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Title: Family planning and the MDGs: Saving lives, saving resources.
Author: Futures Group International. Health Policy Initiative
Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Jun. 8 p.
Abstract: The USAID | Health Policy Initiative, Task Order 1, has completed and updated analyses for more than 30 countries that demonstrate the significant contribution of family planning (FP) to achievement of the Millennium Development Goals (MDGs). Family planning helps to improve health outcomes (e.g., fewer maternal and child deaths) and reduce costs for meeting the MDGs (by reducing the size of the target populations in need of services). This case study describes the FP-MDG analysis methodology and provides examples of how the findings have been used to support advocacy and policy change. Briefs on country-specific findings are also available online. The FP-MDG analyses and briefs are flexible, evidenced-based tools that help make the case that family planning is a strong complement to -- rather than a trade-off with -- other health, development, and poverty-reduction efforts. By showing the economic benefits of investing in family planning, the FP-MDG analyses and briefs can also reach diverse audiences that might not traditionally champion FP issues.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | WOMEN | FAMILY PLANNING | NEEDS | PREGNANCY, UNPLANNED | FAMILY SIZE, DESIRED | HEALTH SERVICES | POVERTY | MALARIA | DISEASE PREVENTION | Demographic Factors | Population | Economic Factors | Reproductive Behavior | Fertility | Population Dynamics | Family Size | Family Characteristics | Family and Household | Sociocultural Factors | Delivery of Health Care | Health | Socioeconomic Factors | Parasitic Diseases | Diseases | Prevention and Control
Document Number: 331540

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Peer Reviewed

Title: Socioeconomic and environmental factors important for acquiring non-severe malaria in children in Yemen: a case-control study.
Author: Al-Taiar A; Assabri A; Al-Habori M; Azazy A; Algabri A; Alganadi M; Whitty CJ; Jaffar S
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jan;103(1):72-8.
Abstract: Little is known about the relative importance of environmental and socioeconomic factors for acquiring malaria in Yemen. A case-control study was conducted to determine the importance of these factors for acquiring malaria among children in Yemen. Cases of non-severe malaria were recruited from health centres; community controls were from the neighbourhood of the cases. Data were collected by personal interview and direct inspection during home visits. In total, 320 cases and 308 controls were recruited. In the multivariate analysis, environmental factors (living near streams and freshwater marshes), earth roofs of houses and history of travel were all significantly and positively associated with the occurrence of malaria, whilst regular spraying with insecticides at home was a protective factor. There was no association with socioeconomic factors, including crowding, education and occupation of parents, and ownership of house assets. An index created based on a number of indicators of wealth showed a significant association with malaria in the univariate analysis but was not significant in the multivariate analysis. Control activities can be targeted on identifiable environmental factors such as stream and freshwater marshes, although this needs further investigation. Extra protective measures may be needed by all those who travel in Yemen.
Language: English
Keywords:
YEMEN | MIDDLE EAST | RESEARCH REPORT | CASE STUDIES | CHILDREN | MALARIA | SOCIOECONOMIC FACTORS | RISK FACTORS | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Economic Factors | Health
Document Number: 330835

Peer Reviewed

Title: Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso.
Author: Baragatti M; Fournet F; Henry MC; Assi S; Ouedraogo H; Rogier C; Salem G
Source: Malaria Journal. 2009;8:13.
Abstract: BACKGROUND: Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas. METHODS: The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas. RESULTS: Overall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou. CONCLUSION: Malaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network. Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | URBAN AREAS | RURAL AREAS | CHILDREN | MALARIA | TRANSMISSION | ANTIBODIES | RISK FACTORS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Infections | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Health
Document Number: 330546

Peer Reviewed

Title: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria.
Author: Berkley JA; Bejon P; Mwangi T; Gwer S; Maitland K; Williams TN; Mohammed S; Osier F; Kinyanjui S; Fegan G; Lowe BS; English M; Peshu N; Marsh K; Newton CR
Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):336-43.
Abstract: BACKGROUND: Human immunodeficiency virus (HIV) infection, malnutrition, and invasive bacterial infection (IBI) are reported among children with severe malaria. However, it is unclear whether their cooccurrence with falciparum parasitization and severe disease happens by chance or by association among children in areas where malaria is endemic. METHODS: We examined 3068 consecutive children admitted to a Kenyan district hospital with clinical features of severe malaria and 592 control subjects from the community. We performed multivariable regression analysis, with each case weighted for its probability of being due to falciparum malaria, using estimates of the fraction of severe disease attributable to malaria at different parasite densities derived from cross-sectional parasitological surveys of healthy children from the same community. RESULTS: HIV infection was present in 133 (12%) of 1071 consecutive parasitemic admitted children (95% confidence interval [CI], 11%-15%). Parasite densities were higher in HIV-infected children. The odds ratio for admission associated with HIV infection for admission with true severe falciparum malaria was 9.6 (95% CI, 4.9-19); however, this effect was restricted to children aged 1 year. Malnutrition was present in 507 (25%) of 2048 consecutive parasitemic admitted children (95% CI, 23%-27%). The odd ratio associated with malnutrition for admission with true severe falciparum malaria was 4.0 (95% CI, 2.9-5.5). IBI was detected in 127 (6%) of 2048 consecutive parasitemic admitted children (95% CI, 5.2%-7.3%). All 3 comorbidities were associated with increased case fatality. CONCLUSIONS: HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area.
Language: English
Keywords:
KENYA | RESEARCH REPORT | CONTROL GROUPS | MULTIVARIATE ANALYSIS | CHILDREN | MALARIA | SIGNS AND SYMPTOMS | HIV INFECTIONS | MALNUTRITION | BACTERIAL AND FUNGAL DISEASES | CASE FATALITY RATE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Nutrition Disorders | Infections | Death Rate | Mortality | Population Dynamics
Document Number: 342633

Title: Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.
Author: Birx D; de Souza M; Nkengasong JN
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):849-51.
Abstract: Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | MALARIA | LABORATORY | NEEDS | INTEGRATED PROGRAMS | HUMAN RESOURCES | LOGISTICS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Viral Diseases | Diseases | Infections | Parasitic Diseases | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Management | Training Programs | Education | Research Methodology
Document Number: 341768

Peer Reviewed

Title: Impact of Plasmodium falciparum infection on the frequency of moderate to severe anaemia in children below 10 years of age in Gabon.
Author: Bouyou-Akotet MK; Dzeing-Ella A; Kendjo E; Etoughe D; Ngoungou EB; Planche T; Koko J; Kombila M
Source: Malaria Journal. 2009 Jul 20;8(1):166.
Abstract: ABSTRACT: BACKGROUND: Improving the understanding of childhood malarial anaemia may help in the design of appropriate management strategies. METHODS: A prospective observational study was conducted over a two-year period to assess the burden of anaemia and its relationship to Plasmodium falciparum infection and age in 8,195 febrile Gabonese children. RESULTS: The proportion of children with anaemia was 83.6% (n=6830), higher in children between the ages of six and 23 months. Those under three years old were more likely to develop moderate to severe anaemia (68%). The prevalence of malaria was 42.7% and P. falciparum infection was more frequent in children aged 36-47 months (54.5%). The proportion of anaemic children increased with parasite density (p<0.01). Most of infected children were moderately to severely anaemic (69.5%, p<0.01). Infants aged from one to 11 months had a higher risk of developing severe malarial anaemia. In children over six years of age, anaemia occurrence was high (>60%), but was unrelated to P. falciparum parasitaemia. CONCLUSION: Malaria is one of the main risk factors for childhood anaemia which represents a public health problem in Gabon. The risk of severe malarial anaemia increases up the age of three years. Efforts to improve strategies for controlling anaemia and malaria are needed.
Language: English
Keywords:
GABON | RESEARCH REPORT | PROSPECTIVE STUDIES | CHILDREN | MALARIA | ANEMIA | PREVALENCE | FEVER | RISK FACTORS | AGE FACTORS | HEMOGLOBIN LEVEL | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Measurement | Body Temperature | Physiology | Biology | Health | Hemic System
Document Number: 342284

Title: Placental malaria, maternal HIV infection and infant morbidity.
Author: Briand V; Badaut C; Cot M
Source: Annals of Tropical Paediatrics. 2009 Jun;29(2):71-83.
Abstract: Co-infection with malaria and HIV in pregnant women is particularly common in sub-Saharan Africa and has serious consequences for both mother and newborn child. Numerous studies have been published on the effects in pregnancy of HIV on malaria infection and on the effects of malaria on HIV infection. The increased prevalence and intensity of parasitaemia (placental and peripheral infection and parasite density) in HIV-infected women is well established. Similarly, malaria infection seems to be associated with higher viral loads. However, there is still uncertainty as to the influence of malaria on the clinical course of HIV infection, mother-to-child transmission of HIV, and the consequences of co-infection on post-neonatal infant morbidity and mortality. These questions require further investigation. In terms of prevention, intermittent preventive treatment with two doses of sulfadoxine-pyrimethamine (SP) has been found less effective in preventing malaria in HIV-infected than uninfected women, and a higher dosage (such as monthly SP) has been recommended. Regarding malaria, there is also a lack of clear recommendations for women taking daily cotrimoxazole prophylaxis, and anti-malarial-anti-retroviral interactions are not well understood. Multi-centre clinical trials should be undertaken to investigate effective, coherent and well-tolerated strategies to prevent malaria in HIV-infected women. Safe alternatives to SP should be identified and evaluated rapidly. Finally, a central pharmaco-vigilance network should be instituted to report adverse effects.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | MALARIA | HIV INFECTIONS | MALARIA PREVENTION | RESEARCH AND DEVELOPMENT | NEEDS | MATERNAL HEALTH | MORBIDITY | Africa | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Technology | Economic Factors | Health
Document Number: 342065

Peer Reviewed

Title: Community-based environmental management for malaria control: evidence from a small-scale intervention in Dar es Salaam, Tanzania.
Author: Castro MC; Tsuruta A; Kanamori S; Kannady K; Mkude S
Source: Malaria Journal. 2009;8:57.
Abstract: BACKGROUND: Historically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains. METHODS: A survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages. RESULTS: Individual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05-0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1-2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success. CONCLUSION: Although environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development.
Language: English
Keywords:
TANZANIA | URBAN AREAS | RESEARCH REPORT | MALARIA PREVENTION | VECTOR CONTROL | INTERVENTIONS | SANITATION | MALARIA | PREVALENCE | COMMUNITY PARTICIPATION | POLITICAL FACTORS | FINANCIAL ACTIVITIES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Parasitic Diseases | Diseases | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Public Health | Health | Measurement | Research Methodology | Sociocultural Factors | Economic Factors
Document Number: 341983

10.
Title: Increased risk for severe malaria in HIV-1-infected adults, Zambia.
Author: Chalwe V; Van geertruyden JP; Mukwamataba D; Menten J; Kamalamba J; Mulenga M; D'Alessandro U
Source: Emerging Infectious Diseases. 2009 May;15(5):749; quiz 858.
Abstract: To determine whether HIV-1 infection and HIV-1-related immunosuppression were risk factors for severe malaria in adults with some immunity to malaria, we conducted a case-control study in Luanshya, Zambia, during December 2005-March 2007. For each case-patient with severe malaria, we selected 2 matched controls (an adult with uncomplicated malaria and an adult without signs of disease). HIV-1 infection was present in 93% of case-patients, in 52% of controls with uncomplicated malaria, and in 45% of asymptomatic controls. HIV-1 infection was a highly significant risk factor for adults with severe malaria compared with controls with uncomplicated malaria (odds ratio [OR] 12.6, 95% confidence interval [CI] 2.0-78.8, p = 0.0005) and asymptomatic controls (OR 16.6, 95% CI 2.5-111.5, p = 0.0005). Persons with severe malaria were more likely to have a CD4 count <350/microL than were asymptomatic controls (OR 23.0, 95% CI 3.35-158.00, p<0.0001).
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | IMMUNOLOGICAL EFFECTS | MALARIA | RISK FACTORS | ANTIMALARIAL DRUGS | SIGNS AND SYMPTOMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Parasitic Diseases | Health
Document Number: 341944

11.

Title: Prenatal origins of undernutrition.
Author: Christian P
Source: Nestle Nutrition Workshop Series. Paediatric Programme. 2009;63:59-73; discussion 74-7, 259-68.
Abstract: Undernutrition continues to be high in many regions of the developing world. Birthweight, a common proxy measure of intrauterine growth, is influenced by nutritional, environmental and lifestyle factors during pregnancy and, in turn, affects immediate survival and function, and is a determinant of later life risk of chronic diseases. Maternal pre-pregnancy weight and height are independently associated with birthweight and also modify the effects of pregnancy weight gain and interventions during pregnancy on birthweight and perinatal mortality. Other prenatal factors commonly known to impact birthweight include maternal age, parity, sex, and birth interval, whereas lifestyle factors such as physical activity and maternal stress, as well as environmental toxicants have variable influences. Tobacco and other substance use and infections, specifically ascending reproductive tract infections, malaria, and HIV, can cause intrauterine growth restriction (IUGR). Few studies have examined the contribution of prenatal factors including low birthweight to childhood wasting and stunting. Studies that have examined this, with adequate adjustment for confounders, have generally found odds ratios associated with low birthweight ranging between 2 and 5. Even fewer studies have examined birth length or maternal nutritional status as risk factors. More research is needed to determine the proportion of childhood under-nutrition attributable to IUGR so that interventions can be targeted to the appropriate life stages.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | ADOLESCENTS, FEMALE | YOUTH | WOMEN | ETHNIC GROUPS | PARITY | REPRODUCTIVE AGE | MALNUTRITION | HEALTH STATUS INDEXES | INTRAUTERINE GROWTH RETARDATION | REPRODUCTIVE TRACT INFECTIONS | MALARIA | HIV INFECTIONS | INTERVENTIONS | Developed Countries | North America | Americas | Adolescents | Age Factors | Population Characteristics | Demographic Factors | Population | Cultural Background | Fertility Measurements | Fertility | Population Dynamics | Reproduction | Nutrition Disorders | Diseases | Health | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Infections | Parasitic Diseases | Viral Diseases | Programs | Organization and Administration
Document Number: 341348

12.

Peer Reviewed

Title: Malaria transmission in two localities in north-western Argentina.
Author: Dantur Juri MJ; Zaidenberg M; Claps GL; Santana M; Almiron WR
Source: Malaria Journal. 2009;8:18.
Abstract: BACKGROUND: Malaria is one of the most important tropical diseases that affects people globally. The influence of environmental conditions in the patterns of temporal distribution of malaria vectors and the disease has been studied in different countries. In the present study, ecological aspects of the malaria vector Anopheles (Anopheles) pseudopunctipennis and their relationship with climatic variables, as well as the seasonality of malaria cases, were studied in two localities, El Oculto and Aguas Blancas, in north-western Argentina. METHODS: The fluctuation of An. pseudopunctipennis and the malaria cases distribution was analysed with Random Effect Poisson Regression. This analysis takes into account the effect of each climatic variable on the abundance of both vector and malaria cases, giving as results predicted values named Incidence Rate Radio. RESULTS: The number of specimens collected in El Oculto and Aguas Blancas was 4224 (88.07%) and 572 (11.93%), respectively. In El Oculto no marked seasonality was found, different from Aguas Blancas, where high abundance was detected at the end of spring and the beginning of summer. The maximum mean temperature affected the An. pseudopunctipennis fluctuation in El Oculto and Aguas Blancas. When considering the relationship between the number of malaria cases and the climatic variables in El Oculto, maximum mean temperature and accumulated rainfall were significant, in contrast with Aguas Blancas, where mean temperature and humidity showed a closer relationship to the fluctuation in the disease. CONCLUSION: The temporal distribution patterns of An. pseudopunctipennis vary in both localities, but spring appears as the season with better conditions for mosquito development. Maximum mean temperature was the most important variable in both localities. Malaria cases were influenced by the maximum mean temperature in El Oculto, while the mean temperature and humidity were significant in Aguas Blancas. In Aguas Blancas peaks of mosquito abundance and three months later, peaks of malaria cases were observed. The study reported here will help to increase knowledge about not only vectors and malaria seasonality but also their relationships with the climatic variables that influence their appearances and abundances.
Language: English
Keywords:
ARGENTINA | RESEARCH REPORT | DATA ANALYSIS | MALARIA | SEASONAL VARIATION | South America, Southern | South America | Latin America | Americas | Developing Countries | Research Methodology | Parasitic Diseases | Diseases | Population Dynamics | Demographic Factors | Population
Document Number: 330545

13.

Peer Reviewed

Title: Malaria-related perceptions and practices of women with children under the age of five years in rural Ethiopia.
Author: Deressa W; Ali A
Source: BMC Public Health. 2009 Jul 23;9(1):259.
Abstract: ABSTRACT: BACKGROUND: Malaria remains to be the major cause of morbidity and mortality among pregnant women and children in Ethiopia. The aim of this study was to investigate the local perceptions, practices and treatment seeking behaviour for malaria among women with children under the age of five years. METHODS: This community-based study was conducted in 2003 in an area of seasonal malaria transmission in Adami Tulu District, south-central Ethiopia. Total samples of 2087 rural women with children less than five years of age from 18 rural kebeles (the smallest administrative units) were interviewed about their perceptions and practices regarding malaria. In addition, focus group discussions and in-depth interviews were conducted on similar issues to complement the quantitative data. RESULTS: Malaria, locally known as busaa, is perceived as the main health problem in the study area. Mosquitoes are perceived to be the main cause of the disease, and other misperceptions were also widespread. The use of prevention measures was very low. Most mothers were familiar with the main signs and symptoms of mild malaria, and some of them indicated high grade fever, convulsions and mental confusion as a manifestation of severe malaria. Very few households (5.6%) possessed one or two nets. More than 60% of the mothers with recent episodes of malaria received initial treatment from non-public health facilities such as community health workers (CHWs) (40%) and private care providers (21%). Less than 40% of the reported malaria cases among women were treated by public health facilities. CONCLUSION: Malaria was perceived as the main health problem among women and children. The use of malaria preventive measures was low. A significant proportion of the respondents received initial malaria treatments from CHWs, private care providers and public health facilities. Concerted effort is needed to scale-up the distribution of insecticide-treated nets and improve the knowledge of the community about the link between malaria and mosquitoes. Effective antimalarial drugs should also be available at the grassroots level where the problem of malaria is rampant.
Language: English
Keywords:
ETHIOPIA | RESEARCH REPORT | SAMPLING STUDIES | FOCUS GROUPS | MOTHERS | RURAL POPULATION | MALARIA | PERCEPTION | KNOWLEDGE | BED NETS | UTILIZATION OF HEALTH CARE | ANTIMALARIAL DRUGS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Data Collection | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Psychological Factors | Behavior | Parasite Control | Public Health | Health | Health Services | Delivery of Health Care
Document Number: 342286

14.

Peer Reviewed

Title: Estimating the burden of malaria in pregnancy: a case study from rural Madhya Pradesh, India.
Author: Diamond-Smith N; Singh N; Gupta RK; Dash A; Thimasarn K; Campbell OM; Chandramohan D
Source: Malaria Journal. 2009;8:24.
Abstract: BACKGROUND: Malaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest. This paper models the burden of MiP and associated foetal losses and maternal deaths, in rural Madhya Pradesh, India. METHODS: Number of pregnancies per year was estimated from the number of births and an estimate of pregnancies that end in foetal loss. The prevalence of MiP, risk of foetal loss attributable to MiP and case fatality rate of MiP were obtained from the literature. The estimated total number of pregnancies was multiplied by the appropriate parameter to estimate the number of MiP cases, and foetal loss and maternal deaths attributable to MiP per year. A Monte Carlo simulation sensitivity analysis was done to assess plausibility of various estimates obtained from the literature. The burden of MiP in tribal women was explored by incorporating the variable prevalence of malaria in tribal and non-tribal populations and in forested and non-forested regions within Madhya Pradesh. RESULTS: Estimates of MiP cases in rural Madhya Pradesh based on the model parameter values found in the literature ranged from 183,000-1.5 million per year, with 73,000-629,000 lost foetuses and 1,500-12,600 maternal deaths attributable to MiP. The Monte Carlo simulation gave a more plausible estimate of 220,000 MiP cases per year (inter-quartile range (IQR): 136,000-305,000), 95,800 lost foetuses (IQR: 56,800-147,600) and 1,000 maternal deaths (IQR: 650-1,600). Tribal women living in forested areas bore 30% of the burden of MiP in Madhya Pradesh, while constituting 18% of the population. CONCLUSION: Although the estimates are uncertain, they suggest MiP is a significant public health problem in rural Madhya Pradesh, affecting many thousands of women and that reducing the MiP burden should be a priority.
Language: English
Keywords:
INDIA | LITERATURE REVIEW | CASE STUDIES | PREVALENCE | RURAL AREAS | PREGNANT WOMEN | MALARIA | MATERNAL MORTALITY | CAUSES OF DEATH | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Measurement | Geographic Factors | Population | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Mortality | Population Dynamics
Document Number: 330550

15.

Peer Reviewed

Title: Health-seeking behaviour for childhood malaria: household dynamics in rural Senegal.
Author: Franckel A; Lalou R
Source: Journal of Biosocial Science. 2009 Jan;41(1):1-19.
Abstract: Research on health care behaviour in sub-Saharan Africa usually considers the mother as the reference in the household when a child is sick. The study of health care management within the family is a key issue for understanding therapeutic rationales. This study was conducted in the region of Fatick in Senegal among 902 children with malaria-related fever. The data were taken from a retrospective quantitative survey conducted in all compounds of the DSS (Demographic Surveillance Site) of Niakhar. The results show that child care-taking is fundamentally a collective process: in 70.9% of out-of-home resorts, the treatment decision was collective. The health care process of 68.1% of morbid episodes involved several individuals. The involvement of the mother, the father and other relatives in the collective management of health care followed different logics. Each care-giver had a specific and complementary function depending on gender norms, intergenerational relations and characteristics of the family unit. Family management of illness aims at optimizing financial and human resources given the economic, logistical and social constraints on health care. Nevertheless, collective management also favoured home-based care, prevented good treatment compliance and delayed the resort to health facilities. These results suggest that health education campaigns should focus on an early involvement of fathers in health care-giving and also on the strengthening of the autonomy of mothers. Mothers' empowerment should give women more autonomy in their child's treatment choice. Lastly, there is a need to develop community health facilities and establish shared funding at the community level.
Language: English
Keywords:
SENEGAL | SUMMARY REPORT | RURAL AREAS | HOUSEHOLDS | CHILDREN | MALARIA | UTILIZATION OF HEALTH CARE | BEHAVIOR | HEALTH SERVICES | TREATMENT | HOME CARE | DECISION MAKING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Geographic Factors | Population | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Delivery of Health Care | Health | Medical Procedures | Medicine | Care and Support
Document Number: 330567

16.

Peer Reviewed

Title: Loss of population levels of immunity to malaria as a result of exposure-reducing interventions: consequences for interpretation of disease trends.
Author: Ghani AC; Sutherland CJ; Riley EM; Drakeley CJ; Griffin JT; Gosling RD; Filipe JA
Source: PLoS One. 2009;4(2):e4383.
Abstract: BACKGROUND: The persistence of malaria as an endemic infection and one of the major causes of childhood death in most parts of Africa has lead to a radical new call for a global effort towards eradication. With the deployment of a highly effective vaccine still some years away, there has been an increased focus on interventions which reduce exposure to infection in the individual and -by reducing onward transmission-at the population level. The development of appropriate monitoring of these interventions requires an understanding of the timescales of their effect. METHODS & FINDINGS: Using a mathematical model for malaria transmission which incorporates the acquisition and loss of both clinical and parasite immunity, we explore the impact of the trade-off between reduction in exposure and decreased development of immunity on the dynamics of disease following a transmission-reducing intervention such as insecticide-treated nets. Our model predicts that initially rapid reductions in clinical disease incidence will be observed as transmission is reduced in a highly immune population. However, these benefits in the first 5-10 years after the intervention may be offset by a greater burden of disease decades later as immunity at the population level is gradually lost. The negative impact of having fewer immune individuals in the population can be counterbalanced either by the implementation of highly-effective transmission-reducing interventions (such as the combined use of insecticide-treated nets and insecticide residual sprays) for an indefinite period or the concurrent use of a pre-erythrocytic stage vaccine or prophylactic therapy in children to protect those at risk from disease as immunity is lost in the population. CONCLUSIONS: Effective interventions will result in rapid decreases in clinical disease across all transmission settings while population-level immunity is maintained but may subsequently result in increases in clinical disease many years later as population-level immunity is lost. A dynamic, evolving intervention programme will therefore be necessary to secure substantial, stable reductions in malaria transmission.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | MATHEMATICAL MODEL | MALARIA | TIME FACTORS | EXPOSURE | TRANSMISSION | INTERVENTIONS | MONITORING | PROGRAM EVALUATION | Developing Countries | Theoretical Models | Research Methodology | Parasitic Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Risk Factors | Health | Infections | Programs | Organization and Administration | Evaluation
Document Number: 331039

17.

Peer Reviewed

Title: Community response to intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in five African settings.
Author: Gysels M; Pell C; Mathanga DP; Adongo P; Odhiambo F; Gosling R; Akweongo P; Mwangi R; Okello G; Mangesho P; Slutsker L; Kremsner PG; Grobusch MP; Hamel MJ; Newman RD; Pool R
Source: Malaria Journal. 2009 Aug 10;8(1):191.
Abstract: ABSTRACT: BACKGROUND: IPTi delivered through EPI has been shown to reduce the incidence of clinical malaria by 20-59%. However, new health interventions can only be effective if they are also socially and culturally acceptable. It is also crucial to ensure that attitudes to IPTi do not negatively influence attitudes to and uptake of immunization, or that people do not misunderstand IPTi as immunization against malaria and neglect other preventive measures or delay treatment seeking. METHODS: These issues were studied in five African countries in the context of clinical trials and implementation studies of IPTi. Mixed methods were used, including structured questionnaires (1,296), semi-structured interviews (168), in-depth interviews (748) and focus group discussions (95) with mothers, fathers, health workers, community members, opinion leaders, and traditional healers. Participant observation was also carried out in the clinics. RESULTS: IPTi was widely acceptable because it resonated with existing traditional preventive practices and a general concern about infant health and good motherhood. It also fit neatly within already widely accepted routine vaccination. Acceptance and adherence were further facilitated by the hierarchical relationship between health staff and mothers and by the fact that clinic attendance had a social function for women beyond acquiring health care. Type of drug and regimen were important, with newer drugs being seen as more effective, but potentially also more dangerous. Single dose infant formulations delivered in the clinic seem to be the most likely to be both acceptable and adhered to. There was little evidence that IPTi per se had a negative impact on attitudes to EPI or that it had any affect on EPI adherence. There was also little evidence of IPTi having a negative impact on health seeking for infants with febrile illness or existing preventive practices. CONCLUSIONS: IPTi is generally acceptable across a wide range of settings in Africa and involving different drugs and regimens, though there is a strong preference for a single dose infant formulation. IPTi does not appear to have any negative effect on attitudes to EPI, and it is not interpreted as immunization against malaria.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | CLINICAL TRIALS | INCIDENCE | INFANT HEALTH | SAFE MOTHERHOOD | MATERNAL HEALTH | MALARIA | IMMUNIZATION | PREVENTIVE HEALTH CARE | PROGRAM ACCEPTABILITY | Developing Countries | Clinical Research | Research Methodology | Measurement | Child Health | Health | Parasitic Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 342542

18.

Peer Reviewed

Title: Community knowledge, attitudes and practices (KAP) on malaria in Swaziland: a country earmarked for malaria elimination.
Author: Hlongwana KW; Mabaso ML; Kunene S; Govender D; Maharaj R
Source: Malaria Journal. 2009;8:29.
Abstract: BACKGROUND: The potential contribution of knowledge, attitudes and practices (KAP) studies to malaria research and control has not received much attention in most southern African countries. This study investigated the local communities' understanding of malaria transmission, recognition of signs and symptoms, perceptions of cause, treatment-seeking patterns, preventive measures and practices in order to inform the country's proposed malaria elimination programme in Swaziland. METHODS: A descriptive cross-sectional survey was undertaken in four Lubombo Spatial Development Initiative (LSDI) sentinel sites in Swaziland. These sentinel sites share borders with Mozambique. A structured questionnaire was administered to 320 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed. RESULTS: A substantial number of research participants showed reasonable knowledge of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and correct treatment practices. Almost 90% (n = 320) of the respondents stated that they would seek treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Most people (78%) perceived clinics and vector control practices as central to treating and preventing malaria disease. Indoor residual spraying (IRS) coverage and bed net ownership were 87.2% and 38.8%, respectively. IRS coverage was in agreement with the World Health Organization's (WHO) recommendation of more than 80% within the targeted communities. CONCLUSION: Despite fair knowledge of malaria in Swaziland, there is a need for improving the availability of information through the preferred community channels, such as tinkhundlas (districts), as well as professional health routes. This recommendation emerges along with the documented evidence suggesting that as the level transmission and disease decreases so does the perception about the importance of malaria control activities. Finally, given the relatively moderate ownership of bed net there is a need for future studies to evaluate the distribution of insecticide-treated nets (ITNs) compared with IRS.
Language: English
Keywords:
SWAZILAND | RESEARCH REPORT | KAP SURVEYS | COMMUNITY PARTICIPATION | KNOWLEDGE | PERCEPTION | SIGNS AND SYMPTOMS | MALARIA | MALARIA PREVENTION | TRANSMISSION | NEEDS ASSESSMENT | INFORMATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Organization and Administration | Sociocultural Factors | Psychological Factors | Behavior | Diseases | Parasitic Diseases | Infections | Evaluation
Document Number: 330813

19.

20.

Title: Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo.
Author: Landis SH; Lokomba V; Ananth CV; Atibu J; Ryder RW; Hartmann KE; Thorp JM; Tshefu A; Meshnick SR
Source: Epidemiology and Infection. 2009 Feb;137(2):294-304.
Abstract: Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3.3, 95% CI 1.3-8.2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0.5, 95% CI 0.3-0.7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | PROSPECTIVE STUDIES | INTRAUTERINE GROWTH RETARDATION | ULTRASONICS | MALARIA | MATERNAL NUTRITION | RISK FACTORS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Parasitic Diseases | Nutrition | Biology
Document Number: 330491

21.

Peer Reviewed

Title: A country-wide malaria survey in Mozambique. II. Malaria attributable proportion of fever and establishment of malaria case definition in children across different epidemiological settings.
Author: Mabunda S; Aponte JJ; Tiago A; Alonso P
Source: Malaria Journal. 2009;8:74.
Abstract: BACKGROUND: Protection against clinical malaria episodes is acquired slowly after frequent exposure to malaria parasites. This is reflected by a decrease with increasing age in both parasite density and incidence of clinical episodes. In many settings of stable malaria transmission, the presence of asymptomatic malaria parasite carriers is common and the definition of clinical malaria remains uncertain. METHODS: Between February 2002 and April 2003, a country-wide malaria survey was conducted in 24 districts of Mozambique, aiming to characterize the malaria transmission intensities and to estimate the proportion of fever cases attributable to malaria infections in order to establish the malaria case definition. A total of 8,816 children less than ten years of age were selected for the study. Axillary temperature was measured in all participating subjects and finger prick blood collections were taken to prepare thick and thin films for identification of parasite species and determination of parasite density. The proportion of fever cases attributable to malaria infection was estimated using a logistic regression of the fever on a monotonic function of the parasite density and, using bootstrap facilities, bootstrapped estimated confidence intervals, as well as the sensitivity and specificity for different parasite density cut-offs were produced. RESULTS: Overall, the prevalence of Plasmodium falciparum was 52.4% (4,616/8,816). The prevalence of fever (axillary temperature >or= 37.5 degrees C) was 9.4% (766/8,816). Fever episodes peaked among children below 12 months of life [15.1% (206/1,517)]. The lowest fever prevalence of 5.9% (67/1,224) was recorded amongst children between five and seven years of age. Among 4,098 parasitized children, 498/4,098 (13.02%) had fever. The prevalence of malaria infections associated with fever peaked among children in the less than twelve months age group and thereafter decreased rapidly with increasing age (p < 0.001). High parasite densities were significantly associated with fever (p < 0.04). The proportion of fever attributed to malaria was 37.8% (95% CI 32.9% - 42.7%). An age-specific pattern was observed with significant variations across different regions in the country. In general, among children less than 12 months of life, the proportion of fever attributed to malaria infection was 43.5% (95% CI 25.8% - 61.2%), in children aged between 12 and 59 months of age was 39.6% (95% CI 30.3% - 48.9%), and among children aged between 5 and 10 years old was 21.5% (95% CI 11.6% - 31.4%). CONCLUSION: This study confirms that malaria remains a major cause of febrile illness during childhood. It also defines the relation between parasite density and fever and how this varies with age and region. This may help guide case definition for clinical trials of preventive tools, as well as provide definitions that may improve the precision of measurement of the burden of disease.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | EPIDEMIOLOGY | CHILDREN | MALARIA | DISEASES | RISK FACTORS | MORBIDITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Public Health | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases
Document Number: 342254

22.

Peer Reviewed

Title: European and Developing Countries Clinical Trials Partnership (EDCTP): the path towards a true partnership.
Author: Matee MI; Manyando C; Ndumbe PM; Corrah T; Jaoko WG; Kitua AY; Ambene HP; Ndounga M; Zijenah L; Ofori-Adjei D; Agwale S; Shongwe S; Nyirenda T; Makanga M
Source: BMC Public Health. 2009 Jul 20;9(1):249.
Abstract: ABSTRACT: BACKGROUND: European and Developing Countries Clinical Trials Partnership (EDCTP) was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU) member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) in the sub-Saharan African region. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases. METHODS: EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC); a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts. RESULTS: The following have been the major achievements of the EDCTP initiative since its formation in 2003; i) increase in the number of participating African countries from two to 26 in 2008 ii) the cumulative amount of funds spent on EDCTP projects has reached E 150 m, iii) the cumulative number of clinical trials approved has reached 40 and iv) there has been a significant increase number and diversity in capacity building activities. CONCLUSION: While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional networks of excellence in sub-Saharan Africa is envisaged to lead to a sustainable programme. Current data shows that the number of projects supported by EDCTP is increasing. DCCC proposes that this success story of true partnership should be used as model by partners involved in the fight against other infectious diseases of public health importance in the region.
Language: English
Keywords:
EUROPE | DEVELOPING COUNTRIES | SUMMARY REPORT | CLINICAL TRIALS | INTERNATIONAL COOPERATION | HIV INFECTIONS | AIDS | MALARIA | TUBERCULOSIS | PREVENTION AND CONTROL | CAPACITY BUILDING | FINANCIAL ACTIVITIES | Developed Countries | Clinical Research | Research Methodology | Political Factors | Sociocultural Factors | Viral Diseases | Diseases | Parasitic Diseases | Infections | Program Sustainability | Programs | Organization and Administration | Economic Factors
Document Number: 342291

23.

Peer Reviewed

Title: Placental Malarial Infection as a Risk Factor for Hypertensive Disorders During Pregnancy in Africa: A Case-Control Study in an Urban Area of Senegal, West Africa.
Author: Ndao CT; Dumont A; Fievet N; Doucoure S; Gaye A; Lehesran JY
Source: American Journal of Epidemiology. 2009 Aug 13;
Abstract: In tropical countries, malaria and hypertension are common diseases of pregnancy. They have physiopathologic similarities such as placental ischemia, endothelial dysfunction, and production of proinflammatory cytokines. Recent findings suggested their possible link. The authors conducted a case-control study to explore the relation between malaria and hypertension at Guediawaye, a hypoendemic malarial setting in Senegal. Cases were pregnant women admitted to the delivery unit for hypertension. Controls were pregnant women admitted for normal delivery, without any history of hypertension or proteinuria during the present pregnancy. Malarial infection was determined by placental tissue examination. From January to December 2002, 77 cases of gestational hypertension, 113 cases of preeclampsia, 59 cases of eclampsia, and 241 controls were enrolled. Placental malarial infection (PMI) was present in 14 cases (6.3%) and in 15 controls (6.2%). The prevalence of PMI was 4.6% for eclampsia, 4.0% for preeclampsia, and 11.6% for gestational hypertension. In multivariate analysis, PMI appeared to be an independent risk factor for gestational hypertension (adjusted odds ratio = 2.7, 95% confidence interval: 1.0, 7.6). The authors found an association between PMI and nonproteinuric hypertension in women living in a malaria-hypoendemic area. The exact significance of such relation should be clarified in further studies in different settings of malarial endemicity.
Language: English
Keywords:
SENEGAL | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | RISK FACTORS | HYPERTENSION | PREGNANCY | MALARIA | PREECLAMPSIA | FETAL MEMBRANES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Vascular Diseases | Diseases | Reproduction | Parasitic Diseases | Pregnancy Complications | Fetus
Document Number: 342554

24.

Peer Reviewed

Title: The effects of acute malaria on Epstein-Barr Virus (EBV) load and EBV-specific T cell immunity in Gambian children.
Author: Njie R; Bell AI; Jia H; Croom-Carter D; Chaganti S; Hislop AD; Whittle H; Rickinson AB
Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):31-8.
Abstract: Background. To investigate how intense Plasmodium falciparum infection predisposes to Epstein-Barr virus (EBV)-positive Burkitt lymphoma (BL), we analyzed the effect of acute malaria on existing EBV-host balance. Methods. EBV genome loads in peripheral blood mononuclear cells were assayed by quantitative polymerase chain reaction, and EBV-specific CD8_ T cell responses were assayed by interferon-y enzyme-linked immunospot assay. Results. Gambian children, from whom samples were obtained during an acute malaria attack and again up to 6 weeks later, had extremely high viral loads, reaching levels that in the United Kingdom are seen only in patients with infectious mononucleosis. Gambian control subjects (children and adults with no recent history of malaria) had lower median viral loads, although they were still >10-fold above the median for healthy UK adults. Limited experiments with EBV epitope peptides (restricted through the HLA-B*3501 and HLA-B*5301 alleles) also suggested an impairment of virus-specific CD8+ T cell function in children with malaria, but only during acute disease. Conclusions. Acute malaria is associated with sustained increase in EBV load and, possibly, a transient decrease in EBV-specific T cell surveillance. We infer that the unusually high set point of virus carriage in P. falciparum-challenged populations, allied with the parasite's capacity to act as a chronic B cell stimulus, probably contributes to the pathogenesis of endemic BL.
Language: English
Keywords:
GAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | CHILDREN | VIRAL DISEASES | IMMUNITY, CELLULAR | MALARIA | COMPLICATIONS | IMMUNOLOGICAL EFFECTS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Immunity | Immune System | Physiology | Biology | Parasitic Diseases
Document Number: 328587

25.

Peer Reviewed

Title: Age patterns of severe paediatric malaria and their relationship to Plasmodium falciparum transmission intensity.
Author: Okiro EA; Al-Taiar A; Reyburn H; Idro R; Berkley JA; Snow RW
Source: Malaria Journal. 2009;8:4.
Abstract: BACKGROUND: The understanding of the epidemiology of severe malaria in African children remains incomplete across the spectrum of Plasmodium falciparum transmission intensities through which communities might expect to transition, as intervention coverage expands. METHODS: Paediatric admission data were assembled from 13 hospitals serving 17 communities between 1990 and 2007. Estimates of Plasmodium falciparum transmission intensity in these communities were assembled to be spatially and temporally congruent to the clinical admission data. The analysis focused on the relationships between community derived parasite prevalence and the age and clinical presentation of paediatric malaria in children aged 0-9 years admitted to hospital. RESULTS: As transmission intensity declined a greater proportion of malaria admissions were in older children. There was a strong linear relationship between increasing transmission intensity and the proportion of paediatric malaria admissions that were infants (R2 = 0.73, p < 0.001). Cerebral malaria was reported among 4% and severe malaria anaemia among 17% of all malaria admissions. At higher transmission intensity cerebral malaria was a less common presentation compared to lower transmission sites. There was no obvious relationship between the proportions of children with severe malaria anaemia and transmission intensity. CONCLUSION: As the intensity of malaria transmission declines in Africa through the scaling up of insecticide-treated nets and other vector control measures a focus of disease prevention among very young children becomes less appropriate. The understanding of the relationship between parasite exposure and patterns of disease risk should be used to adapt malaria control strategies in different epidemiological settings.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CHILDREN | COMMUNITY | PREVALENCE | AGE FACTORS | MALARIA | HUMAN GEOGRAPHY | TIME FACTORS | LOCALE | CENTRAL NERVOUS SYSTEM EFFECTS | ANEMIA | INFECTION TRANSMISSION | Africa | Developing Countries | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Measurement | Parasitic Diseases | Diseases | Geography | Social Sciences | Science | Sociocultural Factors | Population Dynamics | Central Nervous System | Physiology | Biology | Infections
Document Number: 330371

26.
Peer Reviewed

Title: Human immunodeficiency virus co-infection increases placental parasite density and transplacental malaria transmission in Western Kenya.
Author: Perrault SD; Hajek J; Zhong K; Owino SO; Sichangi M; Smith G; Shi YP; Moore JM; Kain KC
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jan;80(1):119-25.
Abstract: Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90-15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80-3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59-505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection.
Language: English
Keywords:
KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVALENCE | HIV INFECTIONS | COMPLICATIONS | MALARIA | CONGENITAL ABNORMALITIES | PREGNANCY COMPLICATIONS | MOTHER-TO-CHILD TRANSMISSION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Parasitic Diseases | Neonatal Diseases and Abnormalities | Transmission | Infections
Document Number: 330313

28.

Peer Reviewed

Title: Malaria has no effect on birth weight in Rwanda.
Author: Rulisa S; Mens PF; Karema C; Schallig HD; Kaligirwa N; Vyankandondera J; de Vries PJ
Source: Malaria Journal. 2009 Aug 10;8(1):194.
Abstract: ABSTRACT: BACKGROUND: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002-2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space. METHODS: Obstetric indicators (birth weight and pregnancy outcome) and malaria incidence were compared and analyzed to their association over time (2002-2007) and space. Birth data from 12,526 deliveries were collected from maternity registers of 11 different primary health centers located in different malaria endemic areas. Malaria data for the same communities were collected from the National Malaria Control Programme. Associations were sought with mixed effects models and logistic regression. RESULTS: In all health centres, a significant increase of birth weight over the years was observed (p < 0.001) with a significant seasonal fluctuation. Malaria incidence had no significant effect on birth weight. There was a slight but significant decreasing effect of malaria incidence on the occurrence of premature delivery (p-value 0.045) and still birth (p-value 0.009). Altitude showed a slight but significant negative correlation with birth weight. Overall, a decrease over the years of premature delivery (p = 0.010) and still birth (p=0.036) was observed. CONCLUSION: In Rwanda, birth weight and pregnancy outcome are not directly influenced by malaria, which is in contrast to many other studied areas. Although malaria incidence overall has declined and mean birth weight increased over the studied period, no direct association was found between the two. Socio-economic factors and improved nutrition could be responsible for birth weight changes in recent years.
Language: English
Keywords:
RWANDA | RESEARCH REPORT | INCIDENCE | BIRTH RECORDS | MALARIA | BIRTH WEIGHT | NUTRITION | PROGRAM EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Vital Statistics | Population Statistics | Parasitic Diseases | Diseases | Body Weight | Physiology | Biology | Health | Programs | Organization and Administration
Document Number: 342541

29.

Peer Reviewed

Title: Rapid decrease of malaria morbidity following the introduction of community-based monitoring in a rural area of central Vietnam.
Author: Thang ND; Erhart A; Hung le X; Thuan le K; Xa NX; Thanh NN; Ky PV; Coosemans M; Speybroeck N; D'Alessandro U
Source: Malaria Journal. 2009;8:3.
Abstract: BACKGROUND: Despite a successful control programme, malaria has not completely disappeared in Vietnam; it remains endemic in remote areas of central Vietnam, where standard control activities seem to be less effective. The evolution of malaria prevalence and incidence over two and half years in a rural area of central Vietnam, after the introduction of community-based monitoring of malaria cases, is presented. METHODS: After a complete census, six cross-sectional surveys and passive detection of malaria cases (by village and commune health workers using rapid diagnostic tests) were carried out between March 2004 and December 2006 in Ninh-Thuan province, in a population of about 10,000 individuals. The prevalence of malaria infection and the incidence of clinical cases were estimated. RESULTS: Malaria prevalence significantly decreased from 13.6% (281/2,068) in December 2004 to 4.0% (80/2,019) in December 2006. Plasmodium falciparum and Plasmodium vivax were the most common infections with few Plasmodium malariae mono-infections and some mixed infections. During the study period, malaria incidence decreased by more than 50%, from 25.7/1,000 population at risk in the second half of 2004 to 12.3/1,000 in the second half of 2006. The incidence showed seasonal variations, with a yearly peak between June and December, except in 2006 when the peak observed in the previous years did not occur. CONCLUSION: Over a 2.5-year follow-up period, malaria prevalence and incidence decreased by more than 70% and 50%, respectively. Possibly, this could be attributed to the setting up of a passive case detection system based on village health workers, indicating that a major impact on the malaria burden can be obtained whenever prompt diagnosis and adequate treatment are available.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | INCIDENCE | RURAL AREAS | MALARIA | EXAMINATIONS AND DIAGNOSES | TREATMENT | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Measurement | Geographic Factors | Population | Parasitic Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331040


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