Comparison of artesunate–mefloquine and artemether–lumefantrine fixed-dose combinations for treatment of uncomplicated Plasmodium falciparum malaria in children younger than 5 years in sub-Saharan Africa: a randomised, multicentre, phase 4 trial

SummaryBackgroundWHO recommends combinations of an artemisinin derivative plus an antimalarial drug of longer half-life as treatment options for uncomplicated Plasmodium falciparum infection. In Africa, artemether–lumefantrine is the most widely used artemisinin-based combination therapy, whereas artesunate–mefloquine is used infrequently because of a perceived poor tolerance to mefloquine. WHO recommends reconsideration of the use of artesunate–mefloquine in Africa. We compared the efficacy and safety of fixed-dose artesunate–mefloquine with that of artemether–lumefantrine for treatment of children younger than 5 years with uncomplicated P falciparum malaria.MethodsWe did this multicentre, phase 4, open-label, non-inferiority trial in Burkina Faso, Kenya, and Tanzania. Children aged 6–59 months with uncomplicated malaria were randomly assigned (1:1), via a computer-generated randomisation list, to receive 3 days' treatment with either one or two artesunate–mefloquine tablets (25 mg artesunate and 55 mg mefloquine) once a day or one or two artemether–lumefantrine tablets (20 mg artemether and 120 mg lumefantrine) twice a day. Parasitological assessments were done independently by two microscopists who were blinded to treatment allocation. The primary outcome was the PCR-corrected rate of adequate clinical and parasitological response (ACPR) at day 63 in the per-protocol population. Non-inferiority was shown if the lower limit of the 95% CI for the difference between groups was greater than −5%. Early vomiting was monitored and neuropsychiatric status assessed regularly during follow-up. This study is registered with ISRCTN, number ISRCTN17472707, and the Pan African Clinical Trials Registry, number PACTR201202000278282.Findings945 children were enrolled and randomised, 473 to artesunate–mefloquine and 472 to artemether–lumefantrine. The per-protocol population consisted of 407 children in each group. The PCR-corrected ACPR rate at day 63 was 90·9% (370 patients) in the artesunate–mefloquine group and 89·7% (365 patients) in the artemether–lumefantrine group (treatment difference 1·23%, 95% CI −2·84% to 5·29%). At 72 h after the start of treatment, no child had detectable parasitaemia and less than 6% had fever, with a similar number in each group (21 in the artesunate–mefloquine group vs 24 in the artemether–lumefantrine group). The safety profiles of artesunate–mefloquine and artemether–lumefantrine were similar, with low rates of early vomiting (71 [15·3%] of 463 patients in the artesunate–mefloquine group vs 79 [16·8%] of 471 patients in the artemether–lumefantrine group in any of the three dosing days), few neurological adverse events (ten [2·1%] of 468 vs five [1·1%] of 465), and no detectable psychiatric adverse events.InterpretationArtesunate–mefloquine is effective and safe, and an important treatment option, for children younger than 5 years with uncomplicated P falciparum malaria in Africa.FundingAgence Française de Développement, France; Department for International Development, UK; Dutch Ministry of Foreign Affairs, Netherlands; European and Developing Countries Clinical Trials Partnership; Fondation Arpe, Switzerland; Médecins Sans Frontières; Swiss Agency for Development and Cooperation, Switzerland

Perceived stressors of climate vulnerability across scales in the Savannah zone of Ghana: a participatory approach

Smallholder farmers in sub-Saharan Africa are confronted with climatic and non-climatic stressors. Research attention has focused on climatic stressors, such as rainfall variability, with few empirical studies exploring non-climatic stressors and how these interact with climatic stressors at multiple scales to affect food security and livelihoods. This focus on climatic factors restricts understanding of the combinations of stressors that exacerbate the vulnerability of farming households and hampers the development of holistic climate change adaptation policies. This study addresses this particular research gap by adopting a multi-scale approach to understand how climatic and non-climatic stressors vary, and interact, across three spatial scales (household, community and district levels) to influence livelihood vulnerability of smallholder farming households in the Savannah zone of northern Ghana. This study across three case study villages utilises a series of participatory tools including semi-structured interviews, key informant interviews and focus group discussions. The incidence, importance, severity and overall risk indices for stressors are calculated at the household, community, and district levels. Results show that climatic and non-climatic stressors were perceived differently; yet, there were a number of common stressors including lack of money, high cost of farm inputs, erratic rainfall, cattle destruction of crops, limited access to markets and lack of agricultural equipment that crossed all scales. Results indicate that the gender of respondents influenced the perception and severity assessment of stressors on rural livelihoods at the community level. Findings suggest a mismatch between local and district level priorities that have implications for policy and development of agricultural and related livelihoods in rural communities. Ghana’s climate change adaptation policies need to take a more holistic approach that integrates both climatic and non-climatic factors to ensure policy coherence between national climate adaptation plans and District development plans

Identifying Risk Factors for Morbidity and Mortality in Patients with Primary Head and Neck Cancers in a Nigerian Population

Background: The risk factors for head and neck cancers (HNC) vary in different parts of the world. Objectives: To identify the risk factors for HNC and the correlation between these factors and the involved anatomical sites. Methods: We retrieved and analyzed health records of patients that met the inclusion criteria for HNC managed at our facility in a 10-year period using the International Classification of Diseases (ICD) version 10. Results: We studied 122 patients with a male to female ratio of 2.1:1 aged 13 years to 85 years (mean = 51 years). Alcohol ( P  = .02), cigarette smoking ( P  = .01), and cooking wood smoke ( P  = .01) were associated with advanced tumor stage. Conclusions: The strongest risk factors for HNC are alcohol, tobacco, HIV, agricultural chemicals, and cooking wood fumes in both sexes in their sixth and seventh decades

The undergraduate medical student's perception of professional mentorship: Results from a developing nation's medical school

INTRODUCTION: There are no documented formal mentoring programs for medical students in Nigeria. This study aims to determine the perception of undergraduate medical students at the University of Jos on professional mentorship, with a view to informing University authorities on creating and developing a mentoring program. MATERIALS AND METHODS: A cross-sectional study conducted in December 2017 in which self-administered questionnaires were distributed among the sixth-year medical students in a University in North-Central Nigeria, eliciting information regarding biodemographic data, knowledge of and experiences with mentoring, desired benefits of mentoring, and the willingness to participate in a mentoring relationship. Data collected was analyzed with EPI Info statistical software® version 7.2.1 (EPI Info, Center for Disease Control, Atlanta, Georgia, 2017). RESULTS: In a class of 166, the response rate was 83.5%. Mean age = 27.4 years; standard deviation = ±2.6 with a male: female ratio of 1.9:1. Moderate knowledge of mentoring was reported by 47 (44.3%). Attitude toward mentoring was very positive in 23.6%. One hundred and four (98.1%) students agreed mentoring are effective in developing potential. Nearly 95.3% agreed a mentorship program would benefit medical students with 70.8% expressing high willingness to participate. A weak positive statistical correlation between the age of students and those who expressed willingness to participate was recorded (r = 0.04; 95% confidence interval (CI) = 0.6–1.16; and P = 0.05). CONCLUSION: Sixth-year medical students of the University of Jos have a moderate knowledge of and a good attitude toward mentorship. The implementation of a formal mentoring program for medical students at the University of Jos is strongly recommended

Characteristics of Nasopharyngeal Cancer in Jos, Nigeria

Background: Nasopharyngeal cancer (NPC) has been reported by scholars as the most lethal and emotionally traumatic malignancy globally, with the outlook even poorer in African Natives from late presentation. We therefore sought to study the characteristics of NPCs in our environment.Method: We retrospectively evaluated all histo-pathologically confirmed cases of NPC managed between May 1, 2009-April 30, 2017 from retrieved case files using the ICD-10 version 10 standard codes at the Jos University Teaching Hospital.Results: Thirty cases, accounting for 0.2% of new Ear, Nose and Throat(ENT) outpatients were analysed. This represents the  commonest Head & Neck Cancer and the 3rd general body squamous cancer with 9.3%. Age range was 18years-69years rd th with a bimodal distribution at the 3 and 7 decades of life. Alcohol consumption/Cigarette smoking was recorded in 73.3% with a maximum pack years of 31.5years. Predominant feature was neck masses in 66.7% where 65.0% had nodes>6cm, 76.7% had T4 tumours and 56.7% anaemia while 76.7% presented late. The WHO type III predominated with 60.0%. Definitive therapy was administered in 16.7% with adismal follow-up visit as 70.0% never returned. Mortality was difficult to ascertain as all were referred.Conclusion: NPC remains infrequent in Africa with WHO type III the predominant form. It is associated with late presentation, advanced disease, inadequate cancer care infrastructure and poor access to chemo-radiation. Early detection strategy using EBV biomarkers is a priority to prevent the misery associated with NPC. Key Words; Nasopharyngeal cancer, Characteristics, advanced disease, late presentatio

Environmental Change, Risky Sexual Behavior, and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti

Deforestation, Environment, Haiti, HIV/AIDS, Rural livelihoods, Natural resources, Population, Remote sensing,