Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, Engineering Systems Division, 2015. / Cataloged from PDF version of thesis. / Includes bibliographical references (pages 162-168). / Diagnosis of malaria is important in order to ensure early and effective treatment, to facilitate public health surveillance, and to prevent drug resistance. Rapid diagnostic tests (RDTs) are an important tool in resource-constrained settings, as they do not rely on costly lab equipment and specially trained personnel. In Uganda's private sector clinics and drug shops, which is where the majority of patients first seek care, diagnosis of malaria is often presumptive and patients receive neither RDT nor microscopy. Several studies have focused on the patient perspective (e.g. willingness to pay and willingness to be tested) but much less is understood about the supplier perspective (e.g. willingness to stock). This study aimed to understand the preferences and priorities of agents across the malaria RDT supply chain in Uganda on stocking the devices using multi-criteria decision analysis. This methodology was adapted to be relevant and understandable for agents in Uganda so that it was possible to analyze business decisions incorporating a multiplicity of attributes such as selling price, purchase cost, sales volume, complexity of regulations, waste management, and training available. Data surveys and semistructured interviews were collected from 28 private sector retailers (i.e., shopkeepers, pharmacists, clinic managers), two first line buyers, and three distributors. Analysis of the data resulted in the construction of value functions for all agents, the relative weights (therefore the tradeoffs) among decision criteria, and the calculation of an overall value for the decision about whether or not to stock RDTs for the different supply chain agents. Results indicate that the best option for one level of the supply chain is not necessarily the best for another. A discussion offers insights on how to align value across the supply chain, which is important for facilitating public health interventions. / by Corinne M. Carland. / S.M. in Technology and Policy

Le paludisme est un problème de santé public dans de nombreux pays. Cinq espèces infectent l'homme : P. falciparum, responsable de la grande majorité des décès, et P. vivax, P. ovale, P. malariae et P. knowlesi qui provoquent des formes bénignes de la maladie. Le diagnostic qui fait partie des moyens de lutte, est une urgence médicale. Les tests de diagnostic rapides (TDRs) dont l'usage est recommandés par l'OMS, sont donc de plus en plus employés. Cependant, la détection et l'identification des espèces non P. falciparum par ces tests est insuffisante. Le besoin en nouveaux couples « antigènes-anticorps » est une nécessité pour améliorer les TDRs. Au cours de ce travail, de nouveaux anticorps anti LDH de P.malariae ont été produits.Une recherche de nouveaux antigènes a également été entreprise. Pour cela, certaines enzymes de la voie de la glycolyse ont été étudiées. Pour la première fois des séquences des enzymes de cette voie ont été obtenues pour P. ovale et P. malariae. Elles ont permis de déterminer de nombreux épitopes cibles potentiels spécifiques et ceux communs à toutes les espèces. Dans un deuxième temps, une recherche en protéomique a été menée pour identifier des biomarqueurs parasitaires. L'étude du culot globulaire et du plasma de patients infectés a permis la sélection de 8 protéines cibles originales. Ces travaux préparent la fabrication et la commercialisation par la société Whidiag d'une nouvelle génération de TDRs pour le paludisme. / Malaria is a public health problem in many countries. Five species infect humans: P. falciparum, responsible for the vast majority of deaths, and P. vivax, P. ovale, P. malariae and P. knowlesi causing mild forms of the disease. The diagnostic is a means of control and a medical emergency. The rapid diagnostic tests (RDT) whose are recommended by WHO, are increasingly used. However, the detection and identification of not P. falciparum species is insufficient. New "antigen-antibody" couples are a need to improve the RDTs performance. In this work, new anti LDH antibodies from P. malariae were produced. A search for new antigens was also undertaken. For this purpose, some enzyme of glycolysis pathway were studied. For the first time the sequences of the enzymes from this pathway were obtained for P. ovale and P. malariae. We identified many potential target epitopes specific and common to all those species. In a second step, a proteomics approches has been conducted to identify parasites biomarkers. The study of red blood cells and plasma of infected patients has led to the selection of 8 original target proteins. This work prepares the manufacturing and marketing of a new generation of RDTs for malaria by the company Whidiag