Malaria Elimination: Challenges and Opportunities

In 2016, 91 countries reported a total of 216 million cases of malaria, an increase of 5 million cases over the previous year, and the estimated malaria deaths worldwide were 445,000 like in 2015. This suggests that despite a substantial reduction in the malaria burden observed since 2010, largely attributed to the scale-up of effective control measures (vector control interventions, efficacious antimalarial treatment), the rate of decline of both clinical cases and malaria deaths has stalled since 2014 and in some regions even reversed. Achieving universal access to standard control interventions, such as case management, implementation of vector control methods, seasonal malaria chemoprevention, and intermittent preventive treatment for pregnant women, remains a priority. It is essential to contain emerging drug resistance in malarial parasite and insecticide resistance in mosquito vector species. Additional new interventions to accelerate interruption of transmission are in crucial need for their rapid integration within the standard control activities. These integrated control approaches must be implemented at community level with the active involvement of the local populations to reach high coverage. Finally, political and financial supports should be maintained and even doubled to reach the 2030 targets of the WHO global technical strategy for malaria

Increased Risk for Severe Malaria in HIV-1–infected Adults, Zambia

In areas in which malaria and HIV-1 are coendemic, adults with severe malaria who show no clinical signs of immunosuppression are likely to be infected with HIV-1

House screening for malaria control: views and experiences of participants in the RooPfs trial

Background The housing stock of rural sub-Saharan Africa is changing rapidly. With millions of new homes required over the coming decades, there is an opportunity to protect residents by screening homes from malaria mosquitoes. This study, undertaken in the Upper River Region of The Gambia, explores local perceptions of what a good house should provide for its inhabitants and responses to living in a house that has been modified as part of a randomized control trial designed to assess whether improved housing provided additional protection against clinical malaria in children (the RooPfs trial). Methods This descriptive, exploratory study was undertaken over 22 months using mixed-methods (informal conversations, observations, focus group discussions, photovoice, and a questionnaire survey) in a parallel convergent design. Analysis was conducted across the data sets using a framework approach. Following coding, the textual data were charted by a priori and emerging themes. These themes were compared with the quantitative survey results. The nature and range of views about housing and the RooPfs study modifications and the relationships among them were identified and described. Results The data were derived from a total of 35 sets of observations and informal conversations in 10 villages, 12 discussions with the photovoice photographers, 26 focus group discussions (across 13 villages) and 391 completed questionnaires. The study participants described a ‘good house’ as one with a corrugate-metal roof, cement walls (preferably cement block, but mud block covered with cement plaster was also an acceptable and cheaper substitute) and well-fitting doors. These features align with local perceptions of a modern house that provides social status and protection from physical harms. The RooPfs modifications were largely appreciated, although poor workmanship caused concerns that houses had become insecure. However, the long-term trusting relationship with the implementing institution and the actions taken to rectify problems provided reassurance and enhanced acceptability. Conclusion In developing housing to address population needs in Africa, attention should be paid to local perceptions of what is required to make a house secure for its inhabitants, as well as providing a healthy environment

The effect of physical barriers under a raised house on mosquito entry: an experimental study in rural Gambia

Background: Anopheles gambiae, the major malaria mosquito in sub-Saharan Africa, feed largely indoors at night. Raising a house off the ground with no barriers underneath reduces mosquito-house entry. This experiment tested whether walling off the space under an elevated hut affects mosquito-hut entry. Methods: Four inhabited experimental huts, each of which could be moved up and down, were used in rural Gambia. Nightly collections of mosquitoes were made using light traps and temperature and carbon dioxide levels monitored indoors and outdoors using loggers. Each night, a reference hut was kept at ground level and three huts raised 2 m above the ground; with the space under the hut left open, walled with air-permeable walls or solid walls. Treatments were rotated every four nights using a randomized block design. The experiment was conducted for 32 nights. Primary measurements were mosquito numbers and indoor temperature in each hut. Results: A total of 1,259 female Anopheles gambiae sensu lato were collected in the hut at ground level, 655 in the hut with an open ground floor, 981 in the hut with air-permeable walls underneath and 873 in the hut with solid walls underneath. Multivariate analysis, adjusting for confounders, showed that a raised hut open underneath had 53% fewer mosquitoes (95% CI 47–58%), those with air-permeable walls underneath 24% fewer (95% CI 9–36%) and huts with solid walls underneath 31% fewer (95% CI 24–37%) compared with a hut on the ground. Similar results were found for Mansonia spp. and total number of female mosquitoes, but not for Culex mosquitoes where hut entry was unaffected by height or barriers. Indoor temperature and carbon dioxide levels were similar in all huts. Conclusion: Raising a house 2 m from the ground reduces the entry of An. gambiae and Mansonia mosquitoes, but not Culex species. The protective effect of height is reduced if the space underneath the hut is walled off

Histological effects of an innovative 445 Nm Blue Laser during oral soft tissue biopsy.

Continuously evolving laser devices can be used in various fields; they are an alternative to the traditional cold blade surgery to perform biopsies of oral soft tissues. The aspect focused on in this paper is the possibility to use the 445 nm diode laser (Eltech K-Laser srl, Treviso, Italy) in complete safety, by evaluating its thermal effects during microscopy. A histological evaluation of the alteration of the peri-incisional edges on 10 samples was realized. All excisional biopsies were related to clinically unsuspected lesions and performed by the same expert operator. The surgical procedure was performed with the same laser parameters and the same pathologist evaluated the thermal effect on the samples. An average value of the detected tissue alteration was calculated; the average damage of the epithelium was 650.93 μm, while in the connective tissue it was 468.07 μm. In all the cases a clear diagnosis was possible, and no clinical complications were observed; so, the 445 nm diode laser proved to be a device that can be safely used for biopsies of clinically unsuspicious lesions. Due to the small number of cases, this in vivo preliminary experience needs to be extended

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) database: open-access data collection in maternal and newborn health

In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for ‘deep phenotyping’ based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal comorbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience

NeVoCGPS network: contributions to the Deformation Analysis in Neapolitan Volcanic area based on Continuous GPS measurements

Osservatorio Vesuviano, department of Istituto Nazionale di Geofisica e Vulcanologia, installed a permanent GPS network (NeVoCGPS), constituted of 25 stations, in Neapolitan volcanic area, where three active volcanoes (Somma-Vesuvius, Campi Flegrei caldera and Ischia Island) rise, each characterized by a peculiar type of ground movements activity. The Somma-Vesuvius system exhibits now a low level of ground deformation; the Campi Flegrei, caracterized from over 2000 years by slow up and down vertical movements (bradyseism), at present is in a very slow uplift phase; Ischia, finally, shows subsidence in the specific areas (Southern and North-West sectors of the island). The presence of these volcanoes and the dense urbanization of the area make the ground deformation monitoring a crucial point for risk mitigation and modelling aims. The 3D ground displacements are calculated using CGPS data, acquired with a 30s rate and with the daily and weekly vertexes position estimate. All the stations are managed by remote control and the data are automatically downloaded and processed using Bernese software package. The entire chain of acquisition, processing and data analysis is accurately described and some results obtained in the last years are shown

Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

Objective To compare the effectiveness of oral quinine with that of artemether-lumefantrine in treating uncomplicated malaria in children

High Complexity of Plasmodium vivax Infections in Symptomatic Patients from a Rural Community in Central Vietnam Detected by Microsatellite Genotyping

Fourteen published and three newly identified polymorphic microsatellites were used to genotype 69 Plasmodium vivax samples obtained from 39 patients detected over a period of two years who lived in a rural community of central Vietnam. All samples were polyclonal with an average expected heterozygosity of 0.86. Among the 39 patients, 16 experienced 1–5 recurrent episodes of P. vivax malaria, most of them (83%) with a different genotype profile compared with previous infections. The minimal set of microsatellites required for differentiating the genotype profiles of the recurrent infections compared with the full set of 17 microsatellites was explored. A combination of five markers was sufficient to identify all recurrent infections with an unrelated or different genotype profile compared with all previous episodes

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network’s first protocol: deep phenotyping in three sub-Saharan African countries

Background: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America. Methods: This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national sample size of 600; these women will provide culturally-, ethnically-, seasonallyand spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/ immediately after birth and 6 weeks after birth. Conclusions: To accelerate progress towards the women’s and children’s health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/ newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health