Pregnancy outcomes and risk of placental malaria after artemisinin-based and quinine-based treatment for uncomplicated falciparum malaria in pregnancy: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis.

Malaria in pregnancy, including asymptomatic infection, has a detrimental impact on foetal development. Individual patient data (IPD) meta-analysis was conducted to compare the association between antimalarial treatments and adverse pregnancy outcomes, including placental malaria, accompanied with the gestational age at diagnosis of uncomplicated falciparum malaria infection. A systematic review and one-stage IPD meta-analysis of studies assessing the efficacy of artemisinin-based and quinine-based treatments for patent microscopic uncomplicated falciparum malaria infection (hereinafter uncomplicated falciparum malaria) in pregnancy was conducted. The risks of stillbirth (pregnancy loss at ≥ 28.0 weeks of gestation), moderate to late preterm birth (PTB, live birth between 32.0 and < 37.0 weeks), small for gestational age (SGA, birthweight of < 10th percentile), and placental malaria (defined as deposition of malaria pigment in the placenta with or without parasites) after different treatments of uncomplicated falciparum malaria were assessed by mixed-effects logistic regression, using artemether-lumefantrine, the most used antimalarial, as the reference standard. Registration PROSPERO: CRD42018104013. Of the 22 eligible studies (n = 5015), IPD from16 studies were shared, representing 95.0% (n = 4765) of the women enrolled in literature. Malaria treatment in this pooled analysis mostly occurred in the second (68.4%, 3064/4501) or third trimester (31.6%, 1421/4501), with gestational age confirmed by ultrasound in 91.5% (4120/4503). Quinine (n = 184) and five commonly used artemisinin-based combination therapies (ACTs) were included: artemether-lumefantrine (n = 1087), artesunate-amodiaquine (n = 775), artesunate-mefloquine (n = 965), and dihydroartemisinin-piperaquine (n = 837). The overall pooled proportion of stillbirth was 1.1% (84/4361), PTB 10.0% (619/4131), SGA 32.3% (1007/3707), and placental malaria 80.1% (2543/3035), and there were no significant differences of considered outcomes by ACT. Higher parasitaemia before treatment was associated with a higher risk of SGA (adjusted odds ratio [aOR] 1.14 per 10-fold increase, 95% confidence interval [CI] 1.03 to 1.26, p = 0.009) and deposition of malaria pigment in the placenta (aOR 1.67 per 10-fold increase, 95% CI 1.42 to 1.96, p < 0.001). The risks of stillbirth, PTB, SGA, and placental malaria were not different between the commonly used ACTs. The risk of SGA was high among pregnant women infected with falciparum malaria despite treatment with highly effective drugs. Reduction of malaria-associated adverse birth outcomes requires effective prevention in pregnant women

Tourism : who wins?

French version available in IDRC Digital Library: Tourisme en AfriqueSpanish version available in IDRC Digital Library: Conozca primero Afric

Roulette amazonienne

Version anglaise disponible dans la Bibliothèque numérique du CRDI: Stand and deliver : tropical moist forestsVersion espagnole disponible dans la Bibliothèque numérique du CRDI: Dejemoslos producier : bosques tropicales humedo

Tourisme Nord - Sud

Version anglaise disponible dans la Bibliothèque numérique du CRDI: See Africa firstVersion espagnole disponible dans la Bibliothèque numérique du CRDI: Conozca primero Afric

Turismo qué trae, qué deja

Versión en inglés disponible en la Biblioteca Digital del IDRC:See Africa firstVersión en francés disponible en la Biblioteca Digital del IDRC:Tourisme en Afriqu

A framework to improve fertilizer recommendations for irrigated rice in West Africa

A framework to optimize soil fertility management in irrigated rice, based on soil and climate variability, fertilizer and paddy prices and farmers' objectives is presented. The framework uses three models in succession. The dynamic ecophysiological ORYZAS model simulates potential rice yields under irrigation, based on weather conditions, cultivar choice and sowing date. This yield potential is used in the static FERRIZ model, together with site specific information on recovery efficiency of applied N, P and K, indigenous soil N, P and K supply, and maximum N, P and K accumulation and dilution in rice dry matter. Resulting outputs are required fertilizer doses to obtain different target yields depending on yield potential and soil nutrient supply. The framework allows sensitivity analysis and agro-economic evaluation of different fertilizer options. In a last step, the dynamic decision tool RIDEV is used to simulate optimal timing of different management actions such as fertilizer application, weeding, and harvest. Resulting integrated crop management recommendations ensure high resource use efficiency adapted to local socio-economic and bio-physical conditions. Provided necessary input data are available, this framework can be applied to field, perimeter or regional scale. The framework was applied to the Office du Niger in Mali, using field data of 58 farmers. In the wet season, fertilizer doses adjusted to three soil fertility classes out-performed current uniform recommendations only slightly, except on soils with very low K supply (10 cases). Only on these soils was application of K profitable. Profit-optimizing fertilizer doses had high costs and low value/cost ratios. Target yields close to potential yield increased farmers' risk. Adjusting fertilizer doses to the lower yield potential in the dry season reduced costs and risk without reducing profit, resulting in better value/cost ratios. New simple recommendations for both wet and dry seasons were formulated. (C) 2003 Elsevier Science Ltd. All rights reserved

Critical Limit of Extractable Phosphorous in a Gleysol for Rice Production in the Senegal River Valley of West Africa

Soil-test correlation and calibration, a useful tool for fertilizer recommendations, has been little used in West Africa. Soils from a long-term fertility experiment have been used to study the relationship between rice yields and soil extractable phosphorus (P) with Bray 1 and Olsen methods. The Cate and Nelson graphical method was used for critical limits of soil P determination. The critical limits of soil extractable P at 95% relative grain yield were 9 mg P for the Bray 1P and 17 mg P kg21 for Olsen P. The Olsen P was more correlated (r ¼ 0.63) with rice grain yields than Bray P (r ¼ 0.50), but a strong correlation (r ¼ 0.92) was also observed between the values of the two methods. Results indicate that at levels less than these critical levels of extractable P, P fertilizers should be applied to increase rice yields

Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: a systematic review and individual patient data meta-analysis.

Malaria in pregnancy affects both the mother and the fetus. However, evidence supporting treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women is scarce and assessed in varied ways. We did a systematic literature review and individual patient data (IPD) meta-analysis to compare the efficacy and tolerability of different artemisinin-based or quinine-based treatments for malaria in pregnant women. We did a systematic review of interventional or observational cohort studies assessing the efficacy of artemisinin-based or quinine-based treatments in pregnancy. Seven databases (MEDLINE, Embase, Global Health, Cochrane Library, Scopus, Web of Science, and Literatura Latino Americana em Ciencias da Saude) and two clinical trial registries (International Clinical Trials Registry Platform and ClinicalTrials.gov) were searched. The final search was done on April 26, 2019. Studies that assessed PCR-corrected treatment efficacy in pregnancy with follow-up of 28 days or more were included. Investigators of identified studies were invited to share data from individual patients. The outcomes assessed included PCR-corrected efficacy, PCR-uncorrected efficacy, parasite clearance, fever clearance, gametocyte development, and acute adverse events. One-stage IPD meta-analysis using Cox and logistic regression with random-effects was done to estimate the risk factors associated with PCR-corrected treatment failure, using artemether-lumefantrine as the reference. This study is registered with PROSPERO, CRD42018104013. Of the 30 studies assessed, 19 were included, representing 92% of patients in the literature (4968 of 5360 episodes). Risk of PCR-corrected treatment failure was higher for the quinine monotherapy (n=244, adjusted hazard ratio [aHR] 6·11, 95% CI 2·57-14·54, p<0·0001) but lower for artesunate-amodiaquine (n=840, 0·27, 95% 0·14-0·52, p<0·0001), artesunate-mefloquine (n=1028, 0·56, 95% 0·34-0·94, p=0·03), and dihydroartemisinin-piperaquine (n=872, 0·35, 95% CI 0·18-0·68, p=0·002) than artemether-lumefantrine (n=1278) after adjustment for baseline asexual parasitaemia and parity. The risk of gametocyte carriage on day 7 was higher after quinine-based therapy than artemisinin-based treatment (adjusted odds ratio [OR] 7·38, 95% CI 2·29-23·82). Efficacy and tolerability of artemisinin-based combination therapies (ACTs) in pregnant women are better than quinine. The lower efficacy of artemether-lumefantrine compared with other ACTs might require dose optimisation. The Bill & Melinda Gates Foundation, ExxonMobil Foundation, and the University of Oxford Clarendon Fund