Interrupting transmission of soil-transmitted helminths : a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya

Introduction: In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most costeffective treatment strategy and delivery system to achieve this goal? Methods and analysis: Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision—termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. Ethics and dissemination: Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a dedicated web site. Trial registration number: NCT0239777

Incidence of Plasmodium falciparum malaria infection in 6-month to 45-year-olds on selected areas of Bioko Island, Equatorial Guinea

BACKGROUND: Extensive malaria control measures have been implemented on Bioko Island, Equatorial Guinea over the past 16 years, reducing parasite prevalence and malaria-related morbidity and mortality, but without achieving elimination. Malaria vaccines offer hope for reducing the burden to zero. Three phase 1/2 studies have been conducted successfully on Bioko Island to evaluate the safety and efficacy of whole Plasmodium falciparum (Pf) sporozoite (SPZ) malaria vaccines. A large, pivotal trial of the safety and efficacy of the radiation-attenuated Sanaria((R)) PfSPZ Vaccine against P. falciparum is planned for 2022. This study assessed the incidence of malaria at the phase 3 study site and characterized the influence of socio-demographic factors on the burden of malaria to guide trial design. METHODS: A cohort of 240 randomly selected individuals aged 6 months to 45 years from selected areas of North Bioko Province, Bioko Island, was followed for 24 weeks after clearance of parasitaemia. Assessment of clinical presentation consistent with malaria and thick blood smears were performed every 2 weeks. Incidence of first and multiple malaria infections per person-time of follow-up was estimated, compared between age groups, and examined for associated socio-demographic risk factors. RESULTS: There were 58 malaria infection episodes observed during the follow up period, including 47 first and 11 repeat infections. The incidence of malaria was 0.25 [95% CI (0.19, 0.32)] and of first malaria was 0.23 [95% CI (0.17, 0.30)] per person per 24 weeks (0.22 in 6-59-month-olds, 0.26 in 5-17-year-olds, 0.20 in 18-45-year-olds). Incidence of first malaria with symptoms was 0.13 [95% CI (0.09, 0.19)] per person per 24 weeks (0.16 in 6-59-month-olds, 0.10 in 5-17-year-olds, 0.11 in 18-45-year-olds). Multivariate assessment showed that study area, gender, malaria positivity at screening, and household socioeconomic status independently predicted the observed incidence of malaria. CONCLUSION: Despite intensive malaria control efforts on Bioko Island, local transmission remains and is spread evenly throughout age groups. These incidence rates indicate moderate malaria transmission which may be sufficient to support future larger trials of PfSPZ Vaccine. The long-term goal is to conduct mass vaccination programmes to halt transmission and eliminate P. falciparum malaria

An affordable, quality-assured community-based system for high-resolution entomological surveillance of vector mosquitoes that reflects human malaria infection risk patterns.

ABSTRACT: BACKGROUND: More sensitive and scalable entomological surveillance tools are required to monitor low levels of transmission that are increasingly common across the tropics, particularly where vector control has been successful. A large-scale larviciding programme in urban Dar es Salaam, Tanzania is supported by a community-based (CB) system for trapping adult mosquito densities to monitor programme performance. Methodology An intensive and extensive CB system for routine, longitudinal, programmatic surveillance of malaria vectors and other mosquitoes using the Ifakara Tent Trap (ITT-C) was developed in Urban Dar es Salaam, Tanzania, and validated by comparison with quality assurance (QA) surveys using either ITT-C or human landing catches (HLC), as well as a cross-sectional survey of malaria parasite prevalence in the same housing compounds. RESULTS: Community-based ITT-C had much lower sensitivity per person-night of sampling than HLC (Relative Rate (RR) [95% Confidence Interval (CI)] = 0.079 [0.051, 0.121], P < 0.001 for Anopheles gambiae s.l. and 0.153 [0.137, 0.171], P < 0.001 for Culicines) but only moderately differed from QA surveys with the same trap (0.536 [0.406,0.617], P = 0.001 and 0.747 [0.677,0.824], P < 0.001, for An. gambiae or Culex respectively). Despite the poor sensitivity of the ITT per night of sampling, when CB-ITT was compared with QA-HLC, it proved at least comparably sensitive in absolute terms (171 versus 169 primary vectors caught) and cost-effective (153US$versus 187US$ per An. gambiae caught) because it allowed more spatially extensive and temporally intensive sampling (4284 versus 335 trap nights distributed over 615 versus 240 locations with a mean number of samples per year of 143 versus 141). Despite the very low vectors densities (Annual estimate of about 170 An gambiae s.l bites per person per year), CB-ITT was the only entomological predictor of parasite infection risk (Odds Ratio [95% CI] = 4.43[3.027,7. 454] per An. gambiae or Anopheles funestus caught per night, P =0.0373). Discussion and conclusion CB trapping approaches could be improved with more sensitive traps, but already offer a practical, safe and affordable system for routine programmatic mosquito surveillance and clusters could be distributed across entire countries by adapting the sample submission and quality assurance procedures accordingly

Community-level epidemiology of soil-transmitted helminths in the context of school-based deworming: Baseline results of a cluster randomised trial on the coast of Kenya.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02397772

Ecological and epidemiological findings associated with zoonotic rabies outbreaks and control in Moshi, Tanzania, 2017–2018

Approximately 1500 people die annually due to rabies in the United Republic of Tanzania. Moshi, in the Kilimanjaro Region, reported sporadic cases of human rabies between 2017 and 2018. In response and following a One Health approach, we implemented surveillance, monitoring, as well as a mass vaccinations of domestic pets concurrently in >150 villages, achieving a 74.5% vaccination coverage (n = 29, 885 dogs and cats) by September 2018. As of April 2019, no single human or animal case has been recorded. We have observed a disparity between awareness and knowledge levels of community members on rabies epidemiology. Self-adherence to protective rabies vaccination in animals was poor due to the challenges of costs and distances to vaccination centers, among others. Incidence of dog bites was high and only a fraction (65%) of dog bite victims (humans) received post-exposure prophylaxis. A high proportion of unvaccinated dogs and cats and the relative intense interactions with wild dog species at interfaces were the risk factors for seropositivity to rabies virus infection in dogs. A percentage of the previously vaccinated dogs remained unimmunized and some unvaccinated dogs were seropositive. Evidence of community engagement and multi-coordinated implementation of One Health in Moshi serves as an example of best practice in tackling zoonotic diseases using multi-level government e orts. The district-level establishment of the One Health rapid response team (OHRRT), implementation of a carefully structured routine vaccination campaign, improved health education, and the implementation of barriers between domestic animals and wildlife at the interfaces are necessary to reduce the burden of rabies in Moshi and communities with similar profiles.The USAID funded project—OSRO/GLO/507/USA on Global Health Security Agenda for the control of zoonosis in Africa.http://www.mdpi.com/journal/ijerpham2020Veterinary Tropical Disease

Micronutrient deficiencies and plasmodium vivax malaria among children in the Brazilian Amazon

Background: There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. Methodology/Principal Findings: We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3-6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. Conclusion: Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results. © 2016 Benzecry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Internet of things to improve agriculture in sub sahara Africa - a case study

International Journal of Advances in Scientific Research and Engineering 2018, Vol. 4(6): pp 8 - 11Agriculture is the main source of income in many countries in sub-Sahara Africa (SSA). In these countries, farmers get less yield because they depend on rainfall only. Integrating Internet of Things and Agriculture (smart agriculture) helps farmers to grow more crops in any season of the year. Also, it improves farmer’s living standard and raises the economy of these countries. Moreover, it reduces labor work or manual work which takes more time and more cost. This paper is evaluating the areas where smart farming can be applied in agriculture and brings the direct impact to farmers in SS

Characterisation and Consolidation of Historical Lime Mortars in Cultural Heritage Buildings and Associated Structures in East Africa

For the period of several centuries, the influence of several distinct cultures produced rich and diverse cultural heritage that we see today in East Africa countries. The most tangible remains of these heritages are stone built buildings and structures including, palaces, mosques, residential houses and tombs. At present, these heritages are in different physical state, some are in relatively good condition while many are in an appalling condition. The presence of these historical monuments has benefited these countries economically and culturally therefore, it is essential to ensure that these monuments continue to exist. Material characterisation of the historical buildings and associated structures was used to develop a suitable method of intervention that is sympathetic to the original materials. Mortar is the most damaged material therefore, historical mortar from Stone Town historical buildings and associated structures has been characterised by visual examination, optical microscopy, x-ray diffraction and hydrostatic weighing and the results have been compared. The historical mortar is mainly comprised of calcite, quartz and feldspar. The mortar condition has been divided into hard mortar, soft mortar and, soft and friable mortar. The deteriorated mortar that required consolidation is soft mortar and, soft and friable mortar with a porosity of approximately 27%. Calcium hydroxide solution (limewater) has been selected as consolidant and the consolidation procedure involves two steps. Firstly a limewater impregnation procedure has been developed and secondly, the effect of limewater treatment has been determined. For the application procedure it has been observed that, when limewater comes into contact with calcium carbonate a precipitation reaction occurs and that is the cause of poor penetration ability of calcium hydroxide solution. Major influencing factors on the penetration ability of calcium hydroxide solution have been established as, application method and absorption capacity of the treated material during the impregnation process. Optimization of the penetration ability of calcium hydroxide solution has been achieved by impregnating from the middle of the impregnated specimen. Sugar has been used to study the influence of additive on enhancing calcium hydroxide solubility. It has been verified that solubility of calcium hydroxide in a solution of sugar is proportional to the amount of sugar in the solution. Porosity and strength tests have been used to study the effectiveness of calcium hydroxide treatment. Under the conditions studied no appreciable change of porosity has been detected. It is postulated that the calcium hydroxide was deposited at the binder/aggregate interface and at the secondary pores. In terms of strength, evidence has been found to suggest the strength increment varies quantitively with the amount of calcite crystals deposited.QC 2010080

Effect environmental activities on the financial performance of small and medium sized companies in Kenya

This study therefore seeks to analyze the effect of annual cost of environmental activities on the financial performance of small and medium sized enterprises in Kenya. The study is anchored on triple bottom line model and stakeholders’ and corporate social responsibility theories. A descriptive study design has been adopted in order to observe and make inferences on the effect of corporate social activities spending of firm financial performance. The study targets a population of 100 top performing medium sized companies in Kenya because of their rank as best financial performers in the country and their involvement in corporate social responsibility activities. Secondary data was collected by use of data collection form and the data was obtained from annual financial reports for years ending 2014 to 2018. Data was edited, coded and analysed using descriptive and inferential statistics. Results were presented in form of tables and graphs. The study will enable the owners of small and medium sized enterprises to understand the resultant effect of corporate social responsibility on financial performance of small and medium enterprises. It will also aid decision makers to make informed decisions about planning of sustainable objectives and allocation of resources towards achievement of those objectives. Using results from random effects model, revealed annual cost of environmental activities by Small and Medium Sized Enterprises in Kenya can be used to predict the outcome of return on investment as a measure of the SMEs financial performance. When amount spent annually on environmental activities is increased by 1 unit, return on investment also decreases by -5.6109 units with other variables kept constant. This indicated that amount spent annu