Plasma zinc concentrations are depressed during the acute phase response in children with falciparum malaria

Plasma concentrations of some micronutrients are altered in the setting of acute infectious or inflammatory stress. Previous studies have provided conflicting evidence concerning the extent and direction of changes in plasma zinc concentrations during the acute phase response. We carried out an observational cohort study in 689 children enrolled in a randomized trial of zinc supplementation during acute falciparum malaria in order to evaluate the relation between plasma zinc concentration and the acute phase response. Plasma zinc was measured by atomic absorption spectrophotometry. On admission, 70% of all subjects had low plasma zinc (\u3c9.2 μmol/L). Multivariate analysis of predictors of admission plasma zinc showed that admission C-reactive protein (CRP), parasite density, and study site were the most important predictors. Predictors of changes in plasma zinc from admission to 72 h included baseline CRP, change in CRP, treatment group, study site, and baseline zinc concentration. In children with acute malaria infection, baseline plasma zinc concentrations were very low and were inversely correlated with CRP (r = -0.24, P \u3c 0.0001) and the degree of parasitemia (r = -0.19, P \u3c 0.0001). Even when CRP and time were taken into account, zinc supplementation increased plasma zinc concentration from admission to 72 h. When available, plasma zinc concentrations should be interpreted with concurrent measures of the acute phase response such as CRP. In children whose age, diet, and/or nutritional status place them at risk of zinc deficiency, those with low plasma zinc levels should be supplemented with oral zinc and followed for clinical and/or biochemical response. © 2005 American Society for Nutritional Sciences

Agronomic potentials of quality protein maize hybrids developed in Ghana

A quality protein maize (QPM) hybrid programme was started in 1991 to develop and promote high and stableyielding QPM hybrids to increase production of nutritionally superior maize varieties in Ghana. Six 3- way QPM hybrids developed from inbred lines originating from germplasm of the International Centre for Maize and Wheat Improvement (CIMMYT) were evaluated on research stations and in farmers\' fields in Ghana from 1995 to 1996. In the on-station evaluations, grain yields across 10 sites in both years averaged 6.0 ton ha-1 for the three hybrids (GH132-28, GH110-5 and GH2328-88), 5.22 ton ha-1 for Obatanpa, and 3.60 ton ha-1 for the local maize variety. In farmers\' fields, data from over 50 farm sites in 1995 and 1996 showed mean yields of 4.95 ton ha-1 for the three hybrids, and 4.28 ton ha-1 for Obatanpa compared to 3.59 ton ha-1 for farmers\' varieties. On the average, the hybrids were similar to Obatanpa in days to 50 per cent silking, but were shorter in plant height and ear placement. Consumer preference tests showed that the three hybrids were rated similar to the local variety in popular traditional food preparations such as ‘kenkey\' and ‘tuo zafi\'. In 1997, the National Variety Release Committee approved the release of GH132-28, GH110-5, and GH2328-88 under the local names Dadaba, Mamaba, and CIDA-ba, respectively. These hybrids are recommended for planting in all the major agro-ecologies to boost maize production in Ghana.Les variétés de maïs hybride (Zea mays L.) dont les plus sésirées que les variétés de pollinisation libre à cause de leur uniformté et leurs potentiels de rendement plus élevés. Pour augmenter la production de variétés de maïs nutritionnellement supérieures au Ghana, I\'Institut de Recherche de Cultures a mis en place un programme hybrid de maïs protéique de qualité (MPQ) en 1991 pour développer et promouvoir des hybrides de MPQ de rendement élevés et stable. Six hybrids en trois de MPQ développés d\'issu de la même souch provenant de germeplasmes de CIMMYT (Centre International pour I\'amélioration de maïs et de blé) étaient évalués aux stations de recherches et aux champs d\'agriculteurs au Ghana de 1995 à 1996. Dans les évaluations sur place, les rendements de grain à travers 10 sites dans les deux années ont atteint la moyenne de 6.0 ton ha-1 pour les trois hybrids (GH132-28, GH110-5 et GH2328-88), 5.22 ton ha-1 pour \'Obatanpa\' et 3.60 ton ha-1 pour la variétés de maïs local. Sur les champs d\'agriculteurs des données de plus que 50 sites de champs en 1995 et 1996 montraient les rendements moyens de 4.95 ton ha-1 pour les trois hybrids et 4.28 ton ha-1 pour les \'Obatanpa\' comparées à 3.59 ton ha-1 pour les variétés d\'agriculteurs. En moyenne, les hybrides étaient semblables à \'Obatanpa\' en jours jusqu à 50% d\'apparition de soie maïs étaient plus courtes en taille de plante et en placement d\'épi. Les essais de préférence de consommateur montraient que les trios hybrides étaient évalués semblables à la variété locale dans les préparations de nouriture traditionnelle populaire telle que \'kenkey\' et \'tuo zafi\'. En 1997, le comité pour la mise en vente de Variété Nationale a approuvé la mise en vente de GH132-28, GH110-5 et GH2328-88 sous les noms locaux respectifs de Dadaba, Mamaba, et CIDA-ba. Ce hybrides sont recommandés pour la popultion dans toutes les agroéclogies majeures pour stimuler la production de maïs au Ghana. Ghana Journal of Agricultural Science Vol. 40 (1) 2007: pp. 81-8

Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated Plasmodium falciparum malaria

The prevalence of chloroquine-resistant Plasmodium falciparum malaria has been increasing in sub-Saharan Africa and parts of South America over the last 2 decades, and has been associated with increased anaemia-associated morbidity and higher mortality rates. Prospectively collected clinical and parasitological data from a multicentre study of 788 children aged 6-59 months with uncomplicated P. falciparum malaria were analysed in order to identify risk factors for chloroquine treatment failure and to assess its impact on anaemia after therapy. The proportion of chloroquine treatment failures (combined early and late treatment failures) was higher in the central-eastern African countries (Tanzania, 53%; Uganda, 80%; Zambia, 57%) and Ecuador (54%) than in Ghana (36%). Using logistic regression, predictors of early treatment failure included younger age, higher baseline temperature, and greater levels of parasitaemia. We conclude that younger age, higher initial temperature, and higher baseline parasitaemia predict early treatment failure and a higher probability of worsening anaemia between admission and days 7 or 14 post-treatment

Effect of zinc on the treatment of Plasmodium falciparum malaria in children: A randomized controlled trial

Background: Zinc supplementation in young children has been associated with reductions in the incidence and severity of diarrheal diseases, acute respiratory infections, and malaria. Objective: The objective was to evaluate the potential role of zinc as an adjunct in the treatment of acute, uncomplicated falciparum malaria; a multicenter, double-blind, randomized placebo-controlled clinical trial was undertaken. Design: Children (n = 1087) aged 6 mo to 5 y were enrolled at sites in Ecuador, Ghana, Tanzania, Uganda, and Zambia. Children with fever and ≥ 2000 asexual forms of Plasmodium falciparum/μL in a thick blood smear received chloroquine and were randomly assigned to receive zinc (20 mg/d for infants, 40 mg/d for older children) or placebo for 4 d. Results: There was no effect of zinc on the median time to reduction of fever (zinc group: 24.2 h; placebo group: 24.0 h; P = 0.37), a ≥75% reduction in parasitemia from baseline in the first 72 h in 73.4% of the zinc group and in 77.6% of the placebo group (P = 0.11), and no significant change in hemoglobin concentration during the 3-d period of hospitalization and the 4 wk of follow-up. Mean plasma zinc concentrations were low in all children at baseline (zinc group: 8.54 ± 3.93 μmol/L; placebo group: 8.34 ± 3.25 μmol/L), but children who received zinc supplementation had higher plasma zinc concentrations at 72 h than did those who received placebo (10.95 ± 3.63 compared with 10.16 ± 3.25 μmol/L, P \u3c 0.001). Conclusion: Zinc does not appear to provide a beneficial effect in the treatment of acute, uncomplicated falciparum malaria in preschool children

Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone

ABSTRACT

The use of adherence aids by adults with diabetes: A cross-sectional survey

BACKGROUND: Adherence with medication taking is a major barrier to physiologic control in diabetes and many strategies for improving adherence are in use. We sought to describe the use of mnemonic devices and other adherence aids by adults with diabetes and to investigate their association with control of hyperglycemia, hyperlipidemia and hypertension. METHODS: Cross sectional survey of diabetic adults randomly selected from Primary Care practices in the Vermont Diabetes Information System. We used linear regression to examine the associations between the use of various aids and physiologic control among subjects who used oral agents for hyperglycemia, hypercholesterolemia, and hypertension. RESULTS: 289 subjects (mean age 65.4 years; 51% female) used medications for all three conditions. Adherence aids were reported by 80%. The most popular were day-of-the-week pill boxes (50%), putting the pills in a special place (41%), and associating pill taking with a daily event such as a meal, TV show, or bedtime (11%). After adjusting for age, sex, marital status, income, and education, those who used a special place had better glycemic control (A1C -0.36%; P = .04) and systolic blood pressure (-5.9 mm Hg; P = .05) than those who used no aids. Those who used a daily event had better A1C (-0.56%; P = .01) than patients who used no aids. CONCLUSION: Although adherence aids are in common use among adults with diabetes, there is little evidence that they are efficacious. In this study, we found a few statistically significant associations with adherence aids and better diabetes control. However, these findings could be attributed to multiple comparisons or unmeasured confounders. Until more rigorous evaluations are available, it seems reasonable to recommend keeping medicines in a special place for diabetic adults prescribed multiple medications

Arterial stiffness in hypertensive and type 2 diabetes patients in Ghana: comparison of the cardio-ankle vascular index and central aortic techniques

Background Diabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither. Method Testing the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart–ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured. Results In patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01). Conclusion In this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention

Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: An Analytic Cross-Sectional Study

Background. Hypertension remains a cause of morbidity and mortality in the Ashanti Region of Ghana. It has been featured in the top ten causes of OPD attendance, admissions, and deaths since 2012. We investigated the sociodemographic characteristics and spatial distribution of inpatient hypertensives and factors associated with their admission outcomes. Methods. A 2014 line list of 1715 inpatient HPT cases aged ≥25 years was used for the cross-sectional analytic study. Accounting for clustering, all analyses were performed using the “svy” command in Stata. Frequencies, Chi-square test, and logistic regression analysis were used in the analysis. Arc view Geographic Information System (ArcGIS) was used to map the density of cases by place of residence and reporting hospital. Results. Mean age of cases was 58 (S.D 0.0068). Females constituted 67.6% of the cases. Age, gender, and NHIS status were significantly associated with admission outcomes. Cases were clustered in the regional capital and bordering districts. However, low case densities were recorded in the latter. Conclusion. Increasing NHIS access can potentially impact positively on hypertension admission outcomes. Health educational campaigns targeting men are recommended to address hypertension-related issues

Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled study

ABSTRACT: BACKGROUND: Presumptive treatment of all febrile patients with anti-malarials leads to massive over-treatment. The aim was to assess the effect of implementing malaria rapid diagnostic tests (mRDTs) on prescription of anti-malarials in urban Tanzania. METHODS: The design was a prospective collection of routine statistics from ledger books and cross-sectional surveys before and after intervention in randomly selected health facilities (HF) in Dar es Salaam, Tanzania. The participants were all clinicians and their patients in the above health facilities. The intervention consisted of training and introduction of mRDTs in all three hospitals and in six HF. Three HF without mRDTs were selected as matched controls. The use of routine mRDT and treatment upon result was advised for all patients complaining of fever, including children under five years of age. The main outcome measures were: (1) anti-malarial consumption recorded from routine statistics in ledger books of all HF before and after intervention; (2) anti-malarial prescription recorded during observed consultations in cross-sectional surveys conducted in all HF before and 18 months after mRDT implementation. RESULTS: Based on routine statistics, the amount of artemether-lumefantrine blisters used post-intervention was reduced by 68% (95%CI 57-80) in intervention and 32% (9-54) in control HF. For quinine vials, the reduction was 63% (54-72) in intervention and an increase of 2.49 times (1.62-3.35) in control HF. Before-and-after cross-sectional surveys showed a similar decrease from 75% to 20% in the proportion of patients receiving anti-malarial treatment (Risk ratio 0.23, 95%CI 0.20-0.26). The cluster randomized analysis showed a considerable difference of anti-malarial prescription between intervention HF (22%) and control HF (60%) (Risk ratio 0.30, 95%CI 0.14-0.70). Adherence to test result was excellent since only 7% of negative patients received an anti-malarial. However, antibiotic prescription increased from 49% before to 72% after intervention (Risk ratio 1.47, 95%CI 1.37-1.59). CONCLUSIONS: Programmatic implementation of mRDTs in a moderately endemic area reduced drastically over-treatment with anti-malarials. Properly trained clinicians with adequate support complied with the recommendation of not treating patients with negative results. Implementation of mRDT should be integrated hand-in-hand with training on the management of other causes of fever to prevent irrational use of antibiotic

Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa.

Guido Bastiaens and colleagues describe barriers to achieving scale-up and appropriate use of rapid diagnostic tests and artemisinin-based combination therapy for malaria in sub-Saharan Africa. Please see later in the article for the Editors' Summary