PERMETHRIN-TREATED BED NETS IN THE PREVENTION OF MALARIA AND ANEMIA IN ADOLESCENT SCHOOLGIRLS IN WESTERN KENYA

TJALLING LEENSTRA Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by TJALLING LEENSTRA in
Current site
Google Scholar
PubMed
Close
,
PENELOPE A. PHILLIPS-HOWARD Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by PENELOPE A. PHILLIPS-HOWARD in
Current site
Google Scholar
PubMed
Close
,
SIMON K. KARIUKI Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by SIMON K. KARIUKI in
Current site
Google Scholar
PubMed
Close
,
WILLIAM A. HAWLEY Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by WILLIAM A. HAWLEY in
Current site
Google Scholar
PubMed
Close
,
JANE A. ALAII Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by JANE A. ALAII in
Current site
Google Scholar
PubMed
Close
,
DANIEL H. ROSEN Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by DANIEL H. ROSEN in
Current site
Google Scholar
PubMed
Close
,
AGGREY J. OLOO Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by AGGREY J. OLOO in
Current site
Google Scholar
PubMed
Close
,
BERNARD L. NAHLEN Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by BERNARD L. NAHLEN in
Current site
Google Scholar
PubMed
Close
,
PIET A. KAGER Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by PIET A. KAGER in
Current site
Google Scholar
PubMed
Close
, and
FEIKO O. TER KUILE Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre for Vector Biology and Control, Research Kenya Medical Research Institute, Kisumu, Kenya; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by FEIKO O. TER KUILE in
Current site
Google Scholar
PubMed
Close
Restricted access

The impact of insecticide (permethrin)-treated bed nets (ITNs) on the health of adolescent schoolgirls was investigated during a community-based, randomized, controlled trial of ITNs in western Kenya. Two school-based cross-sectional surveys were conducted to determine the prevalence of malaria and anemia in 644 schoolgirls 12–18 years old in a rural area with intense perennial malaria transmission. In 12- and 13-year-old schoolgirls, ITNs were associated with a reduced prevalence of all cause anemia (hemoglobin level <12 g/dL, 16.9% versus 31.4%, adjusted odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.21, 0.69%) and a 0.34 g/dL (95% CI = 0.02, 0.66) increase in mean hemoglobin concentrations. No beneficial effect on all-cause anemia (adjusted OR = 0.79, 95% CI = 0.43, 1.45) or hemoglobin concentrations (difference in mean = 0.14 g/dL, 95% CI = −0.24, 0.53) was evident in older girls. In all age groups, no effect was found on malaria parasite prevalence or density, clinical malaria, all-cause morbidity, standard measures of nutritional status and growth, or the use of antimalarials and other medications. ITNs approximately halved the prevalence of mild anemia in young, school-attending, non-pregnant, adolescent girls, but had no impact in older girls or on other malaria-associated morbidity or nutritional status.

Author Notes

  • 1

    Alonso PL, Lindsay SW, Armstrong Schellenberg JR, Gomez P, Hill AG, David PH, Fegan G, Cham K, Greenwood BM, 1993. A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 2. Mortality and morbidity from malaria in the study area. Trans R Soc Trop Med Hyg 87 :13–17.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    D’Alessandro U, Olaleye BO, McGuire W, Langerock P, Bennett S, Aikins MK, Thomson MC, Cham MK, Cham BA, Greenwood BM, 1995. Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bed-net programme. Lancet 345 :479–483.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Binka F, Kubaje A, Adjuik M, Williams L, Lengeler C, Maude G, Armah G, Kajihara B, Adiamah J, Smith P, 1996. Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized controlled trial. Trop Med Int Health 1 :147–154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Nevill C, Some E, Mung’ala V, Mutemi W, New L, Marsh K, Lengeler C, Snow R, 1996. Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Health 1 :139–146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Habluetzel A, Diallo DA, Esposito F, Lamizana L, Pagnoni F, Lengeler C, Traore C, Cousens SN, 1997. Do insecticide-treated curtains reduce all-cause child mortality in Burkina Faso? Trop Med Int Health 2 :855–862.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Phillips-Howard PA, Nahlen BL, Kolczak MS, Hightower AW, ter Kuile FO, Alaii JA, Gimnig JE, Arudo J, Vulule JM, Odacha A, Kachur SP, Schoute E, Rosen DH, Sexton JD, Oloo AJ, Hawley WA, 2003. Efficacy of permethrin-treated bed nets in the prevention of mortality in young children in an area of high perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):23–29.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Armstrong Schellenberg JRM, 2001. Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania. Lancet 357 :1241–1247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg 60 :641–648.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    McElroy PD, Lal AA, Hawley WA, Bloland PB, Kuile FO, Oloo AJ, Harlow SD, Lin X, Nahlen BL, 1999. Analysis of repeated hemoglobin measures in full-term, normal birth weight Kenyan children between birth and four years of age. III. The Asemobo Bay Cohort Project. Am J Trop Med Hyg 61 :932–940.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Kurtis JD, Mtalib R, Onyango FK, Duffy PE, 2001. Human resistance to Plasmodium falciparum increases during puberty and is predicted by dehydroepiandrosterone sulfate levels. Infect Immun 69 :123–128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    McElroy PD, ter Kuile FO, Lal AA, Bloland PB, Hawley WA, Oloo AJ, Monto AS, Meshnick SR, Nahlen BL, 2000. Effect of Plasmodium falciparum parasitemia density on hemoglobin concentrations among full-term, normal birth weight children in western Kenya, IV. The Asembo Bay Cohort Project. Am J Trop Med Hyg 62 :504–512.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Barr F, Brabin L, Agbaje S, Buseri F, Ikimalo J, Briggs N, 1998. Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutr 1 :249–257.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Holding PA, Snow RW, 2001. Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence. Am J Trop Med Hyg 64 :68–75.

  • 14

    Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya. I: Development of infrastructure and description of study site. Am J Trop Med Hyg 68 (Suppl 4):3–9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Bloland PB, Ruebush TK, McCormick JB, Ayisi J, Boriga DA, Oloo AJ, Beach R, Hawley W, Lal A, Nahlen B, Udhayakumar V, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission I. Description of study site, general methodology, and study population. Am J Trop Med Hyg 60 :635–640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Beier JC, Oster CN, Onyango FK, Bales JD, Sherwood JA, Perkins PV, Chumo DK, Koech DV, Whitmire RE, Roberts CR, 1994. Plasmodium falciparum incidence relative to entomologic inoculation rates at a site proposed for testing malaria vaccines in western Kenya. Am J Trop Med Hyg 50 :529–536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, Phillips-Howard PA, Mathenge EM, ter Kuile FO, Nahlen BL, Hightower AW, Hawley WA, 2003. Impact of permethrin-treated bed nets on entomologic indices in an area of intense year round malaria transmission. Am J Trop Med Hyg 68 (Suppl 4):16–22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Bloland PB, Lackritz EM, Kazembe PN, Were JB, Steketee R, Campbell CC, 1993. Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J Infect Dis 167 :932–937.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Friedman JF, Phillips-Howard PA, Hawley WA, Terlouw DJ, Kolczak MS, Barber M, Okello N, Vulule JM, Duggan C, Nahlen BL, ter Kuile FO, 2003. Impact of permethrin-treated bed nets on growth, nutritional status, and body composition of primary school children in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):78–85.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki SK, Shi YP, Kachur SP, Hightower AW, Vulule JM, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya. II: Study design and methods. Am J Trop Med Hyg 68 (Suppl 4):10–15.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Alaii JA, Hawley WA, Kolczak MS, ter Kuile FO, Gimnig JE, Vulule JM, Odhacha A, Oloo AJ, Nahlen BL, Phillips-Howard PA, 2003. Factors affecting use of permethrin-treated bed nets during a randomized-controlled trial in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):137–141.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Kirkwood B, 1998. Essentials of Medical Statistics. Oxford, United Kingdom: Blackwell Science.

    • PubMed
    • Export Citation
  • 23

    Hightower AW, Ombok M, Otieno R, Odhiambo R, Oloo AJ, Lal AA, Nahlen BL, Hawley WA, 1998. A geographic information system applied to a malaria field study in western Kenya. Am J Trop Med Hyg 58 :266–272.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Bennett S, Woods T, Linyanage WM, Smith DL, 1991. A simplified general model for cluster-sample surveys of health in developing countries. World Health Stat Q 44 :98–106.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Tanner J, 1962. Growth at Adolescence: Oxford, United Kingdom: Blackwell Science.

    • PubMed
    • Export Citation
  • 26

    WHO Working Group, 1986. Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Org 64 :929–941.

  • 27

    UNICEF, 1998. The State of the World’s Children. Oxford, United Kingdom: Oxford University Press.

    • PubMed
    • Export Citation
  • 28

    Knight WB, Hiatt RA, Cline BL, Ritchie LS, 1976. A modification of the formol-ether concentration technique for increased sensitivity in detecting Schistosoma mansoni eggs. Am J Trop Med Hyg 25 :818–823.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Edson DC, Smith JW, 1982. Comparison of concentration procedures for detection of Schistosoma mansoni eggs in a CAP parasitology survey specimen. Am J Clin Pathol 78 :671–672.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Katz N, Chaves A, Pellegrino J, 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14 :397–400.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Shaker ZA, Hassan SI, el-Attar GM, Talaat M, el-Nahal HM, el-Behairy NM, Mansour MM, Kamel LM, 1994. Use of Kato and nucleopore techniques for qualitative diagnosis of schistosomiasis. J Egypt Soc Parasitol 24 :656–662.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    DeMaeyer E, Adiels-Tegman M, 1985. The prevalence of anaemia in the world. World Health Stat Q 38 :302–316.

  • 33

    WHO Expert Committee on Physical Status, 1995. Physical status: the use and interpretation of anthropometry. World Health Organ Tech Rep Ser 854.

    • PubMed
    • Export Citation
  • 34

    Kleinbaum D, 1994. Logistic Regression: A Self-Learning Text. New York: Springer-Verlag.

    • PubMed
    • Export Citation
  • 35

    Sutanto I, Pribadi W, Purnomo, Bandi R, Rusmiarto S, Atmosoedjono S, Freisleben HJ, 1999. Efficacy of permethrin-impregnated bed nets on malaria control in a hyperendemic area in Irian Jaya, Indonesia: differentiation between two age groups. Southeast Asian J Trop Med Public Health 30 :440–446.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Frood JD, 1971. Relationship between pattern of infection and development of hypoalbuminaemia and hypo-beta-lipo-protinaemia in rural Ugandan children. Lancet 2 :1047–1049.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Bradley-Moore AM, Greenwood BM, Bradley AK, Kirkwood BR, Gilles HM, 1985. Malaria chemoprophylaxis with chloroquine in young Nigerian children. III. Its effect on nutrition. Ann Trop Med Parasitol 79 :575–584.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Snow RW, Molyneux CS, Njeru EK, Omumbo J, Nevill CG, Muniu E, Marsh K, 1997. The effects of malaria control on nutritional status in infancy. Acta Trop 65 :1–10.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kolczak MS, Kariuki SK, Shi YP, Kwena AM, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria and all cause morbidity in young children in an area of intense perennial malaria transmission in western Kenya: Cross-sectional survey. Am J Trop Med Hyg 68 (Suppl 4):100–107.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    ter Kuile FO, Terlouw DJ, Kariuki SK, Phillips-Howard PA, Mirel LB, Hawley WA, Friedman JF, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria, anemia, and growth in infants in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):68–77.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Senderowitz J, 1995. Adolescent Health: Reassessing the Passage to Adulthood. World Bank Discussion Paper no. 272. Washington, DC: World Bank.

    • PubMed
    • Export Citation
  • 42

    Steketee RW, Nahlen BL, Parise ME, Menendez C, 2001. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 64 :28–35.

  • 43

    Harrison KA, 1985. Child-bearing, health and social priorities: a survey of 22 774 consecutive hospital births in Zaria, Northern Nigeria. Br J Obstet Gynaecol 92 :1–119.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Gimnig JE, Kolczak MS, Hightower AW, Vulule JM, Schoute E, Kamau L, Phillips-Howard PA, ter Kuile FO, Nahlen BL, Hawley WA, 2003. Effect of permethrin-treated bed nets on the spatial distribution of malaria vectors in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):115–120.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Hawley WA, Phillips-Howard PA, ter Kuile FO, Terlouw DJ, Vulule JM, Ombok M, Nahlen BL, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, 2003. Community-wide effects of permethrin-treated bed nets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):121–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Murray DM, 1998. Design and Analysis of Group-Randomized Trials. New York: Oxford University Press.

    • PubMed
    • Export Citation
  • 47

    Hawley WA, ter Kuile FO, Steketee RS, Nahlen BL, Trelouw DJ, Gimnig JE, Shi YP, Vulule JM, Alaii JA, Hightower AW, Kolczak MS, Kariuki SK, Phillips-Howard PA, 2003. Implications of the western Kenya insecticide-treated bed net study for policy, program implementation, and future research. Am J Trop Med Hyg 68 (Suppl 4):168–173.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kariuki SK, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Reduction of malaria during pregnancy by permethrin-treated bed nets in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):50–60.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Marchant T, Schellenberg JA, Edgar T, Nathan R, Abdulla S, Mukasa O, Mponda H, Lengeler C, 2002. Socially marketed insecticide-treated nets improve malaria and anaemia in pregnancy in southern Tanzania. Trop Med Int Health 7 :149–158.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50

    Fazio-Tirrozzo G, Brabin L, Brabin B, Agbaje O, Harper G, Broadhead R, 1998. A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire Valley, Southern Malawi. Eur J Clin Nutr 52 :637–642.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Cowan FM, Langhaug LF, Mashugupa GP, Nyamurera T, Hargrove J, Jaffar S, Peeling RW, Brown DW, Power R, Johnson AM, Stephenson JM, Bassett MT, Hayes RJ, 2002. School based HIV prevention in Zimbabwe: feasibility and acceptability of evaluation trials using biological outcomes. AIDS 16 :1673–1678.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52

    Hall A, Bobrow E, Brooker S, Jukes M, Nokes K, Lambo J, Guyatt H, Bundy D, Adjei S, Wen ST, Satoto, Subagio H, Rafiluddin MZ, Miguel T, Moulin S, de Graft Johnson J, Mukaka M, Roschnik N, Sacko M, Zacher A, Mahumane B, Kihamia C, Mwanri L, Tatala S, Lwambo N, Siza J, Khanh LN, Khoi HH, Toan ND, 2001. Anaemia in schoolchildren in eight countries in Africa and Asia. Public Health Nutr 4 :749–756.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 493 493 20
Full Text Views 3011 173 4
PDF Downloads 60 9 3
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save