Risk associated with asymptomatic parasitaemia occurring post-antimalarial treatment

OBJECTIVE: Parasites may recur asymptomatically after initial clearance by antimalarial treatment. Current guidelines recommend treatment only when patients develop symptoms or at the end of follow-up. We wanted to assess prospectively the probability of becoming symptomatic and the risks of this practice. METHODS: We analysed data collected in 13 trials of uncomplicated paediatric malaria conducted in eight sub-Saharan African countries. These studies followed all cases of post-treatment asymptomatic parasitaemia until they developed symptoms or to the end of the 28-day follow-up period, at which time parasite genotypes were compared to pre-treatment isolates to distinguish between recrudescences and new infections. RESULTS: There were 425 asymptomatic recurrences after 2576 treatments with either chloroquine, sulfadoxine/pyrimethamine or amodiaquine, of which 225 occurred by day 14 and 200 between day 15 and day 28. By day 28, 42% developed fever (median time to fever = 5 days) and 30% remained parasitaemic but afebrile, while 23% cleared their parasites (outcome unknown in 4%). Young age, parasitaemia >/=500 parasites/microl; onset of parasitaemia after day 14, and treatment with amodiaquine were the main variables associated with higher risk of developing fever. CONCLUSION: In areas of moderate to intense transmission, asymptomatic recurrences of malaria after treatment carry a substantial risk of becoming ill within a few days and should be treated as discovered. Young children are at higher risk. The higher risk carried by cases occurring in the second half of follow-up may be explained by falling residual drug levels

The place of giftedness in the Nigerian education system

This paper had made serious effort in defining the concept “giftedness”. It went further to discuss the place of giftedness in Nigerian education system in the light of the recommendation of the national policy on education, disregard for merit in our society, the menace of our quota system syndrome, and tribal sentiments in the country. Consequently, in conclusion among other things the paper suggested that merit should not be compromised with, for any reason. The school system, educators, planners, administrators, counsellors, psychologists and government should play their parts in identifying and developing the gifted persons early enough, as doing this would mean developing the nation technologically and otherwise, for self-reliance and nation building

Treatment of malaria restricted to laboratory-confirmed cases: a prospective cohort study in Ugandan children.

BACKGROUND: Presumptive treatment of malaria in febrile children is widely advocated in Africa. This may occur in the absence of diagnostic testing or even when diagnostic testing is performed but fails to detect malaria parasites. Such over-treatment of malaria has been tolerated in the era of inexpensive and safe monotherapy. However, with the introduction of new artemisinin-based combination therapy (ACT), presumptive treatment becomes economically and clinically less acceptable. METHODS: The risks and benefits of only treating children with microscopy confirmed malaria using a prospective cohort design were investigated. A representative sample of 601 children between one and 10 years of age were recruited from a census population in Kampala, Uganda and were followed for all of their health care needs in a study clinic. Standard microscopy was performed each time a child presented with a new episode of fever and antimalarial therapy given only if the blood smear was positive. RESULTS: Of 5,895 visits for new medical problems 40% were for febrile illnesses. Of the 2,359 episodes of new febrile illnesses, blood smears were initially reported as negative in 1,608 (68%) and no antimalarial therapy was given. Six of these initially negative smears were reported to be positive following quality control reading of all blood smears: four of these patients were subsequently diagnosed with uncomplicated malaria and two cleared their parasites without antimalarial treatment. Of the 1,602 new febrile illnesses in which the final blood smear reading was classified as negative, only 13 episodes (0.8%) were diagnosed with malaria in the subsequent 7 days. All 13 of these episodes of malaria were uncomplicated and were successfully treated. CONCLUSION: In this urban setting, malaria was responsible for only 32% of febrile episodes. Withholding antimalarial therapy in febrile children with negative blood smears was safe and saved over 1,600 antimalarial treatments in 601 children over an 18-month period. In the era of expensive ACT, directing resources towards improving diagnostic and treatment practices may provide a cost-effective measure for promoting rational use of antimalarial therapy

Information Technology as a Mechanism for Educational Transformations in a Changing Society

Education is a definite and ground-breaking channel for a high standard of living, an opportunity for intellectual interactions, social networking amongst current academic professionals, college and university graduates, at local, state, and community. The primary purpose of life-long education is to promote personal and professional development, and advancement of the national and world economy. Ancient times support the premise that after continued self-regulating attempts, the time has come for current and future graduates, professionals, and the entire education community to focus on the primacy of computer information technology, which has widened human access to vital data, video, and information transmission and communication, also created an irreversible phenomenon in instruction and learning endeavors, and continues to serve as the best medium for multiple sources of information and communication. The emergence of computer information technology has equally created a wide range of opportunities for greater production; doing away with the lingering global language barriers, and creating a working podium in the academic and political world. It is a proven tenet that the continued use of computer information technology and associated devices such as the Internet, mobile telephones, and electronic mail for data, information transmission, and communication has improved the standard of living and enhanced the exchange of ideas, effective method of learning endeavours, a decrease in alarming attrition rate of students dropping out of the degree programmes and improvement in academic performance

Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial

OBJECTIVES: To assess if the clinical outcome of patients treated after performing a Rapid Diagnostic Test for malaria (RDT) is at least equivalent to that of controls (treated presumptively without test) and to determine the impact of the introduction of a malaria RDT on clinical decisions. METHODS: Randomized, multi-centre, open clinical trial in two arms in 2006 at the end of the dry and of the rainy season in 10 peripheral health centres in Burkina Faso: one arm with use of RDT before treatment decision, one arm managed clinically. Primary endpoint: persistence of fever at day 4. Secondary endpoints: frequency of malaria treatment and of antibiotic treatment. RESULTS: A total of 852 febrile patients were recruited in the dry season and 1317 febrile patients in the rainy season, and randomized either to be submitted to RDT (P_RTD) or to be managed presumptively (P_CLIN). In both seasons, no significant difference was found between the two randomized groups in the frequency of antimalarial treatment, nor of antibiotic prescription. In the dry season, 80.8% and 79.8% of patients with a negative RDT were nevertheless diagnosed and treated for malaria, and so were 85.0% and 82.6% negative patients in the rainy season. In the rainy season only, both diagnosis and treatment of other conditions were significantly less frequent in RDT positive vs. negative patients (48.3% vs. 61.4% and 46.2% vs. 59.9%, P = 0.00 and 0.00, respectively). CONCLUSION: Our study was inconclusive on RDT safety (clinical outcome in the two randomized groups), because of an exceedingly and unexpectedly low compliance with the negative test result. Further research is needed on best strategies to promote adherence and on the safety of a test based strategy compared with the current, presumptive treatment strategy

Exploring preparedness of social workers to address the environmental justice issue in communities: the case of selected dumping sites in King Sabata Dalindyebo (KSD) municipality, Eastern Cape

Social workers are mandated to address environmental justice issues as part of working towards promoting community and environmental sustainability within and between communities. This thesis reports from a research study that was aimed at exploring the preparedness of social workers to address pollution in King Sabata Dalindyebo communities with the objective to: understand the social work intervention strategies social workers use to address pollution in KSD communities; identify the challenges if any social workers face when addressing pollution in KSD communities; and explore the confidence of social workers when addressing pollution in KSD communities. To achieve its aim and objectives, this study was exclusively informed by a qualitative research approach and thus utilised an explorative case study design to obtain in-depth qualitative data. Semi-structured interviews were conducted with twelve social workers using a semi-structured interview guide. The interviewed social workers were sampled utilizing convenience and snowball sampling techniques. Mass collected data was analysed thematically and thus presented according to themes and subthemes. Findings indicated that social workers are not sufficiently prepared to address pollution in KSD communities because of lack of environmental education and training, coupled with lack of enabling resources. Therefore, this study recommended environmental social work education and training through organisational workshops as well as improved support and resourcing. This study also recommended a future study that will explore the progress of social work towards promoting environmental sustainability in communities.Thesis (MSW) -- Faculty of Social Sciences and Humanities, 202

Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment

BACKGROUND: Studies of malaria in well-defined cohorts offer important data about the epidemiology of this complex disease, but few have been done in urban African populations. To generate a sampling frame for a longitudinal study of malaria incidence and treatment in Kampala, Uganda, a census, mapping and survey project was conducted. METHODS: All households in a geographically defined area were enumerated and mapped. Probability sampling was used to recruit a representative sample of children and collect baseline descriptive data for future longitudinal studies. RESULTS: 16,172 residents living in 4931 households in a densely-populated community (18,824 persons/km(2)) were enumerated. A total of 582 households were approached with at least one child less than 10 years of age in order to recruit 601 children living in 322 households. At enrollment, 19% were parasitaemic, 24% were anaemic, 43% used bednets, and 6% used insecticide-treated nets. Low G6PD activity (OR = 0.33, P = 0.009) and bednet use (OR = 0.64, P = 0.045) were associated with a decreased risk of parasitaemia. Increasing age (OR = 0.62 for each year, P < 0.001) and bednet use (OR = 0.58, P = 0.02) were associated with a decreased risk of anaemia CONCLUSION: Detailed surveys of target populations in urban Africa can provide valuable descriptive data and provide a sampling frame for recruitment of representative cohorts for longitudinal studies. Plans to use a multi-disciplinary approach to improve the understanding of the distribution and determinants of malaria incidence and response to therapy in this population are discussed

Exploring preparedness of social workers to address the environmental justice issue in communities: the case of selected dumping sites in King Sabata Dalindyebo (KSD) municipality, Eastern Cape

Social workers are mandated to address environmental justice issues as part of working towards promoting community and environmental sustainability within and between communities. This thesis reports from a research study that was aimed at exploring the preparedness of social workers to address pollution in King Sabata Dalindyebo communities with the objective to: understand the social work intervention strategies social workers use to address pollution in KSD communities; identify the challenges if any social workers face when addressing pollution in KSD communities; and explore the confidence of social workers when addressing pollution in KSD communities. To achieve its aim and objectives, this study was exclusively informed by a qualitative research approach and thus utilised an explorative case study design to obtain in-depth qualitative data. Semi-structured interviews were conducted with twelve social workers using a semi-structured interview guide. The interviewed social workers were sampled utilizing convenience and snowball sampling techniques. Mass collected data was analysed thematically and thus presented according to themes and subthemes. Findings indicated that social workers are not sufficiently prepared to address pollution in KSD communities because of lack of environmental education and training, coupled with lack of enabling resources. Therefore, this study recommended environmental social work education and training through organisational workshops as well as improved support and resourcing. This study also recommended a future study that will explore the progress of social work towards promoting environmental sustainability in communities.Thesis (MSW) -- Faculty of Social Sciences and Humanities, 202

Incidence of Malaria and Efficacy of Combination Antimalarial Therapies over 4 Years in an Urban Cohort of Ugandan Children

Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs) were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP), artesunate/amodiaquine (AS/AQ), or artemether/lumefantrine (AL). Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL) decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria) and no deaths were seen.With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time.isrctn.org ISRCTN37517549

Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya

OBJECTIVE. The recent change of treatment policy for uncomplicated malaria from sulfadoxine-pyrime-thamine to artemether-lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age-specific recommendations on routine malaria treatment practices 4-6 months after AL treatment was implemented. METHODS. Cross-sectional, cluster sample survey using quality-of-care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result. RESULTS. Treatment practices for 706 febrile patients (401 young children and 305 patients =5 years) were evaluated. 43.0% of patients =5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients =5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients =5 years with a negative test result. CONCLUSIONS. Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under-used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.The Wellcome Trust; the Kenya Medical Research Institute; Novartis Pharm