Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated.</p> <p>Methods</p> <p>A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria).</p> <p>The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level.</p> <p>The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season.</p> <p>Results</p> <p>A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%–22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%–71.5%), respectively in the intervention and control arms (p << 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32).</p> <p>The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the health facility level.</p> <p>Conclusion</p> <p>These findings suggest that implementation of HMM, by reducing the workload in health facilities, might contributes to an overall increase of the performance of the peripheral health facilities.</p

Intermittent preventive treatment of malaria provides substantial protection against malaria in children already protected by an insecticide-treated bednet in Burkina Faso: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Intermittent preventive treatment of malaria in children (IPTc) is a promising new approach to the control of malaria in areas of seasonal malaria transmission but it is not known if IPTc adds to the protection provided by an insecticide-treated net (ITN). METHODS AND FINDINGS: An individually randomised, double-blind, placebo-controlled trial of seasonal IPTc was conducted in Burkina Faso in children aged 3 to 59 months who were provided with a long-lasting insecticide-treated bednet (LLIN). Three rounds of treatment with sulphadoxine pyrimethamine plus amodiaquine or placebos were given at monthly intervals during the malaria transmission season. Passive surveillance for malaria episodes was established, a cross-sectional survey was conducted at the end of the malaria transmission season, and use of ITNs was monitored during the intervention period. Incidence rates of malaria were compared using a Cox regression model and generalized linear models were fitted to examine the effect of IPTc on the prevalence of malaria infection, anaemia, and on anthropometric indicators. 3,052 children were screened and 3,014 were enrolled in the trial; 1,505 in the control arm and 1,509 in the intervention arm. Similar proportions of children in the two treatment arms were reported to sleep under an LLIN during the intervention period (93%). The incidence of malaria, defined as fever or history of fever with parasitaemia ≥ 5,000/µl, was 2.88 (95% confidence interval [CI] 2.70-3.06) per child during the intervention period in the control arm versus 0.87 (95% CI 0.78-0.97) in the intervention arm, a protective efficacy (PE) of 70% (95% CI 66%-74%) (p<0.001). There was a 69% (95% CI 6%-90%) reduction in incidence of severe malaria (p = 0.04) and a 46% (95% CI 7%-69%) (p = 0.03) reduction in the incidence of all-cause hospital admissions. IPTc reduced the prevalence of malaria infection at the end of the malaria transmission season by 73% (95% CI 68%-77%) (p<0.001) and that of moderately severe anaemia by 56% (95% CI 36%-70%) (p<0.001). IPTc reduced the risks of wasting (risk ratio [RR] = 0.79; 95% CI 0.65-1.00) (p = 0.05) and of being underweight (RR = 0.84; 95% CI 0.72-0.99) (p = 0.03). Children who received IPTc were 2.8 (95% CI 2.3-3.5) (p<0.001) times more likely to vomit than children who received placebo but no drug-related serious adverse event was recorded. CONCLUSIONS: IPT of malaria provides substantial protection against malaria in children who sleep under an ITN. There is now strong evidence to support the integration of IPTc into malaria control strategies in areas of seasonal malaria transmission. TRIAL REGISTRATION: ClinicalTrials.govNCT00738946. Please see later in the article for the Editors' Summary

Effets de rations à base de déchets de mangue sur les performances pondérales et la qualité de la carcasse de porcs Korhogo en croissance au Burkina Faso

Objectif : L’objet de l’étude a été d’évaluer les effets de l’utilisation de rations à base de provendes de mangue sur les performances de croissance et la qualité de la carcasse de porcs en croissance (25-60kg).Méthodologie et résultats : Deux régimes mangue (R1 et R2) et un témoin (R3) ont été servis à 3 lots de 8 porcs chacun. A la fin de l’essai 2 porcs /lot ont été abattus pour apprécier la qualité des carcasses. Le GMQ de R3 (459±62g) a été significativement supérieur à ceux de R1 (399±81g) et R2 (412±81g) (P&lt;0,05). L’IC de R3 (1,9±0.4) a été significativement supérieur à ceux IC de R1 (2,5±05) et R2 (0,6±06) (P&lt;0,05). Les rendements carcasses de R1 (83,4%) et R2 (77,6%) ont été plus élevés à celui de R3 (76%). Le taux de gras de R3 (32,8%) a été plus élevé que ceux de R1 (30,7%) et R2 (31,7%).Conclusion et application : L’étude a montré l’utilisation possible des provendes de mangue en substitution au maïs. Ceci ouvre des perspectives d’accroissement de la disponibilité d’aliments pour les porcs moins compétitifs entre l’homme et les animaux. Les rations qui les incorporent sont propices à la production de viande maigre très prisée par les consommateurs. Des provendes et des formules les incorporant pourront être proposées pour l’alimentation des porcs, l’amélioration de la productivité des élevages, de la qualité des carcasses et du revenu des éleveurs. Des études complémentaires sur la digestibilité des provendes et de meilleures formules seront nécessaires pour affiner les recommandations d’utilisation aux éleveurs.Mots clés : Rations de mangue, Porcs en croissance, Performances pondérales, Qualité des Carcasses, Burkina Faso Objective: The purpose of the study was to evaluate the effects of the use of mango feed rations on growth performance and carcass quality of growing pigs (25-60kg).Methodology and results: Two mango diets (R1 and R2) and a control (R3) were served to 3 batches of 8 pigs each. At the end of the trial 2 pigs / lot were  slaughtered to assess the quality of the carcasses. The Daily Weight Gain (DWG) of R3 (459±62g) was significantly higher than those of R1 were (399±81g) and R2 (412±81g) (p&lt;0.05). The R3 CI (1.9±0.4) was significantly &lt; at R1 (2.5±0.5) and R2 (2.6± 06) (p&lt;0.05).Carcass yields of R1 (83.4%) and R2 (77.6%) were higher than that of R3 (76%). The fat content of R3 (32.8%) was higher than those of R1 were (30%) and R2 (31.7%).Conclusion and application: The study showed the possible use of mango feed to substitute maize. This opens up prospects for increasing the availability of food and thus less competition between humans and animals. It has also shown the tendency of mango diets to produce lean meat; which is very popular to consumers. Feed and food formulas incorporating mango waste may be proposed for the feeding of pigs hence improving the productivity of livestock, the quality of carcasses and the income of farmers. Further studies on a digestibility of feed and the better diets will be needed to refine the recommendations of use to breeders.Keywords: Mango diets, growing pigs, weight performance, carcass quality, Burkina Fas

Morbidity from malaria in children in the year after they had received intermittent preventive treatment of malaria: a randomised trial.

BACKGROUND: Interventions that reduce exposure to malaria infection may lead to delayed malaria morbidity and mortality. We investigated whether intermittent preventive treatment of malaria in children (IPTc) was associated with an increase in the incidence of malaria after cessation of the intervention. METHODS: An individually randomised, trial of IPTc, comparing three courses of sulphadoxine pyrimethamine (SP) plus amodiaquine (AQ) with placebos was implemented in children aged 3-59 months during the 2008 malaria transmission season in Burkina Faso. All children in the trial were given a long lasting insecticide treated net; 1509 children received SP+AQ and 1505 received placebos. Passive surveillance for malaria was maintained until the end of the subsequent malaria transmission season in 2009, and active surveillance for malaria infection, anaemia and malnutrition was conducted. RESULTS: On thousand, four hundred and sixteen children (93.8%) and 1399 children (93.0%) initially enrolled in the intervention and control arms of the trial respectively were followed during the 2009 malaria transmission season. During the period July 2009 to November 2009, incidence rates of clinical malaria were 3.84 (95%CI; 3.67-4.02) and 3.45 (95%CI; 3.29-3.62) episodes per child during the follow up period in children who had previously received IPT or placebos, indicating a small increase in risk for children in the former intervention arm (IRR = 1.12; 95%CI 1.04-1.20) (P = 0.003). Children who had received SP+AQ had a lower prevalence of malaria infection (adjusted PR: 0.88 95%CI: 0.79-0.98) (P = 0.04) but they had a higher parasite density (P = 0.001) if they were infected. There was no evidence that the risks of moderately severe anaemia (Hb<8 g/dL), wasting, stunting, or of being underweight in children differed between treatment arms. CONCLUSION: IPT with SP+AQ was associated with a small increase in the incidence of clinical malaria in the subsequent malaria transmission season. TRIAL REGISTRATION: ClinicalTrials.gov NCT00738946

Malaria Incidence in Children in South-West Burkina Faso: Comparison of Active and Passive Case Detection Methods

<div><p>Background</p><p>The aim of this study was to determine the incidence and seasonal pattern of malaria in children in South-West Burkina Faso, and to compare, in a randomized trial, characteristics of cases detected by active and passive surveillance. This study also enabled the planning of a malaria vaccine trial.</p><p>Methods</p><p>Households with young children, located within 5 kilometers of a health facility, were randomized to one of two malaria surveillance methods. In the first group, children were monitored actively. Each child was visited twice weekly; tympanic temperature was measured, and if the child had a fever or history of fever, a malaria rapid diagnostic test was performed and a blood smear collected. In the second group, children were monitored passively. The child’s parent or caregiver was asked to bring the child to the nearest clinic if he was unwell. Follow up lasted 13 months from September 2009.</p><p>Results</p><p>Incidence of malaria (Fever with parasitaemia ≥5,000/µL) was 1.18 episodes/child/year in the active cohort and 0.89 in the passive cohort (rate ratio 1.32, 95% CI 1.13–1.54). Malaria cases in the passive cohort were more likely to have high grade fever; but parasite densities were similar in the two groups. Incidence was highly seasonal; when a specific case definition was used, about 60% of cases occurred within the 4 months June-September.</p><p>Conclusion</p><p>Passive case detection required at least a 30%–40% increase in the sample size for vaccine trials, compared to active detection, to achieve the same power. However we did not find any evidence that parasite densities were higher with passive than with active detection. The incidence of malaria is highly seasonal and meets the WHO criteria for Seasonal Malaria Chemoprevention (SMC). At least half of the malaria cases in these children could potentially be prevented if SMC was effectively deployed.</p></div

Number and proportion of the annual^* malaria cases falling in the four months June to September 2010.

*<p>The year studied was from 1^st October 2009 to 30^th September 2010.</p

Correction: Safety and Immunogenicity of the Malaria Vaccine Candidate MSP3 Long Synthetic Peptide in 12–24 Months-Old Burkinabe Children

BACKGROUND:A Phase Ia trial in European volunteers of the candidate vaccine merozoite surface protein 3 (MSP3), a Plasmodium falciparum blood stage membrane, showed that it induces biologically active antibodies able to achieve parasite killing in vitro, while a phase Ib trial in semi-immune adult volunteers in Burkina Faso confirmed that the vaccine was safe. The aim of this study was to assess the safety and immunogenicity of this vaccine candidate in children aged 12-24 months living in malaria endemic area of Burkina Faso. METHODS:The study was a double-blind, randomized, controlled, dose escalation phase Ib trial, designed to assess the safety, reactogenicity and immunogenicity of three doses of either 15 or 30 microg of MSP3-LSP adsorbed on aluminum hydroxide in 45 children 12 to 24 months of age randomized into three equal groups. Each group received 3 vaccine doses (on days 0, 28 and 56) of either 15 microg of MSP3-LSP, 30 microg of MSP3-LSP or of the Engerix B hepatitis B vaccine. Children were visited at home daily for the 6 days following each vaccination to solicit symptoms which might be related to vaccination. Serious adverse events occurring during the study period (1 year) were recorded. Antibody responses to MSP3-LSP were measured on days 0, 28, 56 and 84. RESULTS:All 45 enrolled children received three MSP3 vaccine doses. No serious adverse events were reported. Most of the adverse events reported were mild to moderate in severity. The only reported local symptoms with grade 3 severity were swelling and induration, with an apparently dose related response. All grade 3 adverse events resolved without any sequelae. Both MSP3 doses regimens were able to elicit high levels of anti-MSP3 specific IgG1 and IgG3 antibodies in the volunteers with very little or no increase in IgG2, IgG4 and IgM classes: i.e. vaccination induced predominantly the isotypes involved in the monocyte-dependent mechanism of P. falciparum parasite-killing. CONCLUSION:Our results support the promise of MSP3-LSP as a malaria vaccine candidate, both in terms of tolerability and of immunogenicity. Further assessment of the efficacy of this vaccine is recommended. TRIAL REGISTRATION:ClinicalTrials.gov NCT00452088

Arithmetic mean parasite density among parasite positive malaria cases by calendar month.

<p>Arithmetic mean parasite density among parasite positive malaria cases by calendar month.</p

Study profile.

<p>Study profile.</p

Malaria case definition using objective fever (Temperature≥38.0): Sensitivity and specificity of alternatives parasite threshold.

<p>Malaria case definition using objective fever (Temperature≥38.0): Sensitivity and specificity of alternatives parasite threshold.</p