Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa

BACKGROUND: Over thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs), but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically. METHODS: We searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted. RESULTS: The review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions. CONCLUSIONS: CHW programmes could potentially achieve large gains in child survival in sub-Saharan Africa if these programmes were implemented at scale. Large-scale rigorous studies, including RCTs, are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions

Antibody responses to <i>P. falciparum</i> blood stage antigens and incidence of clinical malaria in children living in endemic area in Burkina Faso

Abstract Background High parasite-specific antibody levels are generally associated with low susceptibility to Plasmodium falciparum malaria. This has been supported by several studies in which clinical malaria cases of P. falciparum malaria were reported to be associated with low antibody avidities. This study was conducted to evaluate the role of age, malaria transmission intensity and incidence of clinical malaria in the induction of protective humoral immune response against P. falciparum malaria in children living in Burkina Faso. Methods We combined levels of IgG and IgG subclasses responses to P. falciparum antigens: Merozoite Surface Protein 3 (MSP3), Merozoite Surface Protein 2a (MSP2a), Merozoite Surface Protein 2b (MSP2b), Glutamate Rich Protein R0 (GLURP R0) and Glutamate Rich Protein R2 (GLURP R2) in plasma samples from 325 children under five (05) years with age, malaria transmission season and malaria incidence. Results We notice higher prevalence of P. falciparum infection in low transmission season compared to high malaria transmission season. While, parasite density was lower in low transmission than high transmission season. IgG against all antigens investigated increased with age. High levels of IgG and IgG subclasses to all tested antigens except for GLURP R2 were associated with the intensity of malaria transmission. IgG to MSP3, MSP2b, GLURP R2 and GLURP R0 were associated with low incidence of malaria. All IgG subclasses were associated with low incidence of P. falciparum malaria, but these associations were stronger for cytophilic IgGs. Conclusions On the basis of the data presented in this study, we conclude that the induction of humoral immune response to tested malaria antigens is related to age, transmission season level and incidence of clinical malaria

Immune and hemorheological changes in Chronic Fatigue Syndrome

BACKGROUND: Chronic Fatigue Syndrome (CFS) is a multifactorial disorder that affects various physiological systems including immune and neurological systems. The immune system has been substantially examined in CFS with equivocal results, however, little is known about the role of neutrophils and natural killer (NK) phenotypes in the pathomechanism of this disorder. Additionally the role of erythrocyte rheological characteristics in CFS has not been fully expounded. The objective of this present study was to determine deficiencies in lymphocyte function and erythrocyte rheology in CFS patients. METHODS: Flow cytometric measurements were performed for neutrophil function, lymphocyte numbers, NK phenotypes (CD56(dim)CD16(+ )and CD56(bright)CD16(-)) and NK cytotoxic activity. Erythrocyte aggregation, deformability and fibrinogen levels were also assessed. RESULTS: CFS patients (n = 10) had significant decreases in neutrophil respiratory burst, NK cytotoxic activity and CD56(bright)CD16(- )NK phenotypes in comparison to healthy controls (n = 10). However, hemorheological characteristic, aggregation, deformability, fibrinogen, lymphocyte numbers and CD56(dim)CD16(+ )NK cells were similar between the two groups. CONCLUSION: These results indicate immune dysfunction as potential contributors to the mechanism of CFS, as indicated by decreases in neutrophil respiratory burst, NK cell activity and NK phenotypes. Thus, immune cell function and phenotypes may be important diagnostic markers for CFS. The absence of rheological changes may indicate no abnormalities in erythrocytes of CFS patients

Antibody levels against GLURP R2, MSP1 block 2 hybrid and AS202.11 and the risk of malaria in children living in hyperendemic (Burkina Faso) and hypo-endemic (Ghana) areas

Differences in parasite transmission intensity influence the process of acquisition of host immunity to Plasmodium falciparum malaria and ultimately, the rate of malaria related morbidity and mortality. Potential vaccines being designed to complement current intervention efforts therefore need to be evaluated against different malaria endemicity backgrounds. The associations between antibody responses to the chimeric merozoite surface protein 1 block 2 hybrid (MSP1 hybrid), glutamate-rich protein region 2 (GLURP R2) and the peptide AS202.11, and the risk of malaria were assessed in children living in malaria hyperendemic (Burkina Faso, n = 354) and hypo-endemic (Ghana, n = 209) areas. Using the same reagent lots and standardized protocols for both study sites, immunoglobulin (Ig) M, IgG and IgG sub-class levels to each antigen were measured by ELISA in plasma from the children (aged 6-72 months). Associations between antibody levels and risk of malaria were assessed using Cox regression models adjusting for covariates. There was a significant association between GLURP R2 IgG3 and reduced risk of malaria after adjusting age of children in both the Burkinabe (hazard ratio 0.82; 95 % CI 0.74-0.91, p &lt; 0.0001) and the Ghanaian (HR 0.48; 95 % CI 0.25-0.91, p = 0.02) cohorts. MSP1 hybrid IgM was associated (HR 0.85; 95 % CI 0.73-0.98, p = 0.02) with reduced risk of malaria in Burkina Faso cohort while IgG against AS202.11 in the Ghanaian children was associated with increased risk of malaria (HR 1.29; 95 % CI 1.01-1.65, p = 0.04). These findings support further development of GLURP R2 and MSP1 block 2 hybrid, perhaps as a fusion vaccine antigen targeting malaria blood stage that can be deployed in areas of varying transmission intensity

Critical success factors for implementing building information modelling (BIM): A longitudinal review

Although building information modelling (BIM) is ubiquitous within the construction industry, a review analysis on critical success factors (CSFs) used to measure successful BIM implementation is not well established. This research conducts a comprehensive review and interpretivist study of published studies on CSFs for BIM implementation during the period 2005 to 2015. Analysis reveals that some countries (e.g. USA, UK and South Korea) have developed clear CSFs for measuring successful BIM implementation, although each country implements a different sets of CSFs, some universal CSFs are shared between these countries, namely: collaboration in design, engineering, and construction stakeholders; earlier and accurate 3D visualisation of design; coordination and planning of construction works; enhancing exchange of information and knowledge management; and improved site layout planning and site safety. These common factors provide a core basis for establishing a standard evaluation model for measuring the success of BIM implementation and serve to identify areas for further improvement. A checklist of CSFs for BIM implementation is developed, and could render new insight for researchers and practitioners to conduct further empirical studies

Species composition and inversion polymorphism of the Anopheles gambiae complex in some sites of Ghana, West Africa.

Sampleso f Anophelesg ambiaes .l. werec ollectedf rom eight localitiesb elongingt o four of the five main ecologicasl tratao f Ghana.A nalysiso f ovarianp olytenec hromosomesre vealedt he presenceo f A. gambiae s.s. in all the sites studied, while l. arabiensisw as detectedo nly in the extremen orthern locality of Navrongoa nd l. rnelasin somes outherns ites.A nopheleas rabiensis howeda degreeo f inversionp olymorphism comparablet o the one observedin other WestA frican countries.T he analysiso f the chromosomal polymorphism of A. gambiaes .s.s howedt he presenceo f the FOREST form in the rain forest localities and the SAVANNA form in the coastal savanna sites. The MOPTI form occurred sympatrically with the SAVANNA form in the northernmostl ocality. The possiblei nfluenceo f the presenceo f various taxa of the A. gambiaec omplexa nd oftheir intra-specificv ariantso n malaria vectorials ystemis discussed

Effects of different weights and lifting postures on balance control following repetitive lifting tasks in construction workers

Purpose Repetitive lifting tasks have detrimental effects upon balance control and may contribute toward fall injuries, yet despite this causal linkage, risk factors involved remain elusive. The purpose of this paper is to evaluate the effects of different weights and lifting postures on balance control using simulated repetitive lifting tasks. Design/methodology/approach In total, 20 healthy male participants underwent balance control assessments before and immediately after a fatiguing repetitive lifting tasks using three different weights in a stoop (ten participants) or a squat (ten participants) lifting posture. Balance control assessments required participants to stand still on a force plate with or without a foam (which simulated an unstable surface) while center of pressure (CoP) displacement parameters on the force plate was measured. Findings Results reveal that: increased weight (but not lifting posture) significantly increases CoP parameters; stoop and squat lifting postures performed until subjective fatigue induce a similar increase in CoP parameters; and fatigue adversely effected the participant’s balance control on an unstable surface vis-à-vis a stable surface. Findings suggest that repetitive lifting of heavier weights would significantly jeopardize individuals’ balance control on unstable supporting surfaces, which may heighten the risk of falls. Originality/value This research offers an entirely new and novel approach to measuring the impact that different lifting weights and postures may have upon worker stability and consequential fall incidents that may arise