Varying efficacy of intermittent preventive treatment for malaria in infants in two similar trials: public health implications.

BACKGROUND\ud \ud Intermittent preventive treatment (IPTi) with sulphadoxine-pyrimethamine (SP) in infants resulted in different estimates of clinical malaria protection in two trials that used the same protocol in Ifakara, Tanzania, and Manhiça, Mozambique. Understanding the reasons for the discrepant results will help to elucidate the action mechanism of this intervention, which is essential for rational policy formulation.\ud \ud METHODS\ud \ud A comparative analysis of two IPTi trials that used the same study design, follow-up, intervention, procedures and assessment of outcomes, in Tanzania and Mozambique was undertaken. Children were randomised to receive either SP or placebo administered 3 times alongside routine vaccinations delivered through the Expanded Program on Immunisation (EPI). Characteristics of the two areas and efficacy on clinical malaria after each dose were compared.\ud \ud RESULTS\ud \ud The most relevant difference was in ITN's use ; 68% in Ifakara and zero in Manhiça. In Ifakara, IPTi was associated with a 53% (95% CI 14.0; 74.1) reduction in the risk of clinical malaria between the second and the third dose; during the same period there was no significant effect in Manhiça. Similarly, protection against malaria episodes was maintained in Ifakara during 6 months after dose 3, but no effect of IPTi was observed in Manhiça.\ud \ud CONCLUSION\ud \ud The high ITN coverage in Ifakara is the most likely explanation for the difference in IPTi efficacy on clinical malaria. Combination of IPTi and ITNs may be the most cost-effective tool for malaria control currently available, and needs to be explored in current and future studies.\ud \ud TRIAL REGISTRATION\ud \ud Manhiça study registration number: NCT00209795Ifakara study registration number: NCT88523834

Overcoming health systems barriers to successful malaria treatment.

The success of malaria control programmes is recognised to be handicapped by the capacity of the health system to deliver interventions such as first-line treatment at optimal coverage and quality. Traditional approaches to strengthening the health system such as staff training have had a less sustained impact than hoped. However, novel strategies including the use of mobile phones to ease stockouts, task-shifting to community health workers, and inclusion of the informal sector appear more promising. As global health funding slows, it is critical to better understand how to deliver a proven intervention most effectively through the existing system

The silent burden of anaemia in Tanzania children:a community-based study

Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud \ud Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud \ud Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud \ud Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria

Clean Home-Delivery in Rural Southern Tanzania: Barriers, Influencers, and Facilitators

The study explored the childbirth-related hygiene and newborn care practices in home-deliveries in Southern\ud Tanzania and barriers to and facilitators of behaviour change. Eleven home-birth narratives and six focus group discussions were conducted with recently-delivering women; two focus group discussions were conducted with birth attendants. The use of clean cloth for delivery was reported as common in the birth narratives; however, respondents did not link its use to newborn’s health. Handwashing and wearing of gloves by birth attendants varied and were not discussed in terms of being important for newborn’s health, with few women giving reasons for this behaviour. The lack of handwashing and wearing of gloves was most commonly linked to the lack of water, gloves, and awareness. A common practice was the insertion\ud of any family member’s hands into the vagina of delivering woman to check labour progress before calling the birth attendant. The use of a new razor blade to cut the cord was near-universal; however, the cord was usually tied with a used thread due to the lack of knowledge and the low availability of clean thread. Applying something to the cord was near-universal and was considered essential for newborn’s health. Three hygiene practices were identified as needing improvement: family members inserting a hand into\ud the vagina of delivering woman before calling the birth attendant, the use of unclean thread, and putting\ud substances on the cord. Little is known about families conducting internal checks of women in labour, and more research is needed before this behaviour is targeted in interventions. The use of clean thread as cord-tie appears acceptable and can be addressed, using the same channels and methods that were used for successfully encouraging the use of new razor blade

Inter-observer variation in the assessment of clinical signs in sick Tanzanian children

We assessed the inter-observer agreement in identification of a range of 24 clinical signs associated with disease presentation in 327 children aged 0·41) although there was only fair agreement (Kappa-score 0·21-0·40) in the detection of neck stiffness and chest indrawing and slight agreement in the detection of dehydration (Kappa-score 0·199). All objective neurological signs were less reliably assessed in infants than in older children. The difficulties surrounding the diagnosis of impaired consciousness in young children should increase vigilance in the diagnosis and management of neurological complications of illnesses in infanc

Field evaluation of the "Bait-lamina test" to determine the soil microfauna feeding activity

Non-Peer ReviewedThe soil microfauna regulate nutrient cycling through predation on soil microorganisms but also through comminution of organic residues in soils. The feeding activity of the soil microfauna has a large impact on nutrient cycling and soil function, but is rarely considered because it is difficult to assess. The Baitlamina test was proposed as a practical mean to assess microfauna feeding activity. The test consists of vertically inserting 16-hole-bearing plastic sticks stuffed with a plant material preparation into the soil. We tested if the plant material used to prepare the bait would be differentially utilized by microfaunal population present under different plant species or mixtures of plants. We evaluated the Bait-lamina test in a 5-year old field experiment with five levels of plant communities (monocultures of Russian wild rye, switchgrass, green needlegrass, or western wheatgrass, and a grass mixture) distributed in four complete blocks, using six levels of bait flavour (Russian wild rye, switchgrass, green needlegrass, western wheatgrass, alfalfa, and wheat bran). Bait-lamina strips were equally spaced at five locations between plant rows. We found that the bait flavour had no significant (P = 0.22) effect on feeding, although the concentration of crude protein in the plant material used in the baits varied (P = 0.006) from 2.9% in switchgrass to 5.9% in Russian wild rye. We found low feeding activity in our field plots over the period of the test ( 13 June to 17 August 2005), with only 2.7% of the lamina (hole stuffing) showing signs of feeding. The data nevertheless revealed that microfauna feeding was more important close to the soil surface (0.5 mm deep), and in Russian wild rye plot mid-rows as compared to green needlegrass or switchgrass plots. Closer to plant rows, however, differences were not significant. We conclude that bait prepared with any plant material used in this study can be used to compare microfauna feeding in different plant stands. We recommend the use of a large number of replicated strips in agricultural field experiments where the microfauna may be scarce

Plant community composition in pastures seeded with native plant species in southwest Saskatchewan

Non-Peer ReviewedPastures made of native species offer good quality forage for grazing in the warm and dry months of July and August in southwestern Saskatchewan, when cool season species loose feeding quality. Long-term research plots were seeded with seven native grass species, with or without either purple prairie clover or alfalfa to further increase forage quality and sustain high productivity. These stands were compared to meadow brome – alfalfa stands. Triple superphosphate was applied at a rate of 0, 50 or 200 kg P2O5 ha-1 in an attempt to enhance root growth and facilitate establishment. Phosphorus fertilization had no effect on root length density, plant biomass, or plant proportions. Very little growth was produced in 2006, the year of seeding. But stands grew rapidly in 2007 and in the first week of July, pastures with native grasses produced 1.5 t ha-1, i.e. approximately half the biomass of meadow brome – alfalfa stands. The late season species, blue grama, little bluestem and purple prairie clover, were just starting their growth cycle in 2007 at that time and larger herbage yield in native stands is expected in 2008. Purple prairie clover made up less than 1% of the biomass of stands where it was seeded and alfalfa, about 14%. Weeds, which were abundant in 2006, were effectively suppressed by the forage plants in 2007, particularly in meadow brome – alfalfa stands. We conclude that stands seeded with native species require a longer period of establishment than meadow brome stands. This establishment period could not be enhanced by P fertilization

Succession in AMF communities from early to late season in grassland national park

Non-Peer ReviewedChange of AMF (arbuscular mycorrhizal fungi) community between two seasons in Grassland National Park had been studied in this article. We used FAMEs analysis and PCR-DGGE analysis tested soil samples collected from 3 different ecosystems at two sampling seasons. Based on our study, we found that AMF activity was significantly higher in early (wet) than late (dry) seasons, and in early season, the amount of AMF also showed significant positive linear relationship with amount of P and N in plant tissue. During late season we didn’t find significant result among these variables, which may suggest that seasonal changes could change the activity of AMF and affect relationship between AMF and their host plant nutrient metabolism. Also, AMF species composition differed in early and late season. Most AMF taxa found in the dry season in our study were unknown to the scientific community. This suggests that AMF biodiversity had difference between seasons and these uncommon AMF taxa are adapted to dry conditions. Besides, crested wheatgrass, the dominant species in the park, although didn’t show significantly directly relationship with AMF activity, it may improve soil organic carbon, soil soluble P, and increase the amount of soil bacteria, which are also three important factors that could further affect AMF activity. However, the absence of activity of crested wheatgrass combined with the low biodiversity in the stand and low association with AMF in the dry season, suggests that a prolonged drought period detrimental to crested wheatgrass would leave a prairie of crested wheatgrass vulnerable and depleted

An Estimation of the Entomological Inoculation Rate for Ifakara: A Semi-Urban Area in a Region of Intense Malaria Transmission in Tanzania.

An entomological study on vectors of malaria and their relative contribution to Plasmodium falciparum transmission in the semi-urban area of Ifakara, south-eastern Tanzania, was conducted. A total of 32 houses were randomly sampled from the area and light trap catches (LTC) performed in one room in each house every 2 weeks for 1 year. A total of 147 448 mosquitoes were caught from 789 LTC; 26 134 Anopheles gambiae s.l., 615 A. funestus, 718 other anophelines and 119 981 culicines. More than 60% of the total A. gambiae s.l. were found in five (0.6%) LTCs, with a maximum of 5889 caught in a single trap. Of 505 A. gambiae s.l. speciated by polymerase chain reaction, 91.5% were found to be A. arabiensis. Plasmodium falciparum sporozoite enzyme-linked immunosorbent assay tests were performed on 10 108 anopheles mosquitoes and 39 (0.38%) were positive. Entomological inoculation rate (EIR) estimates were generated using a standard method and an alternative method that allows the calculation of confidence intervals based on a negative binomial distribution of sporozoite positive mosquitoes. Overall EIR estimates were similar; 31 vs. 29 [95% confidence interval (CI): 19, 44] infectious bites per annum, respectively. The EIR ranged from 4 (95% CI: 1, 17) in the cool season to 108 (95% CI: 69, 170) in the wet season and from 54 (95% CI: 30, 97) in the east of the town to 15 (95% CI: 8, 30) in the town centre. These estimates show large variations over short distances in time and space. They are all markedly lower than those reported from nearby rural areas and for other parts of Tanzania