Factors influencing rapid progress in child health in post-conflict Liberia: a mixed methods country case study on progress in child survival, 2000-2013.

OBJECTIVES: Only 12 countries in the WHO's African region met Millennium Development Goal 4 (MDG 4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country mixed methods study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia was selected for an in-depth case study due to its success in reducing under-five mortality by 73% and thus successfully meeting MDG 4. Liberia's success was particularly notable given the civil war that ended in 2003. We examined some factors contributing to their reductions in under-five mortality. DESIGN: A case study mixed methods approach drawing on data from quantitative indicators, national documents and qualitative interviews was used to describe factors that enabled Liberia to rebuild their maternal, neonatal and child health (MNCH) programmes and reduce under-five mortality following the country's civil war. SETTING: The interviews were conducted in Monrovia (Montserrado County) and the areas in and around Gbarnga, Liberia (Bong County, North Central region). PARTICIPANTS: Key informant interviews were conducted with Ministry of Health officials, donor organisations, community-based organisations involved in MNCH and healthcare workers. Focus group discussions were conducted with women who have experience accessing MNCH services. RESULTS: Three prominent factors contributed to the reduction in under-five mortality: national prioritisation of MNCH after the civil war; implementation of integrated packages of services that expanded access to key interventions and promoted intersectoral collaborations; and use of outreach campaigns, community health workers and trained traditional midwives to expand access to care and improve referrals. CONCLUSIONS: Although Liberia experiences continued challenges related to limited resources, Liberia's effective strategies and rapid progress may provide insights for reducing under-five mortality in other post-conflict settings.

Comparison of Gd-BOPTA with Gd-DTPA in MR imaging of rat liver.

A new lipophilic compound, gadolinium benzyloxypropionictetraacetate (BOPTA), with a high rate of biliary excretion was assessed as a magnetic resonance (MR) hepatospecific contrast-enhancing agent and compared with Gd-DTPA (diethylenetriaminepentaacetic acid) in MR imaging of normal rats. T1-weighted spin-echo images obtained before and after administration of each contrast agent at doses of 0.25, 0.5, and 1.0 mmol/kg showed greater enhancement of the liver with Gd-BOPTA than with Gd-DTPA, with the advantage more evident at lower doses. Images obtained with an inversion recovery sequence at the null value of rat liver parenchyma after injection of 0.1- and 0.5-mmol/kg doses of the contrast agent provided better evidence of the greater and longer-lasting hepatic enhancement due to Gd-BOPTA when compared with that of Gd-DTPA. Gd-BOPTA is a potentially good contrast agent for obtaining prolonged enhancement of the liver, permitting studies during the long time needed to acquire conventional T1-weighted images.

[A comparative study between Gd-BOPTA, a biliary excretion contrast medium, and Gd-DTPA in the magnetic resonance imaging of the rat liver]. / Studio comparativo tra Gd-BOPTA, mezzo di contrasto ad escrezione biliare, e Gd-DTPA nell'imaging a Risonanza Magnetica del fegato di ratto.

A new lipophilic compound, Gd-BOPTA, presenting a high rate (38.6%) of biliary excretion was tested as an hepato-specific MR contrast agent. Its adequacy was compared to that of Gd-DTPA in laboratory animals. T1-weighted spin-echo sequences (TR 220 ms, TE 20 ms) both before and after the administration of the 2 contrast agents (doses: 0.25, 0.5, and 1.0 mmol/kg) showed better liver enhancement with Gd-BOPTA than with Gd-DTPA. Gd-BOPTA superiority was more evident at lower doses, while at 1.0 mmol/kg a comparable enhancement was achieved. Inversion recovery sequence at the T-null of liver parenchyma before contrast (TR 800 ms, TE 30 ms, TI 100 ms) was performed after the injection of 0.1 and 0.5 mmol/kg of Gd-DTPA and Gd-BOPTA. This sequence allowed the good and long-lasting liver enhancement achieved with Gd-BOPTA to be even better demonstrated, while Gd-DTPA provided only a slight and early enhancement with 0.1 mmol/kg and returned to baseline values 60' after the injection of the highest dose (0.5 mmol/kg). Gd-BOPTA proved to be a good contrast agent to obtain prolonged liver enhancement, thus providing the radiologist with the long time needed to acquire conventional T1-weighted pulse sequences.

A liposomal contrast agent. Preliminary communication.

Iopamidol-carrying liposomes were studied as potential hepatosplenographic contrast agents. Large unilamellar vesicles (0.3-1 mu) prepared from phosphatidylcholine:Dipalmotylphosphatidic acid (PC:DPPA) 9:1 and 300 MgI/mL iopamidol solution showed favorable entrapment measured as mg entrapped iodine/mg lipids (I/L). The effect of extrusion through polycarbonate membranes on liposome characteristics and in vivo distribution was investigated. Extrusion above the transition temperature of lipids reduced the average size and size distribution and increased the I/L ratio. Distribution studies of extruded and nonextruded liposomes in rats demonstrated different behavior of the preparations; extruded liposomes showed higher spleen uptake than did unextruded, while liver uptake was comparable; lung entrapment, observed with unextruded particles, was almost eliminated with extruded liposomes. Preliminary imaging studies in rats were carried out at a dose of 250 mgI/kg; typical computed tomography (CT) scans of the liver demonstrated contrast enhancement of greater than or equal to 60 HU from 90' up to 240' after injection.