Intermittent preventive treatment of malaria provides substantial protection against malaria in children already protected by an insecticide-treated bednet in Burkina Faso: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Intermittent preventive treatment of malaria in children (IPTc) is a promising new approach to the control of malaria in areas of seasonal malaria transmission but it is not known if IPTc adds to the protection provided by an insecticide-treated net (ITN). METHODS AND FINDINGS: An individually randomised, double-blind, placebo-controlled trial of seasonal IPTc was conducted in Burkina Faso in children aged 3 to 59 months who were provided with a long-lasting insecticide-treated bednet (LLIN). Three rounds of treatment with sulphadoxine pyrimethamine plus amodiaquine or placebos were given at monthly intervals during the malaria transmission season. Passive surveillance for malaria episodes was established, a cross-sectional survey was conducted at the end of the malaria transmission season, and use of ITNs was monitored during the intervention period. Incidence rates of malaria were compared using a Cox regression model and generalized linear models were fitted to examine the effect of IPTc on the prevalence of malaria infection, anaemia, and on anthropometric indicators. 3,052 children were screened and 3,014 were enrolled in the trial; 1,505 in the control arm and 1,509 in the intervention arm. Similar proportions of children in the two treatment arms were reported to sleep under an LLIN during the intervention period (93%). The incidence of malaria, defined as fever or history of fever with parasitaemia ≥ 5,000/µl, was 2.88 (95% confidence interval [CI] 2.70-3.06) per child during the intervention period in the control arm versus 0.87 (95% CI 0.78-0.97) in the intervention arm, a protective efficacy (PE) of 70% (95% CI 66%-74%) (p<0.001). There was a 69% (95% CI 6%-90%) reduction in incidence of severe malaria (p = 0.04) and a 46% (95% CI 7%-69%) (p = 0.03) reduction in the incidence of all-cause hospital admissions. IPTc reduced the prevalence of malaria infection at the end of the malaria transmission season by 73% (95% CI 68%-77%) (p<0.001) and that of moderately severe anaemia by 56% (95% CI 36%-70%) (p<0.001). IPTc reduced the risks of wasting (risk ratio [RR] = 0.79; 95% CI 0.65-1.00) (p = 0.05) and of being underweight (RR = 0.84; 95% CI 0.72-0.99) (p = 0.03). Children who received IPTc were 2.8 (95% CI 2.3-3.5) (p<0.001) times more likely to vomit than children who received placebo but no drug-related serious adverse event was recorded. CONCLUSIONS: IPT of malaria provides substantial protection against malaria in children who sleep under an ITN. There is now strong evidence to support the integration of IPTc into malaria control strategies in areas of seasonal malaria transmission. TRIAL REGISTRATION: ClinicalTrials.govNCT00738946. Please see later in the article for the Editors' Summary

Assessing the Climate-Smartness of the West Africa Agricultural Productivity Programme (WAAPP): What can we learn from Benin, Guinea, Niger, Togo and Chad projects?

This info note summarizes the findings from participatory assessments of the climate-smartness of World Bank funded West Africa Agricultural Productivity Programme (WAAPP)”. This activity was implemented by CCAFS West Africa regional programme in partnership with CORAF under the Capacitating Stakeholders in Using Climate Information for Enhanced Resilience in the Agricultural Sector in West Africa (CaSCIERA-WA) project to strengthen the capacity of country stakeholders of WAAPP to mainstream and implement CSA in their activities in West Africa

Formulation of a Robust National Rural Sector Program in Burkina Faso: What new themes have emerged from the socio-economic and climate scenarios process?

Under the partnership initiated in 2015 between the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) and the Permanent Secretariat for Coordination of Agricultural Sector Policies (SP-CPSA), in collaboration with other CGIAR research programs and centers, an analysis of the National Rural Sector Program (PNSR) based on the CCAFS socio-economic and climate scenarios was conducted with the effective participation of rural sector stakeholders in Burkina Faso. Twenty-two (22) recommendations were made to allow for the effective mainstreaming of plausible socio-economic, environmental and climatic factors in the near and distant future, that will make PNSR II more robust to face future uncertainties related to climate change, global dynamics, socio-economic changes, changes in norms and values, etc. In addition, an exercise with all the stakeholders helped in translating the said recommendations into new actions and themes to be taken into account when formulating PNSR II. Discussions between the stakeholders also underscored the need for crosscutting involvement of research in the implementation of the activities of PNSR II

Formulation d’un Programme National du Secteur Rural robuste au Burkina Faso : Quelles thématiques nouvelles issues du processus des scénarios socio- économiques et climatiques?

Dans le cadre du partenariat initié en 2015 entre le Programme de recherche du CGIAR sur le Changement Climatique, l’Agriculture et la Sécurité Alimentaire (CCAFS) et le Secrétariat Permanent de la Coordination des Politiques Sectorielles Agricoles (SP-CPSA), en collaboration avec d’autres programmes et centres de recherche du CGIAR, une analyse du Programme National du Secteur Rural (PNSR) fondée sur les scénarios socio-économiques et climatiques du CCAFS a pu être menée avec la participation effective des parties prenantes du secteur rural du Burkina Faso. Les 22 recommandations qui en sont issues devraient permettre une prise en compte effective des facteurs socio- économiques, environnementaux et climatiques plausibles dans le futur proche et lointain, et ainsi aider à rendre le PNSR II plus robuste face aux incertitudes futures liées au changement climatique, aux dynamiques mondiales, aux évolutions socioéconomiques, aux changements des normes et valeurs, etc. En outre, un exercice avec l’ensemble des acteurs impliqués a consisté à traduire lesdites recommandations en actions et thématiques nouvelles à prendre en compte lors de la formulation du PNSR II. Les échanges entre acteurs ont également fait ressortir la nécessité d’une implication transversale de la recherche dans la mise en œuvre des activités de cet important outil politique qu’est le PNSR I

Transplacental Transmission of Plasmodium falciparum in a Highly Malaria Endemic Area of Burkina Faso

Malaria congenital infection constitutes a major risk in malaria endemic areas. In this study, we report the prevalence of transplacental malaria in Burkina Faso. In labour and delivery units, thick and thin blood films were made from maternal, placental, and umbilical cord blood to determine malaria infection. A total of 1,309 mother/baby pairs were recruited. Eighteen cord blood samples (1.4%) contained malaria parasites (Plasmodium falciparum). Out of the 369 (28.2%) women with peripheral positive parasitemia, 211 (57.2%) had placental malaria and 14 (3.8%) had malaria parasites in their umbilical cord blood. The umbilical cord parasitemia levels were statistically associated with the presence of maternal peripheral parasitemia (OR = 9.24, P ≪ 0.001), placental parasitemia (OR = 10.74, P ≪ 0.001), high-density peripheral parasitemia (OR = 9.62, P ≪ 0.001), and high-density placental parasitemia (OR = 4.91, P = 0.03). In Burkina Faso, the mother-to-child transmission rate of malaria appears to be low

Evaluation of seasonal malaria chemoprevention in two areas of intense seasonal malaria transmission: Secondary analysis of a household-randomised, placebo-controlled trial in Houndé District, Burkina Faso and Bougouni District, Mali.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is now widely deployed in the Sahel, including several countries that are major contributors to the global burden of malaria. Consequently, it is important to understand whether SMC continues to provide a high level of protection and how SMC might be improved. SMC was evaluated using data from a large, household-randomised trial in Houndé, Burkina Faso and Bougouni, Mali. METHODS AND FINDINGS: The parent trial evaluated monthly SMC plus either azithromycin (AZ) or placebo, administered as directly observed therapy 4 times per year between August and November (2014-2016). In July 2014, 19,578 children aged 3-59 months were randomised by household to study group. Children who remained within the age range 3-59 months in August each year, plus children born into study households or who moved into the study area, received study drugs in 2015 and 2016. These analyses focus on the approximately 10,000 children (5,000 per country) under observation each year in the SMC plus placebo group. Despite high coverage and high adherence to SMC, the incidence of hospitalisations or deaths due to malaria and uncomplicated clinical malaria remained high in the study areas (overall incidence rates 12.5 [95% confidence interval (CI): 11.2, 14.1] and 871.1 [95% CI: 852.3, 890.6] cases per 1,000 person-years, respectively) and peaked in July each year, before SMC delivery began in August. The incidence rate ratio comparing SMC within the past 28 days with SMC more than 35 days ago-adjusted for age, country, and household clustering-was 0.13 (95% CI: 0.08, 0.20), P < 0.001 for malaria hospitalisations and deaths from malaria and 0.21 (95% CI 0.20, 0.23), P < 0.001 for uncomplicated malaria, indicating protective efficacy of 87.4% (95% CI: 79.6%, 92.2%) and 78.3% (95% CI: 76.8%, 79.6%), respectively. The prevalence of malaria parasitaemia at weekly surveys during the rainy season and at the end of the transmission season was several times higher in children who missed the SMC course preceding the survey contact, and the smallest prevalence ratio observed was 2.98 (95% CI: 1.95, 4.54), P < 0.001. The frequency of molecular markers of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) resistance did not increase markedly over the study period either amongst study children or amongst school-age children resident in the study areas. After 3 years of SMC deployment, the day 28 PCR-unadjusted adequate clinical and parasitological response rate of the SP + AQ regimen in children with asymptomatic malaria was 98.3% (95% CI: 88.6%, 99.8%) in Burkina Faso and 96.1% (95% CI: 91.5%, 98.2%) in Mali. Key limitations of this study are the potential overdiagnosis of uncomplicated malaria by rapid diagnostic tests and the potential for residual confounding from factors related to adherence to the monthly SMC schedule. CONCLUSION: Despite strong evidence that SMC is providing a high level of protection, the burden of malaria remains substantial in the 2 study areas. These results emphasise the need for continuing support of SMC programmes. A fifth monthly SMC course is needed to adequately cover the whole transmission season in the study areas and in settings with similar epidemiology. TRIAL REGISTRATION: The AZ-SMC trial in which these data were collected was registered at clinicaltrials.gov: NCT02211729

Capacitating stakeholders to using Climate Information in West Africa: Achievements and lessons learned from the WAAPP-funded CaSCIERA-TA project

This Info note summarizes the achievements and lessons learned from the implementation of a 2-year project on ‘’Capacitating Stakeholders in Using Climate Information for Enhanced Resilience in the Agricultural Sector in West Africa (CaSCIERA-TA)’’, funded by Conseil Ouest et Centre Africain pour la Recherche et le Développement Agricole (CORAF) under the West Africa Agricultural Productivity Program (WAAPP)”. This project was implemented by a consortium of partners led by ICRAF Sahel Office and included CCAFS West Africa Program, AGRHYMET, INRAB-Benin, IRAG-Guinea, INRAN-Niger and ITRA-Togo. The project aimed at strengthening the capacity of the stakeholders of four WAAPP implementing countries to mainstream and implement Climate Smart Agriculture (CSA) into their activities

Caregiver Recognition of Childhood Diarrhea, Care Seeking Behaviors and Home Treatment Practices in Rural Burkina Faso: A Cross-Sectional Survey

Introduction: To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices. Methods: A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children,27 months were interviewed to assess child diarrhea prevalence and related car

Transplacental Transmission of Plasmodium falciparum in a Highly Malaria Endemic Area of Burkina Faso

Malaria congenital infection constitutes a major risk in malaria endemic areas. In this study, we report the prevalence of transplacental malaria in Burkina Faso. In labour and delivery units, thick and thin blood films were made from maternal, placental, and umbilical cord blood to determine malaria infection. A total of 1,309 mother/baby pairs were recruited. Eighteen cord blood samples (1.4%) contained malaria parasites (Plasmodium falciparum). Out of the 369 (28.2%) women with peripheral positive parasitemia, 211 (57.2%) had placental malaria and 14 (3.8%) had malaria parasites in their umbilical cord blood. The umbilical cord parasitemia levels were statistically associated with the presence of maternal peripheral parasitemia (OR = 9.24, P 0.001), placental parasitemia (OR = 10.74, P 0.001), high-density peripheral parasitemia (OR = 9.62, P 0.001), and high-density placental parasitemia (OR = 4.91, P = 0.03). In Burkina Faso, the mother-to-child transmission rate of malaria appears to be low

Temporal variation in body measurements in three Taurine cattle populations of Burkina Faso supports introgression of Zebu genes into West African Taurine cattle

A total of 769 adult females belonging to 3 taurine and one zebu cattle populations sampled in 3 provinces of Burkina Faso were assessed for 19 body measurements during two different years (2014 and 2018). The aim of this research was to identify temporal morphological variation in cattle bred in the humid southern zones to obtain empirical evidence supporting a possible introgression of zebu cattle genes into Gourounsi and Lobi taurine cattle breeds. Zebu cattle samples were used as out-group for both 2014 and 2018 subsets. Least square means of body measurements allowed to classify Burkina Faso taurine cattle into three subgroups according to body size (Gourounsi–Sanguié –GourS-, Gourounsi-Nahouri –GourN- and Lobi from the tallest to the smallest respectively). Principal Component Analysis suggested that in 2014, taurine populations were structured. Dispersion map constructed using the two first factors informed that the GourS population was well separated from both the Lobi and the GourN, which, in turn, overlapped. However, in 2018 a strong signal of homogenization was identified, with GourN partially overlapping the other two populations. Linear Discriminant Analysis suggested that about 20% of both GourS and GourN individuals were reciprocally misclassified. Clues for such increase have been pointed out by MANOVA analysis. Although on 2014, Lobi cattle was clearly smaller than Gourounsi and both GourS and GourN populations showed clear differences on body traits, on 2018 it could be assessed an increase in size in Lobi cattle and a strong homogenization signal within Gourounsi cattle. Zebu cattle gene flow southwards in Burkina Faso is likely to have caused these changes, suggesting a fast erosion of taurine cattle genetic background. Keywords: Body traits, quantitative traits, Gourounsi cattle, Lobi, Burkina Faso