History of rotavirus research in children in Malawi: the pursuit of a killer

Rotavirus gastroenteritis is a major health problem among Malawian children. Studies spanning 20 years have described the importance, epidemiology and viral characteristics of rotavirus infections in the country. Despite a wide diversity of circulating rotavirus strains causing severe disease inyoung infants, a clinical trial of a human rotavirus vaccine clearly demonstrated the potential for rotavirus vaccination to greatly reduce the morbidity and mortality due to rotavirus diarrhoea in Malawi. This new enteric vaccine initiative represents a major opportunity to improve the health andsurvival of Malawian children

Population Differences in Death Rates in HIV-Positive Patients with Tuberculosis.

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi. OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB. DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment. RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga. CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality

Present day challenges in understanding the geomagnetic hazard to national power grids

Power grids and pipeline networks at all latitudes are known to be at risk from the natural hazard of geomagnetically induced currents. At a recent workshop in South Africa, UK and South African scientists and engineers discussed the current understanding of this hazard, as it affects major power systems in Europe and Africa. They also summarised, to better inform the public and industry, what can be said with some certainty about the hazard and what research is yet required to develop useful tools for geomagnetic hazard mitigation

Tuberculosis lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis

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A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi

Background Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations.Aim To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables.Methods We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or bloodborne infection. We performed the haematological tests at the Malawi- Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories.Results Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer’s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer’s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups.Conclusions Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results

Effect of human rotavirus vaccine on severe diarrhea in African infants.

BACKGROUND: Rotavirus is the most common cause of severe gastroenteritis among young children worldwide. Data are needed to assess the efficacy of the rotavirus vaccine in African children. METHODS: We conducted a randomized, placebo-controlled, multicenter trial in South Africa (3166 infants; 64.1% of the total) and Malawi (1773 infants; 35.9% of the total) to evaluate the efficacy of a live, oral rotavirus vaccine in preventing severe rotavirus gastroenteritis. Healthy infants were randomly assigned in a 1:1:1 ratio to receive two doses of vaccine (in addition to one dose of placebo) or three doses of vaccine--the pooled vaccine group--or three doses of placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis caused by wild-type rotavirus during the first year of life were assessed through active follow-up surveillance and were graded with the use of the Vesikari scale. RESULTS: A total of 4939 infants were enrolled and randomly assigned to one of the three groups; 1647 infants received two doses of the vaccine, 1651 infants received three doses of the vaccine, and 1641 received placebo. Of the 4417 infants included in the per-protocol efficacy analysis, severe rotavirus gastroenteritis occurred in 4.9% of the infants in the placebo group and in 1.9% of those in the pooled vaccine group (vaccine efficacy, 61.2%; 95% confidence interval, 44.0 to 73.2). Vaccine efficacy was lower in Malawi than in South Africa (49.4% vs. 76.9%); however, the number of episodes of severe rotavirus gastroenteritis that were prevented was greater in Malawi than in South Africa (6.7 vs. 4.2 cases prevented per 100 infants vaccinated per year). Efficacy against all-cause severe gastroenteritis was 30.2%. At least one serious adverse event was reported in 9.7% of the infants in the pooled vaccine group and in 11.5% of the infants in the placebo group. CONCLUSIONS: Human rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among African infants during the first year of life. (ClinicalTrials.gov number, NCT00241644.

Is manure from ecological sanitation latrines safe for use to fertilize crops? A review of evidence from literature

Studies have shown that manure harvested in ecological sanitation (ecosan) latrines has more thermo tolerant bacteria and helminthic eggs than the World Health Organisation (WHO) recommendation. The review was aimed at assessing adequacy of available guidelines on use of ecosan to produce safe manure. Relevant literature was searched and critically reviewed. Literature on effect on pathogen die off was not consistent from one study to the next and in some situations conflicting results have been found. Guidelines on waiting period after pit is sealed differed from one country to the next and there is an agreement that six months waiting period is not enough to produce safe manure. There is need for further research in real latrine situation to investigate all potential factors that affect pathogen die off. These may assist to explain inconsistencies in literature on pathogen die off and assist to develop specific guidelines for different locations

Characteristics and outcomes in paediatric patients presenting with congenital colorectal diseases in sub-Saharan Africa

In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age ≤ 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 ± 2.7 years) and 51 had anorectal malformations (ARM) (1.8 ± 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes

Reverse transcriptase drug resistance mutations in HIV-1 subtype C infected patients on ART in Karonga District, Malawi

<p>Abstract</p> <p>Background</p> <p>Drug resistance testing before initiation of, or during, antiretroviral therapy (ART) is not routinely performed in resource-limited settings. High levels of viral resistance circulating within the population will have impact on treatment programs by increasing the chances of transmission of resistant strains and treatment failure. Here, we investigate Drug Resistance Mutations (DRMs) from blood samples obtained at regular intervals from patients on ART (Baseline-22 months) in Karonga District, Malawi. One hundred and forty nine reverse transcriptase (RT) consensus sequences were obtained via nested PCR and automated sequencing from blood samples collected at three-month intervals from 75 HIV-1 subtype C infected individuals in the ART programme.</p> <p>Results</p> <p>Fifteen individuals showed DRMs, and in ten individuals DRMs were seen from baseline samples (reported to be ART naïve). Three individuals in whom no DRMs were observed at baseline showed the emergence of DRMs during ART exposure. Four individuals who did show DRMs at baseline showed additional DRMs at subsequent time points, while two individuals showed evidence of DRMs at baseline and either no DRMs, or different DRMs, at later timepoints. Three individuals had immune failure but none appeared to be failing clinically.</p> <p>Conclusion</p> <p>Despite the presence of DRMs to drugs included in the current regimen in some individuals, and immune failure in three, no signs of clinical failure were seen during this study. This cohort will continue to be monitored as part of the Karonga Prevention Study so that the long-term impact of these mutations can be assessed. Documenting proviral population is also important in monitoring the emergence of drug resistance as selective pressure provided by ART compromises the current plasma population, archived viruses can re-emerge</p

Productivity and profitability on groundnut (Arachis hypogaea L) and maize (Zea mays L) in a semi-arid area of southern Malawi

In many parts of Malawi, including Balaka district in Southern Malawi, are prone to erratic rains with poor soil productivity and famer practices. A research and outreach project was initiated in October 2015 to establish learning centres (LCs) of groundnut: maize rotations as an entry point to diversify nutrition and income base of smallholder farmers, while building up on soil fertility for increased resilience to production under climatic variation. Some 132 plots of groundnut were established in 2015/2016 in four sections of Ulongwe Extension Planning Area (EPA) in Balaka district. Of these, 44 fields were sampled for yield, biomass, plant stand and soils data. In the second season of 2016/2017, a maize fertilizer response trial (five rates of NP2O5K2O; 0, 23:21:0+4S, 46:21:0+4S, 69:21:0+4S, and 92:21:0+4S) was super-imposed in plots where farmers incorporated groundnut residues, in comparison with continuous maize from adjacent own field. In the first season, rainfall was below average and erratic, with 10-day dry spells recorded in two of four recording stations. The soils were generally poor, with test values below threshold for many variables including organic matter, nitrogen and phosphorus. Groundnut average yields and standard deviation were 754 (±186) kg/ha, respectively. Plant stands were poor, with up to 24% of the 46 LCs attaining ≤50% of targeted plant stand of 8.88 plants m-2. Poor plant stand is suggested as a major contributor to low yields. Results from the 2016/2017 fertilizer response trials showed linear response of maize to fertilizer application. Yields ranged from an average of 1.47 t/ha without fertilizer application to 4.0 t/ha at 92:21:0+4S. It is concluded that the poor soil fertility, low field plant densities, and dry spells are the main causes of low yields. Gross margins were positive for groundnut yield of 1,000 kg/ha and fertilizer rates on maize of 46:23:0+4S and above