroquine[aROR:11.70 (10.40–13.16)], chloroquine[aROR:18.97 (11.30–31.87)], quinine[aROR:16.66 (10.18–27.25)], atovaquone[aROR:6.91 (4.14–11.56)], azithromycin alone [aROR:28.02 (22.87–34.32)] and hydroxychloroquine + azithromycin [aROR:75.23 (51.15–110.66)]. TdP safety signals were found for hydroxychloroquine [aROR: 5.62 (4.94–6.38)], chloroquine[aROR:49.37 (30.63–79.58)], and hydroxychloroquine + azithromycin[aROR:33.09 (21.22–51.61)].
Conclusion
: Hydroxychloroquine/chloroquine and/or azithromycin was associated with QTp/TdP safety signals and their use should be monitored carefully.
Over the past decade, Mali has been engaged in a process of improving access and quality of education within the framework of the education for all of the Millennium Development Goals. An important aspect of that process is the participative schools' management of local authorities through teachers-parents-students associations. This paper analyzes the role and effectiveness of such institutional arrangement that involve the local community in the governance of primary schools in Mali, using the accountability framework and data from the quantitative service delivery survey implemented in 2005. We find that although information is likely to be available across the entire chain of education service delivery, the capability to sanction or to reward the public primary schools teachers is at the central level. The capability of the local government in terms of enforceability is weakened in private and Médersa schools while it is somewhat strengthened in community schools. A simple OLS regression shows no strong relation between school-based management - through the local community - and primary schools’ performance. The results also suggest that class size, teaching staff and teachers incentives are important to schools' performance.
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