LiST as a catalyst in program planning: experiences from Burkina Faso, Ghana and Malawi

Background African countries are working to achieve rapid reductions in maternal and child mortality and meet their targets for the Millennium Development Goals (MDGs). Partners in the Catalytic Initiative to Save One Million Lives (CI) are assisting them by providing funding and technical assistance to increase and accelerate coverage for proven interventions. Here we describe how the Lives Saved Tool (LiST) was used as part of an early assessment of the expected impact of CI plans in Malawi, Burkina Faso and Ghana

Apolipoprotein L1 Variant Associated with Increased Susceptibility to Trypanosome Infection

YesAfrican trypanosomes, except Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense, which cause human African trypanosomiasis, are lysed by the human serum protein apolipoprotein L1 (ApoL1). These two subspecies can resist human ApoL1 because they express the serum resistance proteins T. b. gambiense glycoprotein (TgsGP) and serum resistance-associated protein (SRA), respectively. Whereas in T. b. rhodesiense, SRA is necessary and sufficient to inhibit ApoL1, in T. b. gambiense, TgsGP cannot protect against high ApoL1 uptake, so different additional mechanisms contribute to limit this uptake. Here we report a complex interplay between trypanosomes and an ApoL1 variant, revealing important insights into innate human immunity against these parasites. Using whole-genome sequencing, we characterized an atypical T. b. gambiense infection in a patient in Ghana. We show that the infecting trypanosome has diverged from the classical T. b. gambiense strains and lacks the TgsGP defense mechanism against human serum. By sequencing the ApoL1 gene of the patient and subsequent in vitro mutagenesis experiments, we demonstrate that a homozygous missense substitution (N264K) in the membrane-addressing domain of this ApoL1 variant knocks down the trypanolytic activity, allowing the trypanosome to avoid ApoL1-mediated immunity. IMPORTANCE. Most African trypanosomes are lysed by the ApoL1 protein in human serum. Only the subspecies Trypanosoma b. gambiense and T. b. rhodesiense can resist lysis by ApoL1 because they express specific serum resistance proteins. We here report a complex interplay between trypanosomes and an ApoL1 variant characterized by a homozygous missense substitution (N264K) in the domain that we hypothesize interacts with the endolysosomal membranes of trypanosomes. The N264K substitution knocks down the lytic activity of ApoL1 against T. b. gambiense strains lacking the TgsGP defense mechanism and against T. b. rhodesiense if N264K is accompanied by additional substitutions in the SRA-interacting domain. Our data suggest that populations with high frequencies of the homozygous N264K ApoL1 variant may be at increased risk of contracting human African trypanosomiasis.This work, including the efforts of Stijn Deborggraeve, was funded by Research Foundation Flanders (1501413N). This work, including the efforts of Bart Cuypers, was funded by Research Foundation Flanders (11O1614N). This work, including the efforts of Jean-Claude Dujardin and Etienne Pays, was funded by Interuniversity Attraction Poles Program of Belgian Science Policy (P7/41). This work, including the efforts of Jean-Claude Dujardin, was funded by Flemish Ministry of Sciences (SOFI-B SINGLE). This work, including the efforts of Etienne Pays, was funded by EC | European Research Council (ERC) (APOLs 669007)

Failure of a new antivenom to treat Echis ocellatus snake bite in rural Ghana:the importance of quality surveillance

This study compares two antivenoms used to treat Echis ocellatus snake bite patients at Mathias Hospital, Yeji, central Ghana. FAV-Afrique™ antivenom (Aventis Pasteur) was given to 278 patients during 2001-2003, whilst Asna Antivenom C (Bharat Serum and Vaccines Ltd) was used in 2004 to treat 66 patients. The two groups had comparable patient attributes, time from snake bite to treatment and staff adherence to the tested treatment protocol. The antivenom C group required more repeat doses and twice the amount of antivenom to treat coagulopathy. Of greater concern, the antivenom C mortality rate was 12.1%, a marked rise from the 1.8% rate in the earlier FAV-Afrique™ antivenom group. In this study, antivenom C was ineffective as treatment for West African E. ocellatus snake venom. This illustrates the absolute need for regional pilot tests to assess the effectiveness of a new antivenom against local snake venoms before its sole and general distribution in a region is initiated

DUAL FORTIFICATION OF SALT WITH IRON AND IODINE IN WOMEN AND CHILDREN IN RURAL GHANA

ABSTRACTObjective: To test the effi cacy of double-fortifi ed salt (DFS) on the anaemia and iodine defi ciency(ID) status of women and their children.Design: Double-blind randomised controlled trial.Setting: Sekyere West District of Ghana.Subjects: In this eight-month trial, mildly anaemic or non-anaemic, non-pregnant, non-lactatingwomen were randomised into three groups receiving: DFS plus weekly placebo (n = 61); iodisedsalt plus weekly 70 mg iron supplement (n = 65); or iodised salt (IS) plus weekly placebo (controlgroup, n = 58). Correspondingly, their mildly anaemic and non-anaemic children aged 1-5 years wererandomised into two groups receiving either the DFS (n = 23) or IS alone (control group, n = 59).Results: At the end of the intervention, prevalence of anaemia in women remained unchangedin the DFS or IS plus weekly iron supplement group, but signifi cantly increased by 19.5% inthe control group (P = 0.039). In children, prevalence of anaemia in the DFS group signifi cantlydecreased by 21.7% (P = 0.025) while no change was observed in the control group. ID decreasedsignifi cantly in all groups of women (P < 0.001) and children (P < 0.05), with no difference amonggroups of women and children.Conclusion: While the use of DFS prevented anaemia in women, it had a signifi cant role in boththe prevention and treatment of anaemia in children. Both the DFS and IS signifi cantly reducedID in women and children to a similar degree

Dual fortification of salt with iron and iodine in women and children in rural Ghana

No Abstract. East African Medical Journal Vol. 84 (10) 2007: pp. 473-48

The amount and value of work time of community medicine distributors in community case management of malaria among children under five years in the Ejisu-Juaben District of Ghana

<p>Abstract</p> <p>Background</p> <p>The contribution of community medicine distributors (CMD) to prompt health service delivery in areas described as “hard-to-reach” is important but the value of their work time remains unknown and thus makes it difficult to design appropriate regular financial incentives to motivate them. This makes CMDs feel their efforts are not recognized. An attempt to estimate the value of 54 CMDs’ work time involved in community case management of malaria (CCMm) in a rural district in Ghana is presented.</p> <p>Methods</p> <p>Time spent by CMDs on CCMm activities were recorded for a period of 12 months to determine the work-time value. Cost analysis was performed in Microsoft Excel with data from CMD records and at 2007 market price in Ghana.</p> <p>Results</p> <p>A CMD spent 4.8 hours, [95% CI: 3.9; 5.3] on all CCMm-related activities per day. The time value of CMD work ranged from GH¢ 2.04 (US$2.24) to GH¢ 4.1 [US$ 4.6] per week and GH¢ 19.2 - 86.4 (US$21.10-94.95) per month. The gross wage outside CCMm as reported by CMD was GH¢ 58.4 [US$ 64.69] and value of foregone income of GH¢ 86.40 (US$94.95) per month, about 14-times higher than the monthly incentives of GH¢ 6.0 given by the CCMm programme.</p> <p>Conclusion</p> <p>The value of work time and the foregone income of CMDs in CCMm are high and yet there are no regular and sustainable incentives provided for them. The results are significant to policy in designing incentives to motivate CMDs in large-scale implementation of CCMm.</p