Substandard and falsified medicines pose significant risks to global health, including increased deaths, prolonged treatments, and growing drug resistance. Antimalarials are one of the most common medications to be of poor quality in low-and middle-income countries. We assessed the health and economic impact of substandard and falsified antimalarials for children less than 5 years of age in the Democratic Republic of the Congo, which has one of the world's highest malaria mortality rates. We developed an agent-based model to simulate patient care-seeking behavior and medicine supply chain processes to examine the impact of antimalarial quality in Kinshasa province and Katanga region. We simulated the impact of potential interventions to improve medicinal quality, reduce stockouts, or educate caregivers. We estimated that substandard and falsified antimalarials are responsible for $20.

Introduction sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic. Methods a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value < 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire. Results a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence. Conclusion the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.

Diarrhea is a leading cause of morbidity and mortality in the world but mostly in Sub-Saharan Africa. These could be prevented if universal coverage of current available interventions were implemented. The study aimed to identify factors associated with the choice of health care source among caretakers seeking treatment for under-5 children with diarrhea illness. Using women’s questionnaire we extracted a subset of data of children aged 0 to 59 months from the 2017 Demographic & Health Survey. Questions regarding history of childhood diarrhea for the past 24 hours or last 2 weeks prior to the survey were key in data extraction. Caregivers were asked to report the place where they sought treatment. In this study, 4 types of health facilities were defined: public, private, pharmacies, and other unspecified sources. A multinomial logistic regression model was used to identify sources of health facility used and corresponding factors associated with the choice. Factors associated with choice of health care source included education (educated women were less likely to self-medicate their children [relative risk ration (RRR) = 0.46; 95% confidence interval (CI) = 0.22-0.94]), income (better income earning families were more likely to seek care from private facility such as pharmacy [RRR = 1.87; 95% CI = 1.14-3.09]), and rural living (those in rural areas were more likely to seek treatment from other unspecified sources [RRR = 7.33, 95% CI = 1.40-38.36]). Public health facilities (79.9%) were the main source of health care service; however, reducing under-5 mortality due to diarrhea illness would require significant efforts to address other inequalities in accessing and utilizing health care services.

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Summary measures of health or well-being must assign a value to averting death and relate it to the value of preventing or curing morbidity. The authors address two key questions about how to value the prevention of death: (1) how the age at which someone dies affects how bad their death is and (2) at what age death starts to be bad for the decedent. Current practice includes, by default, views about both questions that the authors think are mistaken. Regarding (1), the authors argue in favor of gradualism: the value assigned to preventing mortality should gradually increase during early cognitive development, so that the prevention of perinatal deaths is assigned a lower value than the prevention of the deaths of older children. Regarding (2), value should be assigned to preventing deaths from the point of the onset of sentience—at around 28 weeks gestational age—so that the prevention of stillbirths is also valued. The authors tentatively suggest a function for calculating the disvalue of death at different ages and apply this and alternative functions to South African data on interventions to prevent stillbirths and neonatal deaths.