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The Tumbuka term for malaria is phungu and this term was mostly mentioned by old men and women in the study area. They said that a child who has phungu vomits yellowish stuff kubokola nyongo ; , shivers quite a lot kunjenjemera chomene ; and has very high fever kotcha thupi ; , despite the fact that the child feels cold at the same time. Phungu, according to elderly informants, is caused by changes in habitation, for example, if the child stays with its family in the urban areas and they then go to their home village in the rural areas, the child would suffer from phungu since he has been exposed to a new environment where he drinks maji ya chilendo strange water ; . A number of cases were cited in which Malawian migrants working in the mines in Zambia and Zimbabwe had their children suffering from phungu upon returning to their rural Malawian homes. While they acknowledged that even adults suffered from phungu, they emphasised that children were the ones who were most vulnerable. In order to prevent phungu, they carried water from the urban areas which they mixed with water from the local sources which were in most cases rivers such a mixture was then given to the child to drink. Old men and women said that whenever they did this, children never suffered from phungu. In a UNICEF-commissioned ethnographic study on malaria, Matinga and Munthali reported that the term phungu is also used in Mzimba and Nkhata Bay districts where Tumbuka is also widely spoken Matinga and Munthali 2001 ; . While old men and women referred to malaria as phungu, most young men and women neither knew nor used this term. They referred to malaria as "malaria" in Tumbuka, as well as in English. Young men and women said that this is the word that they have always used. If someone were to ask the elderly for the Tumbuka term for malaria they would answer that it is phungu otherwise the term "malaria" is commonly used in western Rumphi and everyone understands it. Even the health workers said that the term they use is malaria. In 2002 some posters, which showed that malaria is phungu in Tumbuka, had been distributed and posted at the local health centre; possibly from now onwards and with publicity, people will start using the term phungu instead of malaria. During the in-depth interviews, mothers mentioned the disease malaria by its English name and at the same time attributed fever kotcha thupi ; to malaria. All the young women interviewed were able to mention the signs and symptoms of malaria namely kotcha thupi high body temperature ; , kubokola nyongo vomiting yellow stuff ; and kunjenjemera shivering ; , the same symptoms as elders mentioned for phungu. It was also learnt that whenever a child has fever, most, because clomipramine anafranil.
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Findings, the reduction in ventilation was mainly due to change in V T during the alphatheta transition Table 1; Fig. 2A ; . P ET, CO2 in post-transition was significantly elevated compared with pre-transition P 0.01, Table 1 ; . Figure 2A indicates that P ET, CO2 increased steadily, the increase being significant 45 breaths post-transition P 0.01 ; . SaO2 did not change significantly Table 1.
Like many companies in its peer group, a mid-size pharmaceutical manufacturer had very R&D-centric early commercialization processes. R&D Project Management was ultimately in charge of defining the product and clinical strategy with inputs from New Product Marketing. Reimbursement issues were largely overlooked until the year prior to launch, resulting in sub-par product positioning and market preparation. Capgemini was brought in by Managed Care to build a new process that would ensure the reimbursement perspective is built into product development and commercialization strategy early in development. After many interviews and workshops with both commercial and R&D stakeholders, it became obvious that the company needed to develop and communicate a long-term reimbursement strategy plan along with its product development plan to ensure payer needs were appropriately addressed and maximize future reimbursement potential. A cross-functional team, including Managed Care, New Product Marketing, and R&D was developed to drive the strategy. More importantly, processes were put in place so that recommendations for reimbursement strategy would be translated into evidence that matters to payers: adequate clinical and health economic end points and studies. The process is now being implemented. If everything goes according to plans, reimbursement, health economics and pricing considerations will be incorporated into product strategy as early as pre-clinical development. The company will then be equipped to make rationale decisions to fund the potentially larger clinical and or health economic studies required to demonstrate evidence-based differentiation to payers and chloroquine.
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