***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background  Intermittent preventive treatment in infants ( IPTi )  is a new malaria control tool . However , it is uncertain whether IPTi works mainly through chemoprophylaxis or treatment of existing infections . Underst and ing the mechanism is essential for development of replacements for sulfadoxine-pyrimethamine ( SP ) where it is no longer effective . This study investigated how protection against malaria given by SP , chlorproguanil-dapsone ( CD ) and mefloquine ( MQ ) , varied with time since administration of IPTi . Methods and Findings A secondary analysis of data from a r and omised , placebo-controlled trial in an area of high antifolate resistance in Tanzania was conducted . IPTi using SP , CD , MQ or placebo was given to 1280 infants at 2 , 3 and 9 months of age . Poisson regression with r and om effects to adjust for potential clustering of malaria episodes within children was used to calculate incidence rate ratios for clinical malaria in defined time strata following IPTi . The short-acting antimalarial CD gave no protection against clinical malaria , whereas long-acting MQ gave two months of substantial protection ( protective efficacy ( PE ) 73.1 % ( 95 % CI : 23.9 , 90.5 ) and 73.3 % ( 95 % CI : 0 , 92.9 ) in the first and second month respectively ) . SP gave some protection in the first month after treatment ( PE 64.5 % ( 95 % CI : 10.6 , 85.9 ) ) although it did not reduce the incidence of malaria up to 12 months of age . There was no evidence of either long-term protection or increased risk of malaria for any of the regimens . Conclusion Post-treatment chemoprophylaxis appears to be the main mechanism by which IPTi protects children against malaria . Long-acting antimalarials are therefore likely to be the most effective drugs for IPTi , but as monotherapies could be vulnerable to development of drug resistance . Due to concerns about tolerability , the mefloquine formulation used in this study is not suitable for IPTi . Further investigation of combinations of long-acting antimalarials for IPTi is needed . Trial Registration Clinical trials.gov Background Intermittent Preventive Treatment for malaria control in infants ( IPTi ) consists of the administration of a treatment dose of an anti-malarial drug , usually sulphadoxine-pyrimethamine , at scheduled intervals , regardless of the presence of Plasmodium falciparum infection . A pooled analysis of individually r and omized trials reported that IPTi reduced clinical episodes by 30 % . This study evaluated the effect of IPTi on  child survival  in the context of a five-district implementation project in southern Tanzania . [ Trial registration : clinical trials.gov NCT00152204 ] . Methods After baseline household and health facility surveys in 2004 , five districts comprising 24 divisions were r and omly assigned either to receive IPTi ( n = 12 ) or not ( n = 12 ) . Implementation started in March 2005 , led by routine health services with support from the research team . In 2007 , a large household survey was undertaken to assess the impact of IPTi on survival in infants aged two-11 months through birth history interviews with all women aged 13 - 49 years . The analysis is based on an " intention-to-treat " ecological design , with survival outcomes analysed according to the cluster in which the mothers lived . Results Survival in infants aged two-11 months was comparable in IPTi and comparison areas at baseline . In intervention areas in 2007 , 48 % of children aged 12 - 23 months had documented evidence of receiving three doses of IPTi , compared to 2 % in comparison areas ( P < 0.0001 ) . Over the three years of the study there was a marked improvement in survival in both groups . Between 2001 - 4 and 2005 - 7 , mortality rates in two-11 month olds fell from 34.1 to 23.6 per 1,000 person-years in intervention areas and from 32.3 to 20.7 in comparison areas . In 2007 , divisions implementing IPTi had a 14 % ( 95 % CI -12 % , 49 % ) higher mortality rate in two-11 month olds in comparison with non-implementing divisions ( P = 0.31 ) . Conclusion The lack of evidence of an effect of IPTi on survival could be a false negative result due to a lack of power or imbalance of unmeasured confounders . Alternatively , there could be no mortality impact of IPTi due to low coverage , late administration , drug resistance , decreased malaria transmission or improvements in vector control and case management . This study raises important questions for programme evaluation design Background As a result of rising levels of drug resistance to conventional monotherapy , the World Health Organization ( WHO ) and other international organisations have recommended that malaria endemic countries move to combination therapy , ideally with artemisinin-based combinations ( ACTs ) . Cost is a major barrier to deployment . There is little evidence from field trials on the cost-effectiveness of these new combinations . Methods and Findings An economic evaluation of drug combinations was design ed around a r and omised effectiveness trial of combinations recommended by the WHO , used to treat Tanzanian children with non-severe slide-proven malaria . Drug combinations were : amodiaquine ( AQ ) , AQ with sulfadoxine-pyrimethamine ( AQ+SP ) , AQ with artesunate ( AQ+AS ) , and artemether-lumefantrine ( AL ) in a six-dose regimen . Effectiveness was measured in terms of re source savings and cases of malaria averted ( based on parasitological failure rates at days 14 and 28 ) . All costs to providers and to patients and their families were estimated and uncertain variables were subjected to univariate sensitivity analysis . Incremental analysis comparing each combination to monotherapy ( AQ ) revealed that from a societal perspective AL was most cost-effective at day 14 . At day 28 the difference between AL and AQ+AS was negligible ; both result ed in a gross savings of approximately US$ 1.70 or a net saving of US$ 22.40 per case averted . Varying the accuracy of diagnosis and the subsistence wage rate used to value unpaid work had a significant effect on the number of cases averted and on programme costs , respectively , but this did not change the finding that AL and AQ+AS dominate monotherapy . Conclusions In an area of high drug resistance , there is evidence that AL and AQ+AS are the most cost-effective drugs despite being the most expensive , because they are significantly more effective than other options and therefore reduce the need for further treatment . This is not necessarily the case in parts of Africa where recrudescence following SP and AQ treatment ( and their combination ) is lower so that the relative advantage of ACTs is smaller , or where diagnostic services are not accurate and as a result much of the drug goes to those who do not have malaria The aim of this study is to compare the safety efficacy and cost effectiveness of vaginal misoprostol and intravenous oxytocin in induction of labor . A r and omized trial was performed in 142 women requiring labor induction in Muhimbili National Hospital Dar es Salaam Tanzania from June to December 2004 . Inclusion criteria were singleton vertex presentation ; gestational age > 36 weeks . Exclusion criteria were previous myomectomy uteroplasty or cesarean section . Sequential sealed envelopes generated by computer were used . Patients were assigned to receive either oxytocin or 25 mcg 4-hourly vaginal misoprostol ( Continental pharma Inc Belgium ; maximum dose 100 mcg ) . If contractions were not established 4 h after the insertion of the fourth misoprostol induction was considered a failure and the patient was managed according to hospital protocol s. In the oxytocin group infusion of 5 I in 500 ml of 5 % dextrose ( 10 mU/ ml ) was started ( maximum dosage 40 mU/min ) . If labor was not established within 12 h induction was regarded as a failure and the patient was managed according to hospital protocol s. ( excerpt BACKGROUND The aim of the CRASH-2 trial was to assess the effects of early administration of tranexamic acid on death , vascular occlusive events , and blood transfusion in trauma patients with significant haemorrhage .  Tranexamic acid significantly reduced all-cause mortality . Because tranexamic acid is thought to exert its effect through inhibition of fibrinolysis , we undertook exploratory analyses of its effect on death due to bleeding . METHODS The CRASH-2 trial was undertaken in 274 hospitals in 40 countries . 20,211 adult trauma patients with , or at risk of , significant bleeding were r and omly assigned within 8 h of injury to either tranexamic acid ( loading dose 1 g over 10 min followed by infusion of 1 g over 8 h ) or placebo . Patients were r and omly assigned by selection of the lowest numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number . Both participants and study staff ( site investigators and trial coordinating centre staff ) were masked to treatment allocation . We examined the effect of tranexamic acid on death due to bleeding according to time to treatment , severity of haemorrhage as assessed by systolic blood pressure , Glasgow coma score ( GCS ) , and type of injury . All analyses were by intention to treat . The trial is registered as IS RCT N86750102 , Clinical Trials.gov NCT00375258 , and South African Clinical Trial Register/Department of Health DOH-27 - 0607 - 1919 . FINDINGS 10,096 patients were allocated to tranexamic acid  and 10,115 to placebo , of whom 10,060 and 10,067 , respectively , were analysed . 1063 deaths ( 35 % ) were due to bleeding . We recorded strong evidence that the effect of tranexamic acid on death due to bleeding varied according to the time from injury to treatment ( test for interaction p<0.0001 ) . Early treatment ( ≤1 h from injury ) significantly reduced the risk of death due to bleeding ( 198/3747 [ 5.3 % ] events in tranexamic acid group vs 286/3704 [ 7.7 % ] in placebo group ; relative risk [ RR ] 0.68 , 95 % CI 0.57 - 0.82 ; p<0.0001 ) . Treatment given between 1 and 3 h also reduced the risk of death due to bleeding ( 147/3037 [ 4.8 % ] vs 184/2996 [ 6.1 % ] ; RR 0.79 , 0.64 - 0.97 ; p=0.03 ) . Treatment given after 3 h seemed to increase the risk of death due to bleeding ( 144/3272 [ 4.4 % ] vs 103/3362 [ 3.1 % ] ; RR 1.44 , 1.12 - 1.84 ; p=0.004 ) . We recorded no evidence that the effect of tranexamic acid on death due to bleeding varied by systolic blood pressure , Glasgow coma score , or type of injury . INTERPRETATION Tranexamic acid should be given as early as possible to bleeding trauma patients . For trauma patients admitted late after injury , tranexamic acid is less effective and could be harmful . FUNDING UK NIHR Health Technology Assessment programme , Pfizer , BUPA Foundation , and J P Moulton Charitable Foundation 
    Output:
    
Conclusion Country specific pharmacoeconomic analyses are too scarce and inconsistently used to have had a significant influence on the selection of essential medicines in Tanzania .