human
***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: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting In 1997 to 1998 , Population Services International ( PSI ) carried out a targeted radio campaign in Mozambique to promote behavior change for the prevention of sexually transmitted infections ( STIs ) and HIV/AIDS . To evaluate the coverage and impact of the campaign , PSI design ed and implemented a cross-sectional study using a two-stage r and om sample of " at-risk " individuals ; 754 individuals between the ages of 13 and 49 were interviewed . Over half ( 52.4 % ) heard the campaign and 45.5 % recalled one or more radio messages . However , recall of specific messages in specific risk groups was low . A multivariate model demonstrates that among those exposed to the radio campaign , 97.2 % reported intent to change their sexual behavior compared with 62.8 % of those not exposed to the campaign ( p < .001 ) . Among those who recalled campaign messages , 86.1 % attempted to change their behavior compared with 58 % of those who had no message recall ( p < .001 ) . Success in changing behavior is significantly higher among those with message recall ( 83.8 % ) than those without ( 56.8 % , p < .001 ) . This study illustrates the difficulties in using radio to target a specific group with a corresponding behavior change message . Although general recall of campaign messages was high per target group , the campaign did not succeed in ensuring exposure to the intended target group . The strategy of airing all of the spots simultaneously with different but similar messages result ed in one spot " stepping on " another . Despite the limitations in using radio to target , exposure to the radio campaign has contributed to individual intent to change sexual behavior Background Evidence is emerging on the cost-effectiveness , quality and health coverage of social franchises . But little is known about the motivations of providers to join or remain within a social franchise network , or the impact that franchise membership has on client volumes or revenue earnings . Methods ( i ) Uncontrolled facility based of a r and om sample of 230 franchise members to assess self-reported motivations ; ( ii ) A 24 month prospect i ve cohort study of 3 cohorts of physicians who had been in the franchise for 4 years , 2 years and new members to track monthly case load and revenue generated . Results The most common reasons for joining the franchise were access to high quality and cheap drugs ( 96.1 % ) and feelings of social responsibility , ( 95.2 % ) . The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise , ( p<0.01 ) . These gains are sustained during the 3rd and 4th year of franchise membership , as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician ( p<0.01 ) . The net income of cohort 2009 increased significantly ( p=0.024 ) during their first two years in the franchise . The results for cohorts 2007 and 2005 also show a generalized trend in increasing income . Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services . The increases in client volumes translated directly into increases in earnings among the franchise members , an unanticipated effect for providers who joined in order to better serve the poor . This finding has implication s for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor . The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern . As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practice s , attention should be given towards avoiding commercialization of services Administrative data and experimental design s lead the way The medical profession has long recognized the importance of r and omized evaluations ; such design s are commonly used to evaluate the safety and efficacy of medical innovations such as drugs and devices . Unfortunately , innovations in how health care is delivered ( e.g. , health insurance structures , interventions to encourage the use of appropriate care , and care coordination approaches ) are rarely evaluated using r and omization . We consider barriers to conducting r and omized trials in this setting and suggest ways for overcoming them . R and omized evaluations of fundamental issues in health care policy and delivery should be— and can be — closer to the norm than the exception Background Intermittent iron-folic acid supplementation and regular de-worming are effective initiatives to reduce anemia , iron deficiency , iron deficiency anemia , and soil transmitted helminth infections in women of reproductive age . However , few studies have assessed the long-term effectiveness of population -based interventions delivered in re source -constrained setting s. Methodology /Principal Findings The objectives were to evaluate the impact of weekly iron-folic acid supplementation and de-worming on mean hemoglobin and the prevalence of anaemia , iron deficiency , and soil transmitted helminth infection in a rural population of women in northern Vietnam and to identify predictive factors for hematological outcomes . A prospect i ve cohort design was used to evaluate a population -based supplementation and deworming program over 54 months . The 389 participants were enrolled just prior to commencement of the intervention . After 54 months 76 % ( 95 % CI [ 68 % , 84 % ] ) were taking the iron-folic acid supplement and 95 % ( 95 % CI [ 93 % , 98 % ] ) had taken the most recently distributed deworming treatment . Mean hemoglobin rose from 122 g/L ( 95 % CI [ 120 , 124 ] ) to 131 g/L ( 95 % CI [ 128 , 134 ] ) and anemia prevalence fell from 38 % ( 95 % CI [ 31 % , 45 % ] ) to 18 % ( 95 % CI [ 12 % , 23 % ] ) ; however , results differed significantly between ethnic groups . Iron deficiency fell from 23 % ( 95 % CI [ 17 % , 29 % ] ) to 8 % ( 95 % CI [ 4 % , 12 % ] ) , while the prevalence of iron deficiency anemia was reduced to 4 % ( 95 % CI [ 1 % , 7 % ] ) . The prevalence of hookworm infection was reduced from 76 % ( 95 % CI [ 68 % , 83 % ] ) to 11 % ( 95 % CI [ 5 % , 18 % ] ) . The level of moderate or heavy infestation of any soil-transmitted helminth was reduced to less than 1 % . Conclusions / Significance Population -based interventions can efficiently and effectively reduce anemia and practically eliminate iron deficiency anemia and moderate to heavy soil transmitted helminth infections , maintaining them below the level of public health concern Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea . We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers , sodium hypochlorite water treatment solution , soap , and educational messages . Program participants were more likely to know correct water treatment procedures ( 62 % versus 27 % , P < 0.0001 ) , chlorinate drinking water ( 61 % versus 1 % , P < 0.0001 ) , demonstrate correct h and washing practice s ( 68 % versus 22 % , P < 0.0001 ) , and purchase water treatment solution after free distribution ( 32 % versus 1 % , P < 0.0001 ) . Among participants , 72 % had at least three antenatal visits , 76 % delivered in a health facility , and 54 % had a postnatal check . This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women . Participants had high use of antenatal , delivery , and postnatal services , which could improve maternal and child health Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries . We evaluated the impact of household water treatment , latrines , shallow wells , and rainwater harvesting on  diarrhoea incidence in rural Kenyan children . We compared diarrhoea rates in 960 children aged < 5 years in 556 households in 12 r and omly selected intervention villages and six r and omly selected comparison villages during weekly home visits over an 8-week period . On multivariate analysis , chlorinating stored water  [ relative risk ( RR ) 0.44 , 95 % confidence interval ( CI ) 0.28 - 0.69 ] , latrine presence ( RR 0.71 , 95 % CI 0.54 - 0.92 ) , rainwater use ( RR 0.70 , 95 % CI 0.52 - 0.95 ) , and living in an intervention village ( RR 0.31 , 95 % CI 0.23 - 0.41 ) , were independently associated with lower diarrhoea risk . Diarrhoea risk was higher among shallow well users ( RR 1.78 , 95 % CI 1.12 - 2.83 ) . Chlorinating stored water , latrines  , and  rainwater use all decreased diarrhoea risk ; combined interventions may have increased health impact β-Carotene-rich orange sweet potato ( OSP ) has been shown to improve vitamin A status of infants and young children in controlled efficacy trials and in a small-scale effectiveness study with intensive exposure to project inputs . However , the potential of this important food crop to reduce the risk of vitamin A deficiency in deficient population s will depend on the ability to distribute OSP vines and promote its household production and consumption on a large scale . In rural Mozambique , we conducted a r and omised , controlled effectiveness study of a large-scale intervention to promote household-level OSP production and consumption using integrated agricultural , dem and creation/behaviour change and marketing components . The following two intervention models were compared : a low-intensity ( 1 year ) and a high-intensity ( nearly 3 years ) training model . The primary nutrition outcomes were OSP and vitamin A intakes by children 6 - 35 months and 3 - 5·5 years of age , and women . The intervention result ed in significant net increases in OSP intakes ( model 1 : 46 , 48 and 97 g/d ) and vitamin A intakes ( model 1 : 263 , 254 and 492 μg retinol activity equivalents/d ) among the younger children , older children and women , respectively . OSP accounted for 47 - 60 % of all sweet potato consumed and , among reference children , provided 80 % of total vitamin A intakes . A similar magnitude of impact was observed for both models , suggesting that group-level trainings in nutrition and agriculture could be limited to the first project year without compromising impact . Introduction of OSP to rural , sweet potato-producing communities in Mozambique is an effective way to improve vitamin A intakes Background In 2011 , Cameroon and its health partners distributed over eight million free long-lasting insecticide treated nets ( LLINs ) in an effort to reduce the significant morbidity and mortality burden of malaria in the country . A national communications campaign was launched in July 2011 to ensure that as the nets were delivered , they would be used consistently to close a net use gap : only 51.6 % of adults and 63.4 % of their children in households with at least one net were sleeping under nets before the distribution . Even in households with at least one net for every two people , over 35 % of adults were not sleeping under a net . Malaria No More ( MNM ) adapted its signature NightWatch communications programme to fit within the coordinated “ KO Palu ” ( Knock Out Malaria ) national campaign . This study evaluates the impact of KO Palu NightWatch activities ( that is , the subset of KO Palu-br and ed communications that were funded by MNM ’s NightWatch program ) on bed net use . Methods Using national survey data collected at baseline ( in March/April  
    Output:
    
agent
***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: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting In 1997 to 1998 , Population Services International ( PSI ) carried out a targeted radio campaign in Mozambique to promote behavior change for the prevention of sexually transmitted infections ( STIs ) and HIV/AIDS . To evaluate the coverage and impact of the campaign , PSI design ed and implemented a cross-sectional study using a two-stage r and om sample of " at-risk " individuals ; 754 individuals between the ages of 13 and 49 were interviewed . Over half ( 52.4 % ) heard the campaign and 45.5 % recalled one or more radio messages . However , recall of specific messages in specific risk groups was low . A multivariate model demonstrates that among those exposed to the radio campaign , 97.2 % reported intent to change their sexual behavior compared with 62.8 % of those not exposed to the campaign ( p < .001 ) . Among those who recalled campaign messages , 86.1 % attempted to change their behavior compared with 58 % of those who had no message recall ( p < .001 ) . Success in changing behavior is significantly higher among those with message recall ( 83.8 % ) than those without ( 56.8 % , p < .001 ) . This study illustrates the difficulties in using radio to target a specific group with a corresponding behavior change message . Although general recall of campaign messages was high per target group , the campaign did not succeed in ensuring exposure to the intended target group . The strategy of airing all of the spots simultaneously with different but similar messages result ed in one spot " stepping on " another . Despite the limitations in using radio to target , exposure to the radio campaign has contributed to individual intent to change sexual behavior Background Evidence is emerging on the cost-effectiveness , quality and health coverage of social franchises . But little is known about the motivations of providers to join or remain within a social franchise network , or the impact that franchise membership has on client volumes or revenue earnings . Methods ( i ) Uncontrolled facility based of a r and om sample of 230 franchise members to assess self-reported motivations ; ( ii ) A 24 month prospect i ve cohort study of 3 cohorts of physicians who had been in the franchise for 4 years , 2 years and new members to track monthly case load and revenue generated . Results The most common reasons for joining the franchise were access to high quality and cheap drugs ( 96.1 % ) and feelings of social responsibility , ( 95.2 % ) . The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise , ( p<0.01 ) . These gains are sustained during the 3rd and 4th year of franchise membership , as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician ( p<0.01 ) . The net income of cohort 2009 increased significantly ( p=0.024 ) during their first two years in the franchise . The results for cohorts 2007 and 2005 also show a generalized trend in increasing income . Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services . The increases in client volumes translated directly into increases in earnings among the franchise members , an unanticipated effect for providers who joined in order to better serve the poor . This finding has implication s for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor . The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern . As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practice s , attention should be given towards avoiding commercialization of services Administrative data and experimental design s lead the way The medical profession has long recognized the importance of r and omized evaluations ; such design s are commonly used to evaluate the safety and efficacy of medical innovations such as drugs and devices . Unfortunately , innovations in how health care is delivered ( e.g. , health insurance structures , interventions to encourage the use of appropriate care , and care coordination approaches ) are rarely evaluated using r and omization . We consider barriers to conducting r and omized trials in this setting and suggest ways for overcoming them . R and omized evaluations of fundamental issues in health care policy and delivery should be— and can be — closer to the norm than the exception Background Intermittent iron-folic acid supplementation and regular de-worming are effective initiatives to reduce anemia , iron deficiency , iron deficiency anemia , and soil transmitted helminth infections in women of reproductive age . However , few studies have assessed the long-term effectiveness of population -based interventions delivered in re source -constrained setting s. Methodology /Principal Findings The objectives were to evaluate the impact of weekly iron-folic acid supplementation and de-worming on mean hemoglobin and the prevalence of anaemia , iron deficiency , and soil transmitted helminth infection in a rural population of women in northern Vietnam and to identify predictive factors for hematological outcomes . A prospect i ve cohort design was used to evaluate a population -based supplementation and deworming program over 54 months . The 389 participants were enrolled just prior to commencement of the intervention . After 54 months 76 % ( 95 % CI [ 68 % , 84 % ] ) were taking the iron-folic acid supplement and 95 % ( 95 % CI [ 93 % , 98 % ] ) had taken the most recently distributed deworming treatment . Mean hemoglobin rose from 122 g/L ( 95 % CI [ 120 , 124 ] ) to 131 g/L ( 95 % CI [ 128 , 134 ] ) and anemia prevalence fell from 38 % ( 95 % CI [ 31 % , 45 % ] ) to 18 % ( 95 % CI [ 12 % , 23 % ] ) ; however , results differed significantly between ethnic groups . Iron deficiency fell from 23 % ( 95 % CI [ 17 % , 29 % ] ) to 8 % ( 95 % CI [ 4 % , 12 % ] ) , while the prevalence of iron deficiency anemia was reduced to 4 % ( 95 % CI [ 1 % , 7 % ] ) . The prevalence of hookworm infection was reduced from 76 % ( 95 % CI [ 68 % , 83 % ] ) to 11 % ( 95 % CI [ 5 % , 18 % ] ) . The level of moderate or heavy infestation of any soil-transmitted helminth was reduced to less than 1 % . Conclusions / Significance Population -based interventions can efficiently and effectively reduce anemia and practically eliminate iron deficiency anemia and moderate to heavy soil transmitted helminth infections , maintaining them below the level of public health concern Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea . We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers , sodium hypochlorite water treatment solution , soap , and educational messages . Program participants were more likely to know correct water treatment procedures ( 62 % versus 27 % , P < 0.0001 ) , chlorinate drinking water ( 61 % versus 1 % , P < 0.0001 ) , demonstrate correct h and washing practice s ( 68 % versus 22 % , P < 0.0001 ) , and purchase water treatment solution after free distribution ( 32 % versus 1 % , P < 0.0001 ) . Among participants , 72 % had at least three antenatal visits , 76 % delivered in a health facility , and 54 % had a postnatal check . This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women . Participants had high use of antenatal , delivery , and postnatal services , which could improve maternal and child health Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries . We evaluated the impact of household water treatment , latrines , shallow wells , and rainwater harvesting on  diarrhoea incidence in rural Kenyan children . We compared diarrhoea rates in 960 children aged < 5 years in 556 households in 12 r and omly selected intervention villages and six r and omly selected comparison villages during weekly home visits over an 8-week period . On multivariate analysis , chlorinating stored water  [ relative risk ( RR ) 0.44 , 95 % confidence interval ( CI ) 0.28 - 0.69 ] , latrine presence ( RR 0.71 , 95 % CI 0.54 - 0.92 ) , rainwater use ( RR 0.70 , 95 % CI 0.52 - 0.95 ) , and living in an intervention village ( RR 0.31 , 95 % CI 0.23 - 0.41 ) , were independently associated with lower diarrhoea risk . Diarrhoea risk was higher among shallow well users ( RR 1.78 , 95 % CI 1.12 - 2.83 ) . Chlorinating stored water , latrines  , and  rainwater use all decreased diarrhoea risk ; combined interventions may have increased health impact β-Carotene-rich orange sweet potato ( OSP ) has been shown to improve vitamin A status of infants and young children in controlled efficacy trials and in a small-scale effectiveness study with intensive exposure to project inputs . However , the potential of this important food crop to reduce the risk of vitamin A deficiency in deficient population s will depend on the ability to distribute OSP vines and promote its household production and consumption on a large scale . In rural Mozambique , we conducted a r and omised , controlled effectiveness study of a large-scale intervention to promote household-level OSP production and consumption using integrated agricultural , dem and creation/behaviour change and marketing components . The following two intervention models were compared : a low-intensity ( 1 year ) and a high-intensity ( nearly 3 years ) training model . The primary nutrition outcomes were OSP and vitamin A intakes by children 6 - 35 months and 3 - 5·5 years of age , and women . The intervention result ed in significant net increases in OSP intakes ( model 1 : 46 , 48 and 97 g/d ) and vitamin A intakes ( model 1 : 263 , 254 and 492 μg retinol activity equivalents/d ) among the younger children , older children and women , respectively . OSP accounted for 47 - 60 % of all sweet potato consumed and , among reference children , provided 80 % of total vitamin A intakes . A similar magnitude of impact was observed for both models , suggesting that group-level trainings in nutrition and agriculture could be limited to the first project year without compromising impact . Introduction of OSP to rural , sweet potato-producing communities in Mozambique is an effective way to improve vitamin A intakes Background In 2011 , Cameroon and its health partners distributed over eight million free long-lasting insecticide treated nets ( LLINs ) in an effort to reduce the significant morbidity and mortality burden of malaria in the country . A national communications campaign was launched in July 2011 to ensure that as the nets were delivered , they would be used consistently to close a net use gap : only 51.6 % of adults and 63.4 % of their children in households with at least one net were sleeping under nets before the distribution . Even in households with at least one net for every two people , over 35 % of adults were not sleeping under a net . Malaria No More ( MNM ) adapted its signature NightWatch communications programme to fit within the coordinated “ KO Palu ” ( Knock Out Malaria ) national campaign . This study evaluates the impact of KO Palu NightWatch activities ( that is , the subset of KO Palu-br and ed communications that were funded by MNM ’s NightWatch program ) on bed net use . Methods Using national survey data collected at baseline ( in March/April  
    Output:
    