Randomized Controlled Trial of RTS,S/AS02D and RTS,S/AS01E Malaria Candidate Vaccines Given According to Different Schedules in Ghanaian Children

Background:The target delivery channel of RTS,S candidate malaria vaccines in malaria-endemic countries in Africa is the World Health Organisation Expanded Program on Immunization. As an Adjuvant System, age de-escalation and schedule selection step, this study assessed 3 schedules of RTS,S/AS01E and RTS,S/AS02D in infants and young children 5–17 months of age in Ghana.Methodology:A Phase II, partially-blind randomized controlled study (blind to vaccine, not to schedule), of 19 months duration was conducted in two (2) centres in Ghana between August 2006 and May 2008. Subjects were allocated randomly (1:1:1:1:1:1) to one of six study groups at each study site, each defining which vaccine should be given and by which schedule (0,1-, 0,1,2- or 0,1,7-months). For the 0,1,2-month schedule participants received RTS,S/AS01E or rabies vaccine at one center and RTS,S/AS01E or RTS,S/AS02D at the other. For the other schedules at both study sites, they received RTS,S/AS01E or RTS,S/AS02D. The primary outcome measure was the occurrence of serious adverse events until 10 months post dose 1.Results:The number of serious adverse events reported across groups was balanced. One child had a simple febrile convulsion, which evolved favourably without sequelae, considered to be related to RTS,S/AS01E vaccination. Low grade reactions occurred slightly more frequently in recipients of RTS,S/AS than rabies vaccines; grade 3 reactions were infrequent. Less local reactogenicity occurred with RTS,S/AS01E than RTS,S/AS02D. Both candidate vaccines were highly immunogenic for anti-circumsporozoite and anti-Hepatitis B Virus surface antigen antibodies. Recipients of RTS,S/AS01E compared to RTS,S/AS02D had higher peak anti-circumsporozoite antibody responses for all 3 schedules. Three dose schedules were more immunogenic than 2 dose schedules. Area under the curve analyses for anti-circumsporozoite antibodies were comparable between the 0,1,2- and 0,1,7-month RTS,S/AS01E schedules.Conclusions:Both candidate malaria vaccines were well tolerated. Anti-circumsporozoite responses were greater with RTS,S/AS01E than RTS,S/AS02D and when 3 rather than 2 doses were given. This study supports the selection of RTS,S/AS01E and a 3 dose schedule for further development in children and infants

T Cell Responses to the RTS,S/AS01E and RTS,S/AS02D Malaria Candidate Vaccines Administered According to Different Schedules to Ghanaian Children

BACKGROUND: The Plasmodium falciparum pre-erythrocytic stage candidate vaccine RTS,S is being developed for protection of young children against malaria in sub-Saharan Africa. RTS,S formulated with the liposome based adjuvant AS01(E) or the oil-in-water based adjuvant AS02(D) induces P. falciparum circumsporozoite (CSP) antigen-specific antibody and T cell responses which have been associated with protection in the experimental malaria challenge model in adults. METHODS: This study was designed to evaluate the safety and immunogenicity induced over a 19 month period by three vaccination schedules (0,1-, 0,1,2- and 0,1,7-month) of RTS,S/AS01(E) and RTS,S/AS02(D) in children aged 5-17 months in two research centers in Ghana. Control Rabies vaccine using the 0,1,2-month schedule was used in one of two study sites. RESULTS: Whole blood antigen stimulation followed by intra-cellular cytokine staining showed RTS,S/AS01(E) induced CSP specific CD4 T cells producing IL-2, TNF-α, and IFN-γ. Higher T cell responses were induced by a 0,1,7-month immunization schedule as compared with a 0,1- or 0,1,2-month schedule. RTS,S/AS01(E) induced higher CD4 T cell responses as compared to RTS,S/AS02(D) when given on a 0,1,7-month schedule. CONCLUSIONS: These findings support further Phase III evaluation of RTS,S/AS01(E). The role of immune effectors and immunization schedules on vaccine protection are currently under evaluation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00360230

Nutrient status of two Ghanaian water reservoirs

The Weija and Kpong Reservoirs were constructed as impoundments to satisfy the increasing demands for hydroelectric power and water for domestic, agricultural and industrial purposes. The Weija Reservoir, created in 1977 on the Densu River is about 116 km long. The Weija dam is a rock-and earth-filled structure located about 10 km from the mouth of the River Densu. The reservoir provided industrial and domestic water supplies to the southwestern part of Accra and for fisheries. The Kpong reservoir created in 1981 was formed after the closure of the Volta Dam. It created the potential for two industries, agriculture by irrigation and fishing. The reservoir is also the main source of water supply to the Accra-Tema Metropolitan Area. There is an urgent need to gather, analyse and collate nutrient data in order to mitigate adverse trends for maximum utilisation of these multipurpose reservoirs

Borehole water quality in Volta Region of Ghana

The Danish International Development Agency (DANIDA) in 1991 began to assist the Ghana Water Company Limited (GWCL) to implement a rural water supply and sanitation project to improve health and the standard of living of the people in the Volta Region of Ghana. The Water Research Institute (WRI) has since the formulation of the Volta Rural Water Supply and Sanitation Project (VRWSSP) carried out data collection and monitoring assignments covering water resources in the Volta Region. In addition to the initial data collection, WRI was also contracted to initiate a research project to increase the understanding of the effects of land use changes on surface water resources. This very issue is important for the long-term use of small streams and springs for piped water systems and to develop appropriate methods for protection of their catchment areas

Sustainability and the Social Construction of Technology: The Case of RWH as Source of Water Supply in Greater Accra

The paper discusses the sustainability of roof rainwater harvesting (RWH) in Greater Accra, Ghana We take a holistic approach, but focus especially on the social dimension. The discussion is grounded in a research and development project including a holistic sustainability assessment of selected RWH designs based on LCA, cost-benefit analysis and a KAP survey, as well as training of local artisans, stakeholder dialogue and pilot implementation of 21 RWH systems. The performance of the systems largely met the expectation. The households could expect long-term savings, and there were benefits in terms of convenience, hygiene and water sharing. On the other hand, high initial costs, limited awareness, and lack of capacity to implement supportive policies were impediments to wide-scale adoption. The sustainability of the solutions is discussed in further detail. A social construction of technology (SCOT) perspective is applied to throw light on how the stakeholders constructed drivers, barriers, and indeed the technical solutions themselves. We find that the technology was at a stage of low stabilization, meaning-wise, and this clearly affected its sustainability in the local context. The findings suggest that more attention should be paid to social construction in sustainability research and transition efforts.publishedVersio

Sustainability and the Social Construction of Technology: The Case of RWH as Source of Water Supply in Greater Accra

The paper discusses the sustainability of roof rainwater harvesting (RWH) in Greater Accra, Ghana We take a holistic approach, but focus especially on the social dimension. The discussion is grounded in a research and development project including a holistic sustainability assessment of selected RWH designs based on LCA, cost-benefit analysis and a KAP survey, as well as training of local artisans, stakeholder dialogue and pilot implementation of 21 RWH systems. The performance of the systems largely met the expectation. The households could expect long-term savings, and there were benefits in terms of convenience, hygiene and water sharing. On the other hand, high initial costs, limited awareness, and lack of capacity to implement supportive policies were impediments to wide-scale adoption. The sustainability of the solutions is discussed in further detail. A social construction of technology (SCOT) perspective is applied to throw light on how the stakeholders constructed drivers, barriers, and indeed the technical solutions themselves. We find that the technology was at a stage of low stabilization, meaning-wise, and this clearly affected its sustainability in the local context. The findings suggest that more attention should be paid to social construction in sustainability research and transition efforts

Health consequences of environmental exposures: changing global patterns of exposure and disease

Environmental pollution is a major cause of disease and death. Exposures in early life are especially dangerous. Patterns of exposure vary greatly across countries. In low-income and lower middle income countries (LMICs), infectious, maternal, neonatal, and nutritional diseases are still major contributors to disease burden. By contrast, in upper middle income and high-income countries noncommunicable diseases predominate. To examine patterns of environmental exposure and disease and to relate these patterns to levels of income and development, we obtained publically available data in 12 countries at different levels of development through a global network of World Health Organization Collaborating Centres in Children's Environmental Health. Pollution exposures in early life contribute to both patterns. Chemical and pesticide pollution are increasing, especially in LMICs. Hazardous wastes, including electronic waste, are accumulating. Pollution-related chronic diseases are becoming epidemic. Future Global Burden of Disease estimates must pay increased attention to the short- and long-term consequences of environmental pollution

Environmental pollution: an underrecognized threat to children’s health, especially in low- and middle-income countries

Exposures to environmental pollutants during windows of developmental vulnerability in early life can cause disease and death in infancy and childhood as well as chronic, non-communicable diseases that may manifest at any point across the life span. Patterns of pollution and pollution-related disease change as countries move through economic development. Environmental pollution is now recognized as a major cause of morbidity and mortality in low- and middle-income countries (LMICs). According to the World Health Organization, pollution is responsible for 8.9 million deaths around the world each year; of these, 94% (8.4 million) are in LMICs. Toxic chemical pollution is growing into a major threat to children's health in LMICs. The disease and disability caused by environmental pollution have great economic costs, and these costs can undercut trajectories of national development. To combat pollution, improved programs of public health and environmental protection are needed in countries at every level of development. Pollution control strategies and technologies that have been developed in high-income countries must now be transferred to LMICs to assist these emerging economies to avoid the mistakes of the past. A new international clearinghouse is needed to define and track the health effects of pollution, quantify the economic costs of these effects, and direct much needed attention to environmental pollution as a risk factor for disease

E-waste and harm to vulnerable populations: a growing global problem

Background: Electronic waste (e-waste) is produced in staggering quantities, estimated globally to be 41.8 million tonnes in 2014. Informal e-waste recycling is a source of much-needed income in many low- to middle-income countries. However, its handling and disposal in underdeveloped countries is often unsafe and leads to contaminated environments. Rudimentary and uncontrolled processing methods often result in substantial harmful chemical exposures among vulnerable populations, including women and children. E-waste hazards have not yet received the attention they deserve in research and public health agendas. oBjectives: We provide an overview of the scale and health risks. We review international efforts concerned with environmental hazards, especially affecting children, as a preface to presenting next steps in addressing health issues stemming from the global e-waste problem. discussion: The e-waste problem has been building for decades. Increased observation of adverse health effects from e-waste sites calls for protecting human health and the environment from e-waste contamination. Even if e-waste exposure intervention and prevention efforts are implemented, legacy contamination will remain, necessitating increased awareness of e-waste as a major environmental health threat. conclusion: Global, national, and local levels efforts must aim to create safe recycling operations that consider broad security issues for people who rely on e-waste processing for survival. Paramount to these efforts is reducing pregnant women and children’s e-waste exposures to mitigate harmful health effects. With human environmental health in mind, novel dismantling methods and remediation technologies and intervention practices are needed to protect communities