Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda

Background: Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods: In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio- economic and behavioural parameters as well as medical histories were obtained. Results: Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/ dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion: Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children’s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children.Einleitung: Obwohl Plasmodium-Infektionen und Malaria bei Schulkindern zunehmend als relevantes Problem der öffentlichen Gesundheit erkannt werden, ist die Datenlage zur aktuellen Prävalenz und den gesundheitlichen Folgen unzulänglich. Die Ziele der vorliegenden Studie waren daher eine Einschätzung der aktuellen Prävalenz unter Schulkindern in Südruanda, die Erkennung assoziierter Risikofaktoren sowie die Untersuchung der klinischen Folgen dieser Infektionen. Methodik: Im Rahmen dieser Studie, welche 12 Schulen des Huye Distriktes in Ruanda einschloss, wurden 1089 Kinder im Alter von sechs bis zehn Jahren klinisch und anthropometrisch untersucht, mikroskopisch sowie mittels PCR auf Malariaerreger getestet, die Hämoglobinkonzentration wurde bestimmt, Parameter zu sozioökonomischem Status und Verhalten erhoben sowie die aktuelle Anamnese dokumentiert. Ergebnisse: Bei der klinischen Untersuchung zeigte sich die überwiegende Mehrzahl der Kinder asymptomatisch (Fieber 2,7%). Eine Infektion mit Plasmodien wurde bei 22,4% (Plasmodium falciparum 18,8%) der Kinder nachgewiesen, wovon sich 41% submikros- kopisch darstellten. Als unabhängige Prädiktoren für eine Infektion zeigten sich eine geringe Höhenlage des Wohnortes, ein höheres Alter, vorausgegangene Behandlungen aufgrund von Malaria und die Abwesenheit von Elektrizität oder eines Fahrrades im Haushalt. Eine bestehende Plasmodien-Infektion war assoziiert mit Anämie (mittlere Hämoglobin- differenz von −1,2 g/dL; 95% KI, −0,8 bis −1,5 g/dL), Fieber, Untergewicht, klinisch diagnostizierter Mangelernährung sowie Fieber, Müdigkeit, Schwäche, vermindertem Appetit, abdominellen Schmerzen oder Erbrechen in der Anamnese. Mit Ausnahme des Untergewichts traten diese Symptome auch bei submikroskopischer Infektion vermehrt auf. Schlussfolgerung: Malariainfektionen bei Schulkindern im südlichen Hochland von Ruanda sind häufig. Obwohl in der Mehrheit asymptomatisch erscheinend, zeigte sich eine Infektion durch eine Vielzahl unspezifischer Symptome in der Krankengeschichte der Kinder, zusätzlich zu den negativen Auswirkungen auf die Hämoglobinkonzentration. Dies bestärkt die Forderung nach erweiterten Maßnahmen zur Beobachtung und Kontrolle von Malariainfektionen unter Schulkindern

malaria infection among schoolchildren in highland Rwanda

Background Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio- economic and behavioural parameters as well as medical histories were obtained. Results Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children

Reduced efficacy of albendazole against Ascaris lumbricoides in Rwandan schoolchildren

Control of human soil-transmitted helminths (STHs) relies on preventive chemotherapy of schoolchildren applying the benzimidazoles (BZ) albendazole or mebendazole. Anthelmintic resistance (AR) is a common problem in nematodes of veterinary importance but for human STHs, information on drug efficacy is limited and routine monitoring is rarely implemented. Herein, the efficacy of single dose albendazole (400 mg) was evaluated in 12 schools in the Huye district of Rwanda where Ascaris is the predominant STH. Ascaris eggs were detected by wet mount microscopy and the Mini-FLOTAC method to assess cure rate (CR) and faecal egg count reduction (FECR). Blood and faecal samples were analysed for co-infections with Plasmodium sp. and Giardia duodenalis, respectively. Ascaris positive samples collected before and after treatment were analysed for putatively BZ-resistance associated β-tubulin gene single nucleotide polymorphisms. The overall CR was 69.9% by Mini-FLOTAC and 88.6% by wet mount microscopy. The FECR was 75.4% and the 95% calculated confidence intervals were 50.4–87.8% using sample variance, 55.4–88.8% by bootstrapping, and 75.0–75.7% applying a Markov Chain Monte Carlo Bayesian approach. FECR varied widely between 0 and 96.8% for individual schools. No putative BZ-resistance associated polymorphisms were found in the four Ascaris β-tubulin isotype genes examined. Since FECR

Comment on “The optimal timing of post-treatment sampling for the assessment of anthelminthic drug efficacy against Ascaris infections in humans”

A recent publication by Levecke et al. (Int. J. Parasitol, 2018, 8, 67–69) provides important insights into the kinetics of worm expulsion from humans following treatment with albendazole. This is an important aspect of determining the optimal time-point for post treatment sampling to examine anthelmintic drug efficacy. The authors conclude that for the determination of drug efficacy against Ascaris, samples should be taken not before day 14 and recommend a period between days 14 and 21. Using this recommendation, they conclude that previous data (Krücken et al., 2017; Int. J. Parasitol, 7, 262–271) showing a reduction of egg shedding by 75.4% in schoolchildren in Rwanda and our conclusions from these data should be interpreted with caution. In reply to this, we would like to indicate that the very low efficacy of 0% in one school and 52–56% in three other schools, while the drug was fully efficient in other schools, cannot simply be explained by the time point of sampling. Moreover, there was no correlation between the sampling day and albendazole efficacy. We would also like to indicate that we very carefully interpreted our data and, for example, nowhere claimed that we found anthelmintic resistance. Rather, we stated that our data indicated that benzimidazole resistance may be suspected in the study population. We strongly agree that the data presented by Levecke et al. suggests that recommendations for efficacy testing of anthelmintic drugs should be revised.Peer Reviewe

Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda

Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections.; In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6-10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio-economic and behavioural parameters as well as medical histories were obtained.; Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of -1.2 g/dL; 95% CI, -0.8 to -1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection.; Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children

The Eurosceptic Europeanization of public spheres: print and social media reactions to the 2014 European Parliament elections.

The present study tests the theoretical claim that Eurosceptics contribute to the Europeanization of national public spheres. Although advocating a renationalization of European politics, Eurosceptic parties can engender public media debates of transnational or European relevance. Through a comparative research design of two national cases (Sweden and Denmark), we examine the public discourse on the day following the 2014 European Parliament elections across three media: print, Twitter, and Facebook. Separating the discussions of Eurosceptic issues and actors from other topics of the election coverage, we find that the discourses about Euroscepticism exhibit a higher degree of Europeanization in four of the six media analyzed. Moreover, while we detect significant differences in valence between the Swedish and Danish press when reporting about the Eurosceptics, such national variation is much less pronounced on the social networking sites. The findings suggest, firstly, that Eurosceptics’ contestation of the EU may have the unintended effect of giving national media debates a stronger European dimension. Secondly, the study warrants moderate optimism for the Europeanization potential of social media vis-à-vis traditional media structures: Print media was more Europeanized in scope, whereas social media publics were more aligned in their sentiment toward Euroscepticism