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- Minja, Daniel T. R., et al.
(author)
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Reliability of rapid diagnostic tests in diagnosing pregnancy associated malaria in North Eastern Tanzania
- 2012
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In: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 11, s. 211-
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Journal article (peer-reviewed)abstract
- Background: Accurate diagnosis and prompt treatment of pregnancy-associated malaria (PAM) are key aspects in averting adverse pregnancy outcomes. Microscopy is the gold standard in malaria diagnosis, but it has limited detection and availability. When used appropriately, rapid diagnostic tests (RDTs) could be an ideal diagnostic complement to microscopy, due to their ease of use and adequate sensitivity in detecting even sub-microscopic infections. Polymerase chain reaction (PCR) is even more sensitive, but it is mainly used for research purposes. The accuracy and reliability of RDTs in diagnosing PAM was evaluated using microscopy and PCR. Methods: A cohort of pregnant women in north-eastern Tanzania was followed throughout pregnancy for detection of plasmodial infection using venous and placental blood samples evaluated by histidine rich protein 2 (HRP-2) and parasite lactate dehydrogenase (pLDH) based RDTs (Parascreen (TM)) or HRP-2 only (Paracheck Pf (R) and ParaHIT (R) f), microscopy and nested Plasmodium species diagnostic PCR. Results: From a cohort of 924 pregnant women who completed the follow up, complete RDT and microscopy data was available for 5,555 blood samples and of these 442 samples were analysed by PCR. Of the 5,555 blood samples, 49 ((proportion and 95% confidence interval) 0.9% [0.7 - 1.1]) samples were positive by microscopy and 91 (1.6% [1.3-2.0]) by RDT. Forty-six (50.5% [40.5 - 60.6]) and 45 (49.5% [39.4 - 59.5]) of the RDT positive samples were positive and negative by microscopy, respectively, whereas nineteen (42.2% [29.0 - 56.7]) of the microscopy negative, but RDT positive, samples were positive by PCR. Three (0.05% [0.02 - 0.2]) samples were positive by microscopy but negative by RDT. 351 of the 5,461 samples negative by both RDT and microscopy were tested by PCR and found negative. There was no statistically significant difference between the performances of the different RDTs. Conclusions: Microscopy underestimated the real burden of malaria during pregnancy and RDTs performed better than microscopy in diagnosing PAM. In areas where intermittent preventive treatment during pregnancy may be abandoned due to low and decreasing malaria risk and instead replaced with active case management, screening with RDT is likely to identify most infections in pregnant women and out-performs microscopy as a diagnostic tool.
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| 3. |
- Olesen, Pernille J, et al.
(author)
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Reducing Global Warming and Adapting to Climate Change: The Potential of Organic Agriculture
- 2012
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Reports (other academic/artistic)abstract
- Climate change mitigation is urgent, and adaptation to climate change is crucial, particularly in agriculture, where food security is at stake. Agriculture, currently responsible for 20-30% of global greenhouse gas emissions (counting direct and indirect agricultural emissions), can however contribute to both climate change mitigation and adaptation. The main mitigation po-tential lies in the capacity of agricultural soils to sequester CO2 through building organic matter. This potential can be realized by employing sustainable agricultural practices, such as those com-monly found within organic farming systems. Examples of these practices are the use of organic fertilizers and crop rotations including legume leys and cover crops. Mitigation is also achieved in organic agriculture through the avoidance of open biomass burning, and the avoidance of synthetic fertilizers, the production of which causes emissions from fossil fuel use. Common organic practices also contribute to adaptation. Building soil organic matter increases water retention capacity, and creates more stabile, fertile soils, thus reducing vulnerability to drought, extreme precipitation events, floods and water logging. Adaptation is further supported by increased agro-ecosystem diversity of organic farms, based on management decisions, reduced ni-trogen inputs and the absence of chemical pesticides. The high diversity together with the lower input costs of organic agriculture is key to reducing production risks associated with extreme weather events. All these advantageous practices are not exclusive to organic agriculture. However, they are core parts of the organic production system, in contrast to most non-organic agriculture, where they play a minor role only. Mitigation in agriculture is however not restricted to the agricultural sector alone. Consumer pref-erences for products from conventional or organic farms, seasonal and local production, pest and disease resistant varieties, etc. strongly influence agricultural production systems, and thus the overall mitigation potential of agriculture. Even more influential are meat consumption and food wastage. Any discussion on mitigation of climate change in agriculture thus needs to address the entire food chain, and to be linked to general sustainable development strategies. The main challenges to dealing appropriately with the climate change mitigation and adaptation potential of organic agriculture, and agriculture in general, stem from a) insufficient understanding of some of the basic processes, such as the interaction of N2O emissions and soil carbon sequestra-tion, contributions of roots to soil carbon sequestration, and the life-cycle emissions of organic fer-tilizers, such as compost; b) lack of procedures for emissions accounting which adequately repre-sent agricultural production systems with multiple and diverse outputs, which also encompass eco-system services; c) the problem to identify and design adequate policy frameworks for supporting mitigation and adaptation in agriculture, i.e. such that do not put systemic approaches at a disad-vantage due to difficulties in the quantification of emissions, and in their allocation to single prod-ucts; d) the necessity to assure that the current focus on mitigation does not lead to neglect of other factors influencing the sustainability of agriculture, such as pesticide loads, eutrophication, acidifi-cation or soil erosion; and e) the open questions, how to address consumer behaviour and how to further changes in consumption patterns, in order to utilize their mitigation potential.
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