Suchergebnisse

From the 1980s on Somalia was in the grip of a looming civil war and formal institutions were weak and corrupt, which affected livestock exports. Livestock exports from northern Somalia, now Somaliland, resumed in the early 1990s in the absence of formal institutions and by late 1990, they were back in full swing. Some have made assumptions about the performance of informal institutions in the economy by interpreting the increase in the number of livestock exports from the port of Berbera in the absence of formal institutions to be an indicator of a performing post-war export sector. This study employs an institutional approach, informed by in-depth interviews and personal histories across a wide array of actors in the livestock export trade. Informal institutions have provided governance in the livestock export trade in the absence of formal institutions. However, coordination problems and other crippling challenges that have confronted livestock export since 1991 attest to the fact that informal institutions cannot be a substitute for formal institutions in the complex international trade. Somaliland had reinstated some formal institutions by the mid-1990s. However, the role of these institutions in the international livestock export trade is very limited due to their political status. Meanwhile, in the domestic economy, the interaction between formal and informal institutions has restructured the post-1991 livestock export trade.

Background: To expedite the development of new oral treatment regimens for visceral leishmaniasis (VL), there is a need for early markers to evaluate treatment response and predict long-term outcomes. Methods: Data from 3 clinical trials were combined in this study, in which Eastern African VL patients received various antileishmanial therapies. Leishmania kinetoplast DNA was quantified in whole blood with real-time quantitative polymerase chain reaction (qPCR) before, during, and up to 6 months after treatment. The predictive performance of pharmacodynamic parameters for clinical relapse was evaluated using receiver-operating characteristic curves. Clinical trial simulations were performed to determine the power associated with the use of blood parasite load as a surrogate endpoint to predict clinical outcome at 6 months. Results: The absolute parasite density on day 56 after start of treatment was found to be a highly sensitive predictor of relapse within 6 months of follow-up at a cutoff of 20 parasites/mL (area under the curve 0.92, specificity 0.91, sensitivity 0.89). Blood parasite loads correlated well with tissue parasite loads (ρ = 0.80) and with microscopy gradings of bone marrow and spleen aspirate smears. Clinical trial simulations indicated a > 80% power to detect a difference in cure rate between treatment regimens if this difference was high (> 50%) and when minimally 30 patients were included per regimen. Conclusions: Blood Leishmania parasite load determined by qPCR is a promising early biomarker to predict relapse in VL patients. Once optimized, it might be useful in dose finding studies of new chemical entities. ; This work was supported by the European Union Seventh Framework Programme Africoleish (grant number 305178); the World Health Organization—Special Programme for Research and Training in Tropical Diseases (WHO-TDR); the French Development Agency, France (grant number CZZ2062); UK aid, UK; the Federal Ministry of Education and Research through KfW, Germany; the Medicor Foundation, Liechtenstein; Médecins Sans Frontières, International; the Swiss Agency for Development and Cooperation (SDC), Switzerland (grant number 81017718); the Dutch Ministry of Foreign Affairs (DGIS), the Netherlands (grant number PDP15CH21); the French Ministry for Europe and Foreign Affairs (MEAE), France; The Rockefeller Foundation, USA; BBVA Foundation, Spain; the European Union—AfriKADIA project of the Second European and Developing Countries Clinical Trials Partnership Programme (EDCTP2) (grant number RIA2016S1635); and ZonMw/Dutch Research Council (NWO) Veni grant (project number 91617140 to T. P. C. D.). ; Sí