Life-threatening malaria in African children: a prospective study in a mesoendemic urban setting

BACKGROUND: The population exposed to malaria within African cities has steadily increased. However, comprehensive data on life-threatening malaria features and risk factors in children from urban areas with seasonal malaria transmission, such as in Bamako (Mali), are lacking. METHODS: Children admitted to the Gabriel Touré Hospital in Bamako with severe malarial anemia (SMA) and/or cerebral malaria (CM) were prospectively included in the study. Indicators of either SMA or CM were analyzed using logistic regression; and death hazard ratios (HRs) were estimated through survival analysis. RESULTS: The study included 455 children: 66% presented with CM, 34% with SMA, 3% with hypoglycemia (HG); 5% with dehydration; 17% with respiratory distress (RD); 25% with splenomegaly; and 92% with hepatomegaly. The children with CM were older than those with SMA. CM was more often associated with dehydration, HG, and RD, whereas SMA was more often associated with splenomegaly. The overall case fatality rate was 16%, and 94% of the children who died had CM. HG [HR: 2.37; 95% confidence interval (CI): 1.04-5.39; P = 0.040], RD (HR: 4.23; 95% CI: 2.46-7.30; P < 10(-6)) and a deep coma with a Blantyre score of less than 3 (HR: 6.78, 95% CI: 2.43-18.91; P < 10(-3)), were all independent predictors of death. CONCLUSIONS: These findings delineate the patterns of severe malaria in children in a West African mesoendemic urban setting. They validate practicable prognostic indicators of life-threatening malaria for use in the limited facilities available in African health centers and provide a frame of reference for further research addressing life-threatening malaria in this setting.     

The Atlas of human African trypanosomiasis: a contribution to global mapping of neglected tropical diseases

Background  

Following World Health Assembly resolutions 50.36 in 1997 and 56.7 in 2003, the World Health Organization (WHO) committed itself to supporting human African trypanosomiasis (HAT)-endemic countries in their efforts to remove the disease as a public health problem. Mapping the distribution of HAT in time and space has a pivotal role to play if this objective is to be met. For this reason WHO launched the HAT Atlas initiative, jointly implemented with the Food and Agriculture Organization of the United Nations, in the framework of the Programme Against African Trypanosomosis.     

Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso

We conducted a prospective evaluation of the “Rapid Scale-Up” (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.     

In Vivo Efficacy and Parasite Clearance of Artesunate + Sulfadoxine–Pyrimethamine Versus Artemether–Lumefantrine in Mali

Although artemisinin resistance has yet to be reported in Africa, surveillance of the efficacy of artemisinin-based combination therapies (ACTs) is warranted. Here, the efficacy of artesunate + sulfadoxine–pyrimethamine (AS+SP) and artemether–lumefantrine (AL) was evaluated in Mali. Randomized open-label comparative in vivo assay of AS+SP versus AL were carried out using the 28-day follow-up World Health Organization protocol. Patients with uncomplicated falciparum malaria and at least 6 months of age were recruited between October 2010 and January 2014. A subset of these patients was selected to measure Plasmodium falciparum clearance time. Polymerase chain reaction-corrected adequate clinical and parasitological responses were 100% for AS+SP and 98.2% for AL with no significant difference (P = 0.06). The reinfection rates were comparable (P = 0.63) with 8.0% for AS+SP and 12.6% for AL. Individuals under 8 years were more susceptible to treatment failure (relative risk = 1.9; 95% confidence interval = 1.2, 3.3). Median parasite clearance half-life was 1.7 hours (interquartile range [IQR] = 1.3–2.2) for AS+SP and 1.9 hours (IQR = 1.5–2.5) for AL with no statistically significant difference (P = 0.24). Efficacy of AS+SP and AL was high. This study provides baseline information on parasite clearance half-lives after ACT treatment, particularly AS+SP, in Mali.     

Stärkung von Gemeinschaften: Partizipative Forschung zu HIV-Prävention mit Migrant/innen

Background

Communities play a key role in health promotion, in the concept of structural prevention and also in participatory health research. Community-Based Participatory Research (CBPR) aims to equitably involve community partners in investigating problems, identifying resources and developing solutions in order to improve community health. The participating communities are supposed to benefit from the research collaboration. However, whether this aim is actually realized in practice is only rarely analyzed.

Aim

This article explores how the community partners benefited from participating in a CBPR study on HIV prevention with migrant communities in Germany (PaKoMi).

Methods

The PaKoMi-Project was a 3-year participatory research project which aimed to improve the involvement of migrant communities in HIV research and prevention services. It was conducted by the national association of community-based AIDS service organisations (Deutsche AIDS-Hilfe e. V.) in collaboration with partners from different immigrant communities, AIDS service providers and researchers from the Social Science Research Center Berlin (WZB). Community members were trained as peer researchers and supported to conduct local CBPR-projects (case studies) in four cities. In the final evaluation, the partners stated what they gained from collaborating in the project. The current analysis focuses on the benefits for the participating partners, their communities and the field of HIV prevention.

Results

Competences were developed by the participating individuals and community capacities were strengthened, for example by developing networks, peer-based initiatives and migrant self organisations. Concepts, tools and recommendations for improving HIV prevention services for migrants were developed.

Conclusions

The PaKoMi-project shows how communities can benefit from participatory research.     

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso

Progress towards reducing mortality and malnutrition among children?相似文献   

Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects]

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.     

Development and Characterization of PBSA-Based Green Composites in 3D-Printing by Fused Deposition Modelling

Fused deposition modelling is a rapidly growing additive manufacturing technology due to its ability to build functional parts with complex geometries. The mechanical properties of a built part depend on several process parameters. The effect of wood content on the properties of 3D printed parts has been studied. Four types of filaments using poly(butylene succinate-co-adipate) (PBSA) with different reinforcement levels of Typha stem powder 0%, 5%, 10%, and 15% by weight were used for 3D printing. The density of the filaments and parts printed in this study increased with the Typha stem powder content. The thermal stability, mechanical performance, and viscoelastic properties of the different biocomposite filaments and 3D printed objects were analysed. The results show an increase in the crystallisation kinetics and a slight decrease in the thermal stability of the biomaterials. Compared to virgin PBSA FDM filaments, the PBSA biocomposite filament filled with Typha stem powder showed an increase in the tensile strength of the parts and specimens from 2.5 MPa to 8 MPa and in the modulus of elasticity from 160 MPa to 375 MPa, respectively, with additions of 5%, 10%, and 15% by mass. The addition of Typha stem fibres generated an increase in the elastic behaviour and relaxation time of the biomaterial structure, visualised by increases in the values of the viscosity components. The surface morphology reveals a decrease in the porosity of the printed samples.     

Importation and Circulation of Vaccine-Derived Poliovirus Serotype 2, Senegal, 2020–2021

Environmental surveillance for poliovirus is increasingly used in poliovirus eradication efforts as a supplement to acute flaccid paralysis (AFP) surveillance. Environmental surveillance was officially established in 2017 in Senegal, where no poliovirus had been detected since 2010. We tested sewage samples from 2 sites in Dakar monthly for polioviruses. We identified a vaccine-derived poliovirus serotype 2 on January 19, 2021, from a sample collected on December 24, 2020; by December 31, 2021, we had detected 70 vaccine-derived poliovirus serotype 2 isolates circulating in 7 of 14 regions in Senegal. Sources included 18 AFP cases, 20 direct contacts, 17 contacts in the community, and 15 sewage samples. Phylogenetic analysis revealed the circulation of 2 clusters and provided evidence on the virus introduction from Guinea. Because novel oral polio vaccine serotype 2 was used for response activities throughout Senegal, we recommend expanding environmental surveillance into other regions.