Effect of ion implantation on the oxygen overpotential of Ni anodes

This work investigates the use of ion implantation for decreasing the oxygen-overpotential of nickel anodes. It is part of a search for improved electrocatalysts to increase the energy efficiency of the H2O electrolysis process for producing H2 gas. A series of Ni electrodes were implanted at room temperature with various doses of 50 keV Ag+, Li+, He+, or Kr+ ions. Polarization measurements were then made in a suitable electrolysis cell over a wide range of current densities, using aqueous KOH solution (30%) at 80 °C as electrolyte. In the case of Ag+ implants, Rutherford backscattering (RBS) measurements were performed before and after electrolysis in order to monitor the amount and depth distribution of the Ag atoms. For Li+ or He+ implantation, we observe a negligible change in the measured polarization curves. For high dose Kr+ implants (I0^18 ions cm^(-2)) the Ni electrode exhibits an increase in overpotential, indicating that excessive damage and/or sputtering of the surface causes some deterioration in electrode behaviour. For Ag+ implants, on the other hand, we observe a large (20–40%) reduction in the total overpotential at implant doses of 0.3–4*10^16 Ag+ cm^(-2). Furthermore, RBS measurements show that prolonged electrolysis at higher current density (24–28 h at 1A/cm^(-2)) produces only a small loss of Ag and shifts its depth profile to significantly larger depths. Supplementary nuclear microanalyses, using the 16O(d, p )17O reaction, show that the shift in Ag profile is correlated with the growth of an anodic nickel oxide (+carbon) layer during electrolysis. In one set of runs, the Ni electrodes were thermally oxidized before Ag+ implantation in order to form an 400 Å layer of NiO at the surface. In this case, we observe a somewhat smaller reduction in overpotential following Ag+ implantation; furthermore, a large loss of Ag into the electrolyte occurs during the subsequent electrolysis

Therapeutic efficacy and effects of artesunate-amodiaquine and artemether-lumefantrine on malaria-associated anaemia in Nigerian children aged two years and under

Multilingual abstracts in five official working languages of the United Nations. (PDF 403 kb

Temporal changes in haematocrit following artemisinin-based combination treatments of uncomplicated falciparum malaria in children

Semilog plots of deficit in haematocrit from 30 % versus time in children with haematocrit <30 % at presentation (Pattern 6). (DOCX 16 kb

The role of comprehensive sexuality education (CSE) in reimagining HIV/AIDS inequalities

Over 70 million people globally have been infected with HIV since the beginning of the epidemic. HIV infection has neither a cure nor a vaccine; hence, education and awareness have been adopted to prevent the spread of the virus. Despite the action to reduce the HIV prevalence with access to effective information, prevention, diagnosis, treatment, and care, it remains a major health concern and a chronic health condition that could only be managed by enabling people living with the condition a better, longer, and healthy life. However, comprehensive sexuality education (CSE), which is a right-based approach that provides and equips people with the right knowledge on sexual education and reproductive health, can be utilised in sexual health promotion. It comprises seven essential components that focus on several aspects of sexuality. Thus, this paper provides evidence for the importance of CSE in reducing HIV prevalence, especially amongst the vulnerable population. The incorporation of long-term sexuality education programs in the school-based curriculum will contribute to the massive reduction in teenage pregnancies and abortion, and the decline in rates of sexually transmitted infections and HIV. It will also increase the knowledge about sexual and reproductive issues normalization and self-efficacy. Hence, CSE health educators and school teachers should be adequately trained in comprehensive sexuality education to curb the spread of HIV infection

Community access to rectal artesunate for malaria (CARAMAL): a large-scale observational implementation study in the Democratic Republic of the Congo, Nigeria and Uganda

The key to reducing malaria deaths in highly endemic areas is prompt access to quality case management. Given that many severe cases occur at peripheral level, rectal artesunate (RAS) in the form of suppositories was developed in the 1990s, allowing for rapid initiation of life-saving antimalarial treatment before referral to a health facility with full case management capabilities. One randomized controlled trial published in 2009 showed a protective effect of RAS pre-referral treatment against overall mortality of 26%, but with significant differences according to study sites and length of referral. Two important issues remained unaddressed: (1) whether the mortality impact of RAS observed under controlled trial conditions could be replicated under real-world circumstances; and (2) clear operational guidance for the wide-scale implementation of RAS, including essential health system determinants for optimal impact. From 2018 to 2020, the Community Access to Rectal Artesunate for Malaria (CARAMAL) project was conducted as a large-scale observational implementation study in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda (registered on ClinicalTrials.gov as NCT03568344). CARAMAL aimed to provide high-quality field evidence on the two issues above, in three remote settings with high malaria endemicity. A number of complementary study components were implemented. The core of the CARAMAL study was the Patient Surveillance System (PSS), which allowed tracking of cases of severe febrile illness from first contact at the periphery to a referral health facility, and then on to a Day 28 visit at the home of the patient. Community and provider cross-sectional surveys complemented the PSS. Here we describe in some detail RAS implementation, as well as the key CARAMAL study components and basic implementation experience. This manuscript does not intend to present key study results, but provides an extensive reference document for the companion papers describing the impact, referral process, post-referral treatment and costing of the RAS intervention

Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda

INTRODUCTION: Children who receive prereferral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child's condition after RAS administration may influence a caregiver's decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited. METHODS: An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under 5 years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment-seeking pathways. RESULTS: Referral completion was 67% (1408/2104) in DRC, 48% (287/600) in Nigeria and 58% (2170/3745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted OR (aOR)=0.48, 95% CI 0.30 to 0.77 and aOR=0.72, 95% CI 0.58 to 0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared with RAS non-users in the post-roll-out phase (aOR=0.18, 95% CI 0.05 to 0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR=1.81, 95% CI 1.17 to 2.79). CONCLUSIONS: The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered prereferral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral. TRIAL REGISTRSTION NUMBER: NCT03568344; ClinicalTrials.gov

Effectiveness of rectal artesunate as pre-referral treatment for severe malaria in children under 5 years of age: a multi-country observational study

BACKGROUND: To prevent child deaths from severe malaria, early parenteral treatment is essential. Yet, in remote rural areas, accessing facilities offering parenteral antimalarials may be difficult. A randomised controlled trial found pre-referral treatment with rectal artesunate (RAS) to reduce deaths and disability in children who arrived at a referral facility with delay. This study examined the effectiveness of pre-referral RAS treatment implemented through routine procedures of established community-based health care systems. METHODS: An observational study accompanied the roll-out of RAS in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Children <5 years of age presenting to a community-based health provider with a positive malaria test and signs of severe malaria were enrolled and followed up during admission and after 28 days to assess their health status and treatment history. The primary outcome was death; covariates of interest included RAS use, referral completion, and post-referral treatment. RESULTS: Post-roll-out, RAS was administered to 88% of patients in DRC, 52% in Nigeria, and 70% in Uganda. The overall case fatality rate (CFR) was 6.7% (135/2011) in DRC, 11.7% (69/589) in Nigeria, and 0.5% (19/3686) in Uganda; 13.8% (865/6286) of patients were sick on day 28. The CFR was higher after RAS roll-out in Nigeria (16.1 vs. 4.2%) and stable in DRC (6.7 vs. 6.6%) and Uganda (0.7 vs. 0.3%). In DRC and Nigeria, children receiving RAS were more likely to die than those not receiving RAS (aOR=3.06, 95% CI 1.35-6.92 and aOR=2.16, 95% CI 1.11-4.21, respectively). Only in Uganda, RAS users were less likely to be dead or sick at follow-up (aOR=0.60, 95% CI 0.45-0.79). Post-referral parenteral antimalarials plus oral artemisinin-based combination therapy (ACT), a proxy for appropriate post-referral treatment, was protective. However, in referral health facilities, ACT was not consistently administered after parenteral treatment (DRC 68.4%, Nigeria 0%, Uganda 70.9%). CONCLUSIONS: Implemented at scale to the recommended target group, pre-referral RAS had no beneficial effect on child survival in three highly malaria-endemic settings. RAS is unlikely to reduce malaria deaths unless health system issues such as referral and quality of care at all levels are addressed. TRIAL REGISTRATION: The study is registered on ClinicalTrials.gov : NCT03568344

The evolving SARS-CoV-2 epidemic in Africa: insights from rapidly expanding genomic surveillance

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern—particularly Alpha, Beta, Delta, and Omicron—on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century