Clinical epidemiology of malaria under differing levels of transmission

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Baringo apis Bee Honey: Nutritional, Physicochemical, Phytochemical and Antibacterial Properties Validation Against Wound Bacterial Isolates

Skin wounds are a global public health concern demanding significant resources from the healthcare system. Their consequences include pain, social, physical or psychological impact. Hence the right approach to its management should be considered. This is towards reducing the economic burden while lowering morbidity and mortality through developing new preventive and therapeutic technologies.Bee (Apis) honey samples were collected from their beehives in Marigat Sub County, Baringo County, Kenya, followed by quantitative analysis of physicochemical, nutritive, phytochemical and antioxidant properties contributing to its antibacterial capacity. Different concentrations of honey (10x104, 20x104, 50x104 and 75x104 µg/ml)) in impregnated discs were tested against each type of clinical isolates obtained from wound swabs collected from Nakuru County Referral Hospital Nakuru, as indicated in the previous study on Stingless bee honey analysis. The bacterial isolates obtained included; Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. Their individual antibacterial inhibition was then compared to cartridges containing antibiotics (Levofloxacin 5μg, Ampicillin 10μg, Tazobactam 110 μg, Meropenem 10μg, Gentamicin 10μg and Chloramphenicol 30μg) through disc diffusion (Kirby-Bauer) technique.According to this study, quantitative analysis of the honey samples yielded 90.13 ± 5.76g/100g, 4.07 ± 0.08 and 114.28 ± 26.66 mg/g in sugar, pH and moisture, respectively. The phenolic compounds that act as antioxidants were in the mean value of total phenolic compounds (80.81 ± 36.25mgGAE/100g), total flavonoids (21.83 ± 6.16 mg RE/100g) and total carotenoids (4.41 ± 2.07 mgβ –carotene/kg). These and other components contributed to the honey's antibacterial inhibition with a mean range of 14.54 ± 2.0mm to 17.58 ± 3mm, which was relatively higher than the antibiotics used (Gentamycin, Levofloxacin, Ampicillin, Tazobactum, Meropenem and Chloramphenicol). Control bacterial isolates ATCC 25923, ATCC 25922, ATCC 27736 and ATCC 27858 for Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, respectively, enhanced the standard in the analysis. The potency of honey from different botanical sources reveals important antimicrobial differences comparable to local antibiotics.Over and indiscriminate use of antibiotics has led to the emergence of multidrug-resistant bacterial strains, a global public health problem. Alternative antimicrobial strategies like plants and plant-based products such as honey need to be given more attention to solving this challenge. Hence the present study demonstrates that the composition of honey from honey bees (Apis) enables it to be proposed for prophylaxis and treatment of surface infections, which has traditionally been practiced in the management of wounds and burns. DOI: 10.7176/JHMN/105-01 Publication date: January 31st 202

Who Will Silence The Guns? (The Youth As African Solutions To African Problems)

The 50th Anniversary of the Organization of African Union marked a significant time for reflection on the progress made on the continent, as well as persisting challenges. Protracted civil conflicts, proliferation of small arms and light weapons amongst civilian populations and the spread of violent extremism were identified as significant impediments to the progress of the continent. The initiative \u27Silence the Guns by 2020 recognises dialogue-centred conflict prevention and resolution, human centred development and peace as requisite to ensuring and realizing Agenda 2063: The Africa We Want. This paper identifies alternative dispute resolution methods and soft power approaches as key to conflict prevention and management. It also identifies African youth as the African solution to African problems. Using examples from South Sudan, Somalia, Uganda and Kenya, the paper highlights young people\u27s leadership and peacebuilding efforts towards silencing the guns. The paper calls for recognition and engagement of this emerging leadership

Evidence for over-dispersion in the distribution of clinical malaria episodes in children.

BACKGROUND: It may be assumed that patterns of clinical malaria in children of similar age under the same level of exposure would follow a Poisson distribution with no over-dispersion. Longitudinal studies that have been conducted over many years suggest that some children may experience more episodes of clinical malaria than would be expected. The aim of this study was to identify this group of children and investigate possible causes for this increased susceptibility. METHODOLOGY AND PRINCIPAL FINDINGS: Using Poisson regression, we chose a group of children whom we designated as 'more susceptible' to malaria from 373 children under 10 years of age who were followed up for between 3 to 5 years from 1998-2003. About 21% of the children were categorized as 'more susceptible' and although they contributed only 23% of the person-time of follow-up, they experienced 55% of total clinical malaria episodes. Children that were parasite negative at all cross-sectional survey were less likely to belong to this group [AOR = 0.09, (95% CI: 0.14-0.61), p = 0.001]. CONCLUSIONS AND SIGNIFICANCE: The pattern of clinical malaria episodes follows a negative binomial distribution. Use of lack of a clinical malaria episode in a certain time period as endpoints for intervention or immunological studies may not adequately distinguish groups who are more or less immune. It may be useful in such studies, in addition to the usual endpoint of the time to first episode, to include end points which take into account the total number of clinical episodes experienced per child

FRANCHISING PROPENSITY AND FINANCIAL PERFORMANCE OF FRANCHISING ORGANISATIONS: A CRITICAL LITERATURE REVIEW

ABSTRACT Purpose - This paper investigates the relationship between franchising propensity and financial performance of franchising organisations and explores literature on possible intervening and moderating factors on the relationship. Methodology - This is a critical review of theoretical and empirical literature on franchising propensity and financial performance. Findings - Literature reveals that most studies on franchising focus on the antecedents of franchising but very few examine the consequences moreover, the studies are anchored on either agency theory or resource scarcity theory. Studies examining the relationship between franchising and performance provide conflicting results. Some studies indicate that increasing the number of franchised units result to superior performance while other studies find no significant difference between franchising and running company owned units. The effect of franchising on capital structure of the franchisor has been examined by a few studies with no conclusive results. Furthermore, prior studies indicate that the relationship between franchising and performance is influenced by firm characteristics. There is a dearth of studies examining franchising in sectors other than the restaurant industry moreover there is need to use time series data to observe the consequences of franchising over time. Implications: This review of literature mainly consists of studies carried out in developed economies which have superior business models and access to finance. Developing economies are mostly supported by small and medium enterprises and lack the skills and resources similar to advanced economies. Therefore, although developing economies stand to benefit more from the franchising model, there are few studies carried out in developing economies. Therefore, the findings of this study may vary in the developing economies. Value: This study has presented a new dimension that may explain the inconsistent findings from prior studies and contribute to the discussion of franchising and firm performance. The relationship between franchising and firm performance may be moderated by firm characteristics and mediated by capital structure

Defining childhood severe falciparum malaria for intervention studies.

Background Clinical trials of interventions designed to prevent severe falciparum malaria in children require a clear endpoint. The internationally accepted definition of severe malaria is sensitive, and appropriate for clinical purposes. However, this definition includes individuals with severe nonmalarial disease and coincident parasitaemia, so may lack specificity in vaccine trials. Although there is no “gold standard” individual test for severe malaria, malaria-attributable fractions (MAFs) can be estimated among groups of children using a logistic model, which we use to test the suitability of various case definitions as trial endpoints. Methods and Findings A total of 4,583 blood samples were taken from well children in cross-sectional surveys and from 1,361 children admitted to a Kenyan District hospital with severe disease. Among children under 2 y old with severe disease and over 2,500 parasites per microliter of blood, the MAFs were above 85% in moderate- and low-transmission areas, but only 61% in a high-transmission area. HIV and malnutrition were not associated with reduced MAFs, but gastroenteritis with severe dehydration (defined by reduced skin turgor), lower respiratory tract infection (clinician's final diagnosis), meningitis (on cerebrospinal fluid [CSF] examination), and bacteraemia were associated with reduced MAFs. The overall MAF was 85% (95% confidence interval [CI] 83.8%–86.1%) without excluding these conditions, 89% (95% CI 88.4%–90.2%) after exclusions, and 95% (95% CI 94.0%–95.5%) when a threshold of 2,500 parasites/μl was also applied. Applying a threshold and exclusion criteria reduced sensitivity to 80% (95% CI 77%–83%). Conclusions The specificity of a case definition for severe malaria is improved by applying a parasite density threshold and by excluding children with meningitis, lower respiratory tract infection (clinician's diagnosis), bacteraemia, and gastroenteritis with severe dehydration, but not by excluding children with HIV or malnutrition

Helminth Infection and Eosinophilia and the Risk of Plasmodium falciparum Malaria in 1- to 6-Year-Old Children in a Malaria Endemic Area

Malaria infection and other parasitic infections are widespread in developing countries. There is evidence from some studies that intestinal worm infections may increase the risk of developing febrile malaria. However, the evidence is mixed, and some studies have found no effect or even protective effects. A vaccine trial was recently conducted to assess the efficacy of a candidate malaria vaccine. Episodes of malaria were monitored. The vaccine was not protective, but data was also recorded on the prevalence of worm infections. The rates of febrile malaria did not seem to vary according to worm infection in this study. However, because of the relatively low prevalence of worm infection, the study did not have high power. Given the conflicting findings in the literature, and the potential for the effect of worm infection to vary geographically, it is important that larger, definitive studies are conducted, since even quite small effects might be important for global public health

Heritability of Malaria in Africa

BACKGROUND: While many individual genes have been identified that confer protection against malaria, the overall impact of host genetics on malarial risk remains unknown. METHODS AND FINDINGS: We have used pedigree-based genetic variance component analysis to determine the relative contributions of genetic and other factors to the variability in incidence of malaria and other infectious diseases in two cohorts of children living on the coast of Kenya. In the first, we monitored the incidence of mild clinical malaria and other febrile diseases through active surveillance of 640 children 10 y old or younger, living in 77 different households for an average of 2.7 y. In the second, we recorded hospital admissions with malaria and other infectious diseases in a birth cohort of 2,914 children for an average of 4.1 y. Mean annual incidence rates for mild and hospital-admitted malaria were 1.6 and 0.054 episodes per person per year, respectively. Twenty-four percent and 25% of the total variation in these outcomes was explained by additively acting host genes, and household explained a further 29% and 14%, respectively. The haemoglobin S gene explained only 2% of the total variation. For nonmalarial infections, additive genetics explained 39% and 13% of the variability in fevers and hospital-admitted infections, while household explained a further 9% and 30%, respectively. CONCLUSION: Genetic and unidentified household factors each accounted for around one quarter of the total variability in malaria incidence in our study population. The genetic effect was well beyond that explained by the anticipated effects of the haemoglobinopathies alone, suggesting the existence of many protective genes, each individually resulting in small population effects. While studying these genes may well provide insights into pathogenesis and resistance in human malaria, identifying and tackling the household effects must be the more efficient route to reducing the burden of disease in malaria-endemic areas

A Phase 2b Randomised Trial of the Candidate Malaria Vaccines FP9 ME-TRAP and MVA ME-TRAP among Children in Kenya

OBJECTIVE: The objective was to measure the efficacy of the vaccination regimen FFM ME-TRAP in preventing episodes of clinical malaria among children in a malaria endemic area. FFM ME-TRAP is sequential immunisation with two attenuated poxvirus vectors (FP9 and modified vaccinia virus Ankara), which both deliver the pre-erythrocytic malaria antigen construct multiple epitope–thrombospondin-related adhesion protein (ME-TRAP). DESIGN: The trial was randomised and double-blinded. SETTING: The setting was a rural, malaria-endemic area of coastal Kenya. PARTICIPANTS: We vaccinated 405 healthy 1- to 6-year-old children. INTERVENTIONS: Participants were randomised to vaccination with either FFM ME-TRAP or control (rabies vaccine). OUTCOME MEASURES: Following antimalarial drug treatment children were seen weekly and whenever they were unwell during nine months of monitoring. The axillary temperature was measured, and blood films taken when febrile. The primary analysis was time to a parasitaemia of over 2,500 parasites/μl. RESULTS: The regime was moderately immunogenic, but the magnitude of T cell responses was lower than in previous studies. In intention to treat (ITT) analysis, time to first episode was shorter in the FFM ME-TRAP group. The cumulative incidence of febrile malaria was 52/190 (27%) for FFM ME-TRAP and 40/197 (20%) among controls (hazard ratio = 1.52). This was not statistically significant (95% confidence interval [CI] 1.0–2.3; p = 0.14 by log-rank). A group of 346 children were vaccinated according to protocol (ATP). Among these children, the hazard ratio was 1.3 (95% CI 0.8–2.1; p = 0.55 by log-rank). When multiple malaria episodes were included in the analyses, the incidence rate ratios were 1.6 (95% CI 1.1–2.3); p = 0.017 for ITT, and 1.4 (95% CI 0.9–2.1); p = 0.16 for ATP. Haemoglobin and parasitaemia in cross-sectional surveys at 3 and 9 mo did not differ by treatment group. Among children vaccinated with FFM ME-TRAP, there was no correlation between immunogenicity and malaria incidence. CONCLUSIONS: No protection was induced against febrile malaria by this vaccine regimen. Future field studies will require vaccinations with stronger immunogenicity in children living in malarious areas

Extended Follow-Up Following a Phase 2b Randomized Trial of the Candidate Malaria Vaccines FP9 ME-TRAP and MVA ME-TRAP among Children in Kenya

Background. "FFM ME-TRAP'' is sequential immunisation with two attenuated poxvirus vectors (FP9 and modified vaccinia virus Ankara) delivering the pre-erythrocytic malaria antigen ME-TRAP. Over nine months follow-up in our original study, there was no evidence that FFM ME-TRAP provided protection against malaria. The incidence of malaria was slightly higher in children who received FFM ME-TRAP, but this was not statistically significant (hazard ratio 1.5, 95% CI 1.0-2.3). Although the study was unblinded, another nine months follow-up was planned to monitor the incidence of malaria and other serious adverse events. Methods and Findings. 405 children aged 1-6 yrs were initially randomized to vaccination with either FFM ME-TRAP or control (rabies vaccine). 380 children were still available for follow-up after the first nine months. Children were seen weekly and whenever they were unwell for nine months monitoring. The axillary temperature was measured, and blood films taken when febrile. The primary analysis was time to parasitaemia >2,500/mu l. During the second nine months monitoring, 49 events met the primary endpoint (febrile malaria with parasites >2,500/mu l) in the Intention To Treat (ITT) group. 23 events occurred among the 189 children in the FFM ME-TRAP group, and 26 among the 194 children in the control group. In the full 18 months of monitoring, there were 63 events in the FFM ME-TRAP group and 60 in the control group (HR = 1.2, CI 0.84-1.73, p = 0.35). There was no evidence that the HR changed over the 18 months (test for interaction between time and vaccination p = 0.11). Conclusions. Vaccination with FFM ME-TRAP was not protective against malaria in this study. Malaria incidence during 18 months of surveillance was similar in both vaccine groups. Trial Registration. Controlled-Trials. com ISRCTN88335123