Protective efficacy of co-trimoxazole prophylaxis against malaria in HIV exposed children in rural Uganda: a randomised clinical trial

Objective To evaluate the protective efficacy of co-trimoxazole prophylaxis against malaria in HIV exposed children (uninfected children born to HIV infected mothers) in Africa

Capacity building for conservation: problems and potential solutions for sub-Saharan Africa

To successfully achieve their stated conservation goals individuals, communities and organisations need to acquire a diversity of skills, knowledge and information (capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognised that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapidly growing number and extent of environmental problems in the region. This paper presents a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-Learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi (Kenya) in 2015. At the meeting, 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organisations from 24 African nations and 8 non-African nations. The 39 recommendations constitute five broad types of suggested action: those that recommend (i) the development of new methods, (ii) the provision of capacity building resources e.g. information or data, (iii) the communication of ideas or examples of successful initiatives, (iv) the implementation of new research or gap analyses, (v) the establishment of new structures within and between organisations, and (vi) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions. For example, all four workshops highlighted the need for a greater sense of urgency in developing capacity building activities in response to ongoing and rapid socio-environmental change in the region. Delegates also felt that conservation organisations, responsible agencies and donors need to recognise capacity building as one of the most urgent conservation issues we face. The need to develop novel and cost-efficient capacity building methodologies (and associated evaluation metrics), was also identified as a key issue. However, it was stressed that future of capacity building efforts will be best served by integrating new methods with more established activities. Importantly, given the broad suite of social, cultural and economic contexts found across sub-Saharan Africa, the need to move away from ‘one-size-fits-all’ approaches was strongly recommended in all thematic areas. Lastly, it was recognised that closing the gap between capacity need and capacity provision in the region will only be achieved through multi-partner capacity initiatives and networks.Additional co-authors: Vivian Kosgei, Anthony Kuria, Chris Magero, Maaike Manten, Paul Mugo, Eduard Müller, Julie Mulonga, Leo Niskanen, Josephine Nzilani, Mary Otieno, Nisha Owen, Juliet Owuor, Stuart Paterson, Sébastien Regnaut, Richard Rono, Joseph Ruhiu, Jesse Theuri Njoka, Lucy Waruingi, Brian Waswala Olewe and Emily Wilso

Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case-Control Study from Kampala, Uganda.

Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case-control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1-150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80-254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37-142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42-141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22-56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated

Protecting Important Sites for Biodiversity Contributes to Meeting Global Conservation Targets

Protected areas (PAs) are a cornerstone of conservation efforts and now cover nearly 13% of the world's land surface, with the world's governments committed to expand this to 17%. However, as biodiversity continues to decline, the effectiveness of PAs in reducing the extinction risk of species remains largely untested. We analyzed PA coverage and trends in species' extinction risk at globally significant sites for conserving birds (10,993 Important Bird Areas, IBAs) and highly threatened vertebrates and conifers (588 Alliance for Zero Extinction sites, AZEs) (referred to collectively hereafter as ‘important sites’). Species occurring in important sites with greater PA coverage experienced smaller increases in extinction risk over recent decades: the increase was half as large for bird species with>50% of the IBAs at which they occur completely covered by PAs, and a third lower for birds, mammals and amphibians restricted to protected AZEs (compared with unprotected or partially protected sites). Globally, half of the important sites for biodiversity conservation remain unprotected (49% of IBAs, 51% of AZEs). While PA coverage of important sites has increased over time, the proportion of PA area covering important sites, as opposed to less important land, has declined (by 0.45–1.14% annually since 1950 for IBAs and 0.79–1.49% annually for AZEs). Thus, while appropriately located PAs may slow the rate at which species are driven towards extinction, recent PA network expansion has under-represented important sites. We conclude that better targeted expansion of PA networks would help to improve biodiversity trends

Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Background: Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods: Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results: A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions: In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery

Investigating the impact of onsite sanitation facilities on groundwater source quality in urban settings in Uganda

On-site sanitation and groundwater tend to be inseparable when it comes to informal settlements in urban settings where piped water and sewer lines are hard to reach or unreliable. With the increased urban immigration and informal settlements, groundwater quality may be prone to contamination due to onsite sanitation facilities putting people's health at risk. This study investigated the impact of onsite sanitation facilities on groundwater quality in urban settings in Uganda. The study was conducted in Wakiso and Kakiri Town councils in Wakiso District. From the household surveys, Onsite sanitation facilities and groundwater sources were identified and mapped using a hand-held portable i73+ pocket IMU-RTK. On average, about 5 OSS facilities were near the groundwater source; their distances were 5-30m from the source. The water quality of groundwater sources was also assessed by laboratory analysis. The parameters that were looked at were the distance of the OSS facilities from the groundwater sources and physio-chemical and Pathogens parameters. Pathogens parameters, included E. coli and total coliforms and physio-chemical parameters, which included nitrates, turbidity, electric conductivity, and pH, were considered the significant indicators of contamination in water. Findings revealed that 57% of the sampled water sources in the Wakiso and Kakiri Town councils were contaminated. Of these, 75% were boreholes in Kakiri town council. From the household surveys, 25% reported having had a diarrhoea patient, while 9% had had a typhoid patient in the past four months. Pearson’s correlation coefficient showed that distance is a significant factor in water quality. The study found that the farther the distance of the OSS facility from the water source was, the lesser the contamination

An Assessment of Land Cover and Threats in Important Bird Areas in Africa

Over 1,200 Important Bird Areas (IBAs) have been identified in Africa, each meeting at least one of four objective criteria that identify it as an area of high conservation importance for birds. Despite their biodiversity value, many IBAs are threatened by habitat degradation and a high proportion lack legal protection.We integrate an inventory of these IBAs with remote sensing data to identify patterns that could be used to assess priorities for monitoring and conservation. Land cover composition in IBAs differed significantly from that in buffer zones of the same area immediately surrounding them and was significantly more homogeneous. Agriculture and deforestation were the most prevalent threats to IBAs, particularly in IBAs containing a high proportion of dense forest or shrub. Human population density within IBAs was no lower than that immediately outside IBAs, and was around three times higher than the average for sub-Saharan Africa. However, projected human population growth was lower than the average for sub-Saharan Africa, with the projected increase greatest in IBAs with a high proportional cover of dense forest and mosaic woodland and lowest in IBAs with a higher grassland component.JRC.H.3-Global environement monitorin