Increasing the uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) through seasonal malaria chemoprevention channel delivery: protocol of a multicenter cluster randomized implementation trial in Mali and Burkina Faso

Background: The uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) remains unacceptably low, with more than two-thirds of pregnant women in sub-Saharan Africa still not accessing the three or more doses recommended by the World Health Organisation (WHO). In contrast, the coverage of Seasonal Malaria Chemoprevention (SMC), a more recent strategy recommended by the WHO for malaria prevention in children under five years living in Sahelian countries with seasonal transmission, including Mali and Burkina-Faso, is high (up to 90%). We hypothesized that IPTp-SP delivery to pregnant women through SMC alongside antenatal care (ANC) will increase IPTp-SP coverage, boost ANC attendance, and increase public health impact. This protocol describes the approach to assess acceptability, feasibility, effectiveness, and cost-effectiveness of the integrated strategy. Methods and analysis: This is a multicentre, cluster-randomized, implementation trial of IPTp-SP delivery through ANC + SMC vs ANC alone in 40 health facilities and their catchment populations (20 clusters per arm). The intervention will consist of monthly administration of IPTp-SP through four monthly rounds of SMC during the malaria transmission season (July to October), for two consecutive years. Effectiveness of the strategy to increase coverage of three or more doses of IPTp-SP (IPTp3 +) will be assessed using household surveys and ANC exit interviews. Statistical analysis of IPT3 + and four or more ANC uptake will use a generalized linear mixed model. Feasibility and acceptability will be assessed through in-depth interviews and focus group discussions with health workers, pregnant women, and women with a child < 12 months. Discussion: This multicentre cluster randomized implementation trial powered to detect a 45% and 22% increase in IPTp-SP3 + uptake in Mali and Burkina-Faso, respectively, will generate evidence on the feasibility, acceptability, effectiveness, and cost-effectiveness of IPTp-SP delivered through the ANC + SMC channel. The intervention is designed to facilitate scalability and translation into policy by leveraging existing resources, while strengthening local capacities in research, health, and community institutions. Findings will inform the local national malaria control policies

Stress-moderating effects of positive emotions: Exposure to humorous movies during hemodialytic sessions decreases blood levels of stress hormones

Objective: Although Selye had indicated the relevance of the eustress dimension, scientific interest in the psychobiological and clinical aspects of distress has largely been dominant. In recent years there has been an increased interest in the use of humor in patient care. To contribute in this area, the present study is designed to show the stress moderating effect of the positive emotion of humor during hemodialytic treatment in renal patients. Methods: Nine patients were studied in three sessions at the same time of day. In the first baseline session (BS), adrenocorticotropic hormone (ACTH), beta-endorphin and Cortisol were measured through four different blood samplings from pre-to post-hemodialytic treatment. The two following experimental sessions (ESI ,ES2) were performed identically to BS except for the presentation of two different humorous videos during hemodialytic treatment. Results: A two-way repeated measure ANOVA Session by Time was carried out for each dependent variable. This revealed a reduction of the stressogenic responses due to viewing the humorous material. The expected interactions were highly significant for all the dependent variables considered (ACTH: F = 4.37, P < 0.001; Cortisol: F = 5.93, P < 0.0001; beta-endorphin: F = 6.47, P < 0.00004). Conclusion: The results support our hypothesis that the viewing of a humorous video modifies the pattern of the stress hormone response. These findings appear relevant for basic research in positive emotions and for their possible application in a clinical setting