Over-diagnosis of malaria is not a lost cause.

BACKGROUND: Recent studies have highlighted the over-diagnosis of malaria in clinical settings in Africa. This study assessed the impact of a training programme implemented as part of an intervention trial on diagnostic behaviour of clinicians in a rural district hospital in a low-moderate malaria transmission setting. METHODS: From the beginning of 2005, a randomized controlled trial (RCT) of intermittent preventive treatment for malaria in infants (IPTi) has been conducted at the study hospital. As part of the RCT, the study team offered laboratory quality assurance, and supervision and training of paediatric ward staff using information on malaria epidemiology in the community. Data on clinical and blood slide confirmed cases of malaria from 2001 to 2005 were extracted from the hospital records. RESULTS: The proportion of blood slides positive for malaria parasites had decreased from 21% in 2001 to 7% in 2005 (p < .01). The proportion of outpatient and inpatient cases diagnosed as malaria ranged between 34% and 28% from 2001 to 2004 and this decreased substantially to 17% after the introduction of the package of training and support in 2005 (p < .01). There was no clear trend in the ratio of blood slide examined versus total diagnosis of malaria. CONCLUSION: It may be possible to change the diagnostic behaviour of clinicians by rigorous training using local malaria epidemiology data and supportive supervision

Facteurs d’affiliation aux pairs sont étroitement associés à la criminalité des jeunes incarcérés à la prison centrale de Kinshasa : Affiliation Factors to Peers are strongly associated to the Criminality among the Youth of the Central Prison of Kinshasa

Context and objective. Increasing crime is one of the major social problems facing in the context of armed conflicts of various kinds. The objective of this study is to investigate the determinants of the peer affiliation domain of criminal and violent criminal behavior. Methods. We undertook a case-control study included 500 subjects: 297 incarcerated criminals (189 violent criminals, as crime against a person and 108 non-violent criminals, as crime against property) against 203 noncriminal subjects, between August 2015 and December 2016. We selected control subjects from general population of the city of Kinshasa and matched them with cases according to gender, age (± 2 years) and geographical origin. Logistic regression analysis was used to investigate the determinants of criminality and of violent criminality. Results. Compared to noncriminals, criminals were significantly gang members (55.6% versus 4.9%, p&lt;0.001), carry guns (40.1% versus 7.9%, p&lt;0.001), attend parties with friends without parental supervision (69.7% versus 34%, p&lt;0.001), and have friends who sell drugs (44.4% versus 14.8%, p&lt;0.001). Compared to non-violent criminals, violent criminals were significantly more likely to be gang members (60.8% versus 46.3%, p=0.015), carry weapons (46.6% versus 28.7%, p=0.003) and have friends who sell heroin (50.3% versus 34.3%, p=0.008). In multivariate logistic regression analyse, being a gang member (ORa 13.6; 95% CI: 6.76-27.67), carrying a weapon (ORa 2.85; 95% CI: 1.5-5.42) and unsupervised parties (ORa 1.95; 95% CI: 1.25-3.02) were the independently associated with crime. Only carrying weapons (ORa 1.87; 95% CI: 1.05-3.32) emerged as an independent determinant of violent crime. Conclusion. Violent and non-violent crime is a continuum in which the former differs from the latter in terms of carrying a weapon. Gang involvement, social gatherings with friends and carrying weapons are the common threads of their criminal behavior. Contexte et objectif. La criminalité croissante compte parmi les problèmes sociaux majeurs en République Démocratique du Congo aux prises à des conflits armés de diverse nature. Cette étude a pour objectif de rechercher les déterminants du domaine d’affiliation aux pairs du comportement criminel et criminel violent. Méthodes. Nous avons entrepris une étude cas-témoin enrôlant 500 sujets : 297 criminels incarcérés (189 criminels violents, crime contre la personne et 108 criminels non violents, crime contre la propriété) contre 203 sujets non criminels, entre août 2015 et décembre 2016. Les témoins ont été recrutés dans la population générale de la ville de Kinshasa et appariés aux cas, selon le sexe (même), l’âge (± 2 ans) et la provenance géographique. L’analyse de régression logistique a été utilisée pour rechercher les déterminants de la criminalité. Résultats. Comparés aux non criminels, les criminels étaient significativement membres de gang (55,6% versus 4,9%, p &lt; 0,001), porteurs des armes (40,1% versus 7,9% ; p &lt;0,001), dans des soirées entre amissans supervision parentale (69,7% versus 34%, p&lt;0,001), et&nbsp; avaient des amis vendeurs de drogues (44,4% versus 14,8%, p&lt;0,001). Par rapport aux criminels non violents, les criminels violents étaient significativement membres de gang (60,8% versus 46,3%, p=0,015), porteurs des armes (46,6% versus 28,7%, p=0,003) et avaient des amis vendeurs de drogues (50,3% versus 34,3%, p=0,008). En analyse de régression logistique multivariée, être membre de gang (ORa 13,6; IC 95% : 6,76-27,67), porter une arme (ORa 2,85; IC 95% : 1,5-5,42) et assister dans les soirées sans supervision (ORa 1,95; IC 95% : 1,25-3,02) constituaient les déterminants indépendamment associés à la criminalité. Seul porter des armes (ORa 1,87; IC 95% : 1,05-3,32) a émergé comme déterminant indépendant de la criminalité violente. Conclusion. La criminalité violente et non violente constitue un continuum dans lequel la première se différencie de la deuxième par le port d’arme. La participation à un gang, les soirées entre amis et le port d’arme constituent le fils conducteur de leur comportement criminel. &nbsp

Rapid Assessment of Malaria Transmission Using Age-Specific Sero-Conversion Rates

BACKGROUND: Malaria transmission intensity is a crucial determinant of malarial disease burden and its measurement can help to define health priorities. Rapid, local estimates of transmission are required to focus resources better but current entomological and parasitological methods for estimating transmission intensity are limited in this respect. An alternative is determination of antimalarial antibody age-specific sero-prevalence to estimate sero-conversion rates (SCR), which have been shown to correlate with transmission intensity. This study evaluated SCR generated from samples collected from health facility attendees as a tool for a rapid assessment of malaria transmission intensity. METHODOLOGY AND PRINCIPAL FINDINGS: The study was conducted in north east Tanzania. Antibodies to Plasmodium falciparum merozoite antigens MSP-1(19) and AMA-1 were measured by indirect ELISA. Age-specific antibody prevalence was analysed using a catalytic conversion model based on maximum likelihood to generate SCR. A pilot study, conducted near Moshi, found SCRs for AMA-1 were highly comparable between samples collected from individuals in a conventional cross-sectional survey and those collected from attendees at a local health facility. For the main study, 3885 individuals attending village health facilities in Korogwe and Same districts were recruited. Both malaria parasite prevalence and sero-positivity were higher in Korogwe than in Same. MSP-1(19) and AMA-1 SCR rates for Korogwe villages ranged from 0.03 to 0.06 and 0.07 to 0.21 respectively. In Same district there was evidence of a recent reduction in transmission, with SCR among those born since 1998 [MSP-1(19) 0.002 to 0.008 and AMA-1 0.005 to 0.014 ] being 5 to 10 fold lower than among individuals born prior to 1998 [MSP-1(19) 0.02 to 0.04 and AMA-1 0.04 to 0.13]. Current health facility specific estimates of SCR showed good correlations with malaria incidence rates in infants in a contemporaneous clinical trial (MSP-1(19) r(2) = 0.78, p<0.01 & AMA-1 r(2) = 0.91, p<0.001). CONCLUSIONS: SCRs generated from age-specific anti-malarial antibody prevalence data collected via health facility surveys were robust and credible. Analysis of SCR allowed detection of a recent drop in malaria transmission in line with recent data from other areas in the region. This health facility-based approach represents a potential tool for rapid assessment of recent trends in malaria transmission intensity, generating valuable data for local and national malaria control programs to target, monitor and evaluate their control strategies

One round of azithromycin MDA adequate to interrupt transmission in districts with prevalence of trachomatous inflammation-follicular of 5.0-9.9%: Evidence from Malawi.

BACKGROUND: As highly trachoma-endemic countries approach elimination, some districts will have prevalences of trachomatous inflammation-follicular in 1-9-year-olds (TF1-9) of 5.0-9.9%. The World Health Organization (WHO) previously recommended that in such districts, TF prevalence be assessed in each sub-district (groupings of at least three villages), with three rounds of azithromycin treatment offered to any sub-district in which TF≥10%. Given the large number of endemic districts worldwide and the human and financial resources required to conduct surveys, this recommendation may not be practical. In a group of 8 Malawi districts with baseline TF prevalences of 5.0-9.9%, the Malawi Ministry of Health administered one round of azithromycin mass treatment, to the whole of each district, achieving mean coverage of ~80%. Here, we report impact surveys conducted after that treatment. METHODS: We undertook population-based trachoma surveys in 18 evaluation units of the 8 treated districts, at least 6 months after the MDA. The standardized training package and survey methodologies of Tropical Data, which conform to WHO recommendations, were used. RESULTS: Each of the 18 evaluation units had a TF1-9 prevalence <5.0%. CONCLUSION: The study demonstrates that in Malawi districts with TF of 5.0-9.9%, one round of azithromycin MDA with ~80% coverage associates with a reduction in TF prevalence to <5%. Further evidence for this approach should be collected elsewhere

Bombali Virus in Mops condylurus Bat, Kenya

Bombali virus (genus Ebolavirus) was identified in organs and excreta of an Angolan free-tailed bat (Mops condylurus) in Kenya. Complete genome analysis revealed 98% nucleotide sequence similarity to the prototype virus from Sierra Leone. No Ebola virus-specific RNA or antibodies were detected from febrile humans in the area who reported contact with bats.Peer reviewe

Towards a coordinated strategy for intercepting human disease emergence in Africa

Non peer reviewe

The Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants in Sub-Saharan Africa

BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. METHODS: We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, IPTi delivery costs and country specific provider and household malaria treatment costs. FINDINGS: In sites where IPTi had a significant effect on reducing malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36-4.03 based on trial specific data and USD 0.68-2.27 based on the pooled analysis. For IPTi using alternative antimalarials, the lowest cost per case averted was for AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi was shown to be cost effective in all the sites and highly cost-effective in all but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced health system costs and showed significant savings to households from malaria cases averted. A threshold analysis showed that there is room for the IPTi-efficacy to fall and still remain highly cost effective in all sites where IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS: IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective

The global burden of trichiasis in 2016.

BACKGROUND: Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation. METHODS: We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available. FINDINGS: Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand-1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03-2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283-557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand-1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1-5.2 million). INTERPRETATION: The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets