European Resuscitation Council Guidelines for Resuscitation.

Where malaria prospers most, human societies have prospered least. The global distribution of per-capita gross domestic product shows a striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. There are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.

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The economic and social burden of malaria

Background
Malaria is an important cause of illness and death in many parts of the world, especially in sub-Saharan Africa. There has been a renewed emphasis on preventive measures at community and individual levels. Insecticide-treated nets (ITNs) are the most prominent malaria preventive measure for large-scale deployment in highly endemic areas.

Objectives
To assess the impact of insecticide-treated bed nets or curtains on mortality, malarial illness (life-threatening and mild), malaria parasitaemia, anaemia, and spleen rates.

Search methods
I searched the Cochrane Infectious Diseases Group trials register (January 2003), CENTRAL (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to October 2003), EMBASE (1974 to November 2002), LILACS (1982 to January 2003), and reference lists of reviews, books, and trials. I handsearched journals, contacted researchers, funding agencies, and net and insecticide manufacturers.

Selection criteria
Individual and cluster randomized controlled trials of insecticide-treated bed nets or curtains compared to nets without insecticide or no nets. Trials including only pregnant women were excluded.

Data collection and analysis
The reviewer and two independent assessors reviewed trials for inclusion. The reviewer assessed the risk of bias in the trials, and extracted and analysed data.

Main results
Fourteen cluster randomized and eight individually randomized controlled trials met the inclusion criteria. Five trials measured child mortality: ITNs provided 17% protective efficacy (PE) compared to no nets (relative rate 0.83, 95% confidence interval (CI) 0.76 to 0.90), and 23% PE compared to untreated nets (relative rate 0.77, 95% CI 0.63 to 0.95). About 5.5 lives (95% CI 3.39 to 7.67) can be saved each year for every 1000 children protected with ITNs. In areas with stable malaria, ITNs reduced the incidence of uncomplicated malarial episodes in areas of stable malaria by 50% compared to no nets, and 39% compared to untreated nets; and in areas of unstable malaria: by 62% for compared to no nets and 43% compared to untreated nets for Plasmodium falciparum episodes, and by 52% compared to no nets and 11% compared to untreated nets for P. vivax episodes. When compared to no nets and in areas of stable malaria, ITNs also had an impact on severe malaria (45% PE, 95% CI 20 to 63), parasite prevalence (13% PE), high parasitaemia (29% PE), splenomegaly (30% PE), and their use improved the average haemoglobin level in children by 1.7% packed cell volume.

Authors' conclusions
ITNs are highly effective in reducing childhood mortality and morbidity from malaria. Widespread access to ITNs is currently being advocated by Roll Back Malaria, but universal deployment will require major financial, technical, and operational inputs.

Insecticide‐treated bed nets and curtains for preventing malaria

Generalized Linear Models (2nd ed.)

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About the National Institute for Health and Care Excellence - NICE.

Mortality in sickle cell anaemia in Africa: rates and risk factors from a prospective cohort study in Tanzania

Commentary is directed to Nigel Crooks criticism of John Cleland et al. research on declines in child mortality. The topics in question pertain to interpretations of data analysis. Crooks objections were to a small part of the research which was on the effects of economic recession and structural adjustment on child survival. Among the 12 study populations there were still declines in child mortality between 1975 and 1985 regardless of the economic recession of the early 1980s. It is recognized that there might be a lagged effect; the intention was not to imply that economic recession had no effect or will have no effect on child survival. A review of the literature shows that effects are minimal substantial or not at all. Crooks 2nd criticism was directed to the analysis of the effect of changing socioeconomic composition on secular trends. The criticism is deemed unfair because the purpose of the research was exploratory and descriptive and not directed to testing theory. The underlying expectation of the research was that inequalities had been minimized through more equitable access to health care that the differentials in the 1970s would not continue and that the expanded program of immunization had achieved wide coverage. Crooks final criticism concerned the conclusions about the persistence of large inequalities. Crook considers that affordability is an issue and mortality inequalities would be reduced with more equal access to good quality curative health services. Maternal education is another important way to increase utilization of health services. The research evidence does indeed show that the response to childhood illness is key to the continuation of socioeconomic inequalities in childhood mortality. There is agreement that maternal education reduced risk of infection and equal access to health care are important factors related to child survival.

Economic recession and child survival: a response to Crook.

Background
While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established.

Methods
We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort.

Results
The annual crude mortality rate per 1000 population for podoconiosis patients was 28.7 (95% confidence interval [CI] 17.3 to 44.8; n=663) while that of the general population was 2.8 (95% CI 2.3 to 3.4; n=44 095). The overall SMR for the study period was 6.0 (95% CI 3.6 to 9.4).

Conclusions
Podoconiosis patients experience elevated mortality compared with the general population and further research is required to understand the reasons.

Excess mortality among people with podoconiosis: secondary analysis of two Ethiopian cohorts.

Background Skin cancer, including melanoma and non-melanoma (keratinocyte), is increasing in incidence in the UK. Accounting for half of all cancers in England and Wales, the disease significantly impacts overstretched dermatology services. Research suggests that 86% of melanoma is preventable with modified sun exposure. Educating children about sun safety in schools can help prevent skin cancer and is recommended by major health organisations. In England, teaching sun safety in primary schools is compulsory, while in Wales this is left to school discretion. Aims Understand how primary schools in Wales are responding to growing skin cancer rates and explore the effectiveness of sun safety policies in schools on knowledge and behaviour. Methods Sunproofed is a mixed-methods scoping study comprising 5 work packages (WP) using survey and routine electronic health record (EHR) data supplemented by qualitative case studies. Objective(s) are to: WP1: Discover if primary schools in Wales have sun safety policies; policy characteristics; determine factors that may influence their presence and identify areas where schools need support. WP2: Determine what EHR data is available regarding the incidence of sunburn in primary school children and the feasibility of using this data to evaluate the impact of sun safety policies. WP3: Understand the impact of sun safety policies on sun-safe knowledge and behaviour amongst children, parents, teachers, and school management; identify barriers and facilitators to schools implementing sun safety policies. WP4: Co-produce guidance regarding sun safety policies and best methods for implementation in schools. WP5: Disseminate guidance and findings widely to ensure impact and uptake. Discussion Skin cancer rates are increasing in the UK, straining limited resources. Sunproofed has the potential to inform the development of future prevention activities, both in Wales and beyond. This could reduce the number of skin cancer cases in the future and keep people healthier for longer.

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Greg Fegan

Papers

Mortality in sickle cell anaemia in Africa: rates and risk factors from a prospective cohort study in Tanzania

Economic recession and child survival: a response to Crook.

Excess mortality among people with podoconiosis: secondary analysis of two Ethiopian cohorts.

Sunproofed study protocol: A mixed-methods scoping study of sun safety policies in primary schools in Wales

The acquisition and maintenance of antibodies against Plasmodium falciparum merozoite antigens in childhood