Mobile Money and the importance of timely, complete payments to frontline health campaign workers in the fight to eradicate polio: pilot experience from a World Health Organization digital payment platform in Africa.

BACKGROUND: In response to the increase in vaccine-derived poliovirus type 2 in Côte d'Ivoire, Mali, and many other African countries from 2017 to 2019, concentrated efforts are needed to improve the effectiveness of vaccination campaigns. Frontline polio health campaign worker engagement and job retention are critical to successful campaign implementation, as well as timely, in-full payment to these workers via an electronic system. METHODS: The Global Polio Eradication Initiative and its partners designed a road map to implement the World Health Organization Mobile Money digital payment system for health campaign workers across designated African Region countries and country-specific areas. The road map included: (1) strategy communication about Mobile Money to key stakeholders; (2) prioritization of Mobile Money pilot countries; (3) establishment of a digital finance team to support Mobile Money rollout for polio campaigns; (4) implementation of Mobile Money in select pilot areas; and (5) documentation by the digital finance team of Mobile Money implementation across pilot areas. At the country-specific level, and as described in the first pilot campaign in Côte d'Ivoire, implementation of Mobile Money occurred in 3 phases: precampaign, campaign, and postcampaign. RESULTS: Mobile Money was piloted in Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Mali, and Republic of the Congo. Although program reach varied by country, the percentages of payments successfully made via Mobile Money in pilot countries were high: In campaign round 1, 99% of campaign workers in 2 regions in Mali, and 99% of campaign workers in 5 districts in Ghana were paid successfully. In Cote d'Ivoire, Mobile Money was piloted in all 113 districts for campaign rounds 1, 2 and 3, and in 4 districts in Abidjan for campaign round 3. In rounds 1, 2 and 3, 99.6%, 99.6%, and 99.9% of payments to polio health campaign workers, respectively, were made successfully. CONCLUSION: Implementation of the Mobile Money pilot program, particularly across Côte d'Ivoire, demonstrates the value of an electronic payment system in addressing frontline polio health campaign worker need for timely, in-full payment. The World Health Organization-led Mobile Money pilot program can serve as a model for agencies committed to delivering greater efficiencies and improved health campaigns in resource-challenged settings.

[Myocardial infarction in patients with diabetes: comparative series of 85 patients with 16 patients without diabetes]. / Infarctus du myocarde chez le diabétique: présentation d'une série de 85 patients diabétiques comparée à 106 patients non diabétiques.

OBJECTIVES: The aim of this study was to determine the clinical characteristics, treatment and development of myocardial infarction in patients with diabetes. METHODS: From September 1999 through December 2003, 191 patients with myocardial infarction were hospitalized in the cardiology department of the Mohamed V military teaching hospital in Rabat, Morocco. They included 85 patients with diabetes (D) and 106 without it (ND). RESULTS: Comparison of these two groups showed a higher percentage of women among the patients with diabetes. Hypertension was more frequent in patients with diabetes, while smoking was frequent in both groups. The clinical picture was similar in both groups, as was the frequency of left ventricular dysfunction, determined by transthoracic echocardiography. Coronary angiography showed damage in three arteries was more common in the D group, while single-artery damage was more frequent in the ND group. Treatment was similar in both groups. In all, 49 patients underwent myocardial revascularization, and its method (angioplasty or aortic surgery) did not differ by group. Neither hospital mortality nor other complications differed between the two groups, with a follow-up of 3.98 +/- 1.99 years for ND patients and 2.68 +/- 1.32 years for D patients. CONCLUSION: Correct management of myocardial infarction and its cardiovascular risk factors, development of means of revascularization, and close collaboration between cardiologists and endocrinologists should improve prognosis for patients with diabetes who have myocardial infarctions.

Effect of low-dose perindopril/indapamide on albuminuria in diabetes: preterax in albuminuria regression: PREMIER.

Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP > or =140 mm Hg, <180 mm Hg, diastolic BP <110 mm Hg) were randomly assigned (age 59+/-9 years, 77% previously treated for hypertension). Results from 457 patients (intention-to-treat analysis) were available. After a 4-week placebo period, patients with albuminuria >20 and <500 microg/min were randomly assigned to a combination of 2 mg perindopril/0.625 mg indapamide or to 10 mg daily enalapril. After week 12, doses were adjusted on the basis of BP to a maximum of 8 mg perindopril/2.5 mg indapamide or 40 mg enalapril. The main outcome measures were overnight AER and supine BP. Both treatments reduced BP. Perindopril/indapamide treatment resulted in a statistically significant higher fall in both BP (-3.0 [95% CI -5.6, -0.4], P=0.012; systolic BP -1.5 [95% CI -3.0, -0.1] diastolic BP P=0.019) and AER -42% (95% CI -50%, -33%) versus -27% (95% CI -37%, -16%) with enalapril. The greater AER reduction remained significant after adjustment for mean BP. Adverse events were similar in the 2 groups. Thus, first-line treatment with low-dose combination perindopril/indapamide induces a greater decrease in albuminuria than enalapril, partially independent of BP reduction. A BP-independent effect of the combination may increase renal protection.