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The study aims to investigate the feasibility of integrating the RTS, S/AS02D malaria vaccine as part of the World Health Organization (WHO's) Extended Program on Immunization (EPI). The results indicate that the RTS, S/AS02D can be used as part of the EPI as it is quite effective in reducing the incidence of malaria.

Access to health care is a major health and development issue. Most governments declare that their citizens should enjoy universal and equitable access to good quality care. However, even within [...]

ABSTRACT Background Naturally acquired malaria immunity has many determinants and, in the absence of immunological markers of protection, studies assessing malaria incidence through clinical endpoints remain an approach to defining [...]

ABSTRACT Background Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria [...]

The HIV-1 p24 assay to dried blood spot (DBS) plasma antigen test was adapted to considerably reduce the known high background in DBS samples by introducing a peroxidase quenching step. It was found that DBS-p24 and plasma-p24 concentrations correlated well, independent of the ethnic background of the subjects or the HIV-1 subtype.

Background We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%. Methods and Findings In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1,95% confidence interval [CI] 0.9-1.2, p = 0.339). Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7,008, OR 1.4, C11.3-1.6, p < 0.001), feeding only breast milk for the first 3 d (90% of 7,557 versus 79% of 7,307, OR 2.2, 95% C11.8-2.7, p < 0.001), and clean hands for home delivery (92% of 1,351 versus 88% of 1,799, OR 1.5, 95% CI 1.0-2.3, p = 0.033). Facility delivery improved dramatically in both groups from 41% of 22,243 in 2007 and was 82% of 7,820 versus 75% of 7,553 (OR 1.5, 95% C11.2-2.0, p = 0.002) in intervention and comparison wards in 2013. Methodological limitations include our inability to rule out some degree of leakage of the intervention into the comparison areas and response bias for newborn care behaviours. Conclusion Neonatal mortality remained high despite better care practices and childbirth in facilities becoming common. Public health action to improve neonatal survival in this setting should include a focus on improving the quality of facility-based childbirth care. Trial Registration ClinicalTrials.gov NCT01022788, Introduction Every year, 3 million babies around the world die during their first 28 d of life. Despite major improvements in child survival in the past decade, neonatal mortality has [...]

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five., In this Viewpoint, Blaise Genton and colleagues argue in favor of abandoning presumptive treatment for under-fives. Mike English and colleagues present the opposing Viewpoint in a related article: English M, [...]

Urinary schistosomiasis results from the penetration of the skin by the larval cercaria of the blood fluke Schistosoma hematobium (Sh). The cercariae (that is, organisms at the free-swimming stage) migrate through the lungs to the liver, where they develop into mature adult parasites. The adults migrate to the vesicle veins and copulate, and the females deposit their eggs in the bladder wall and ureters. The eggs traverse the bladder wall, and are passed out into the urine. The disease is endemic in most of the African states, and in the Mediterranean regions of Europe. Uniform control efforts are in place in only 11 of the 43 African states. It is essential to specifically identify foci of infection in order to establish appropriate control programs. Disease control efforts can be effective only if resources are directed at the detection, treatment and protection of patients in high-risk areas rather than at random treatment of persons at low risk. The operational and diagnostic evaluation of a screening program involving questionnaires followed by dip-stick detection of hematuria is described. A questionnaire was administered over a four-week period to 15,073 primary school children in 168 schools in the Kilosa district of Tanzania. Responses were obtained from 164 schools, indicating 49 schools positive for Sh and the remainder negative. Eighty students in each of the 49 positive schools and 26 randomly selected negative schools were further tested for micro- and macrohematuria (blood in the urine) by the head teachers of the schools using urine dip-stick detection methods. The positive findings were validated, and verified cases were administered medication immediately. The findings were used to prepare an epidemiological map of Sh in the district, and formed the basis for treatment programs. This procedure utilized the existing school facilities and staffs to screen more than 15,000 students in a four-month interval, at minimal cost and reliably enough to form the basis of further control efforts. (Consumer Summary produced by Reliance Medical Information, Inc.), Introduction Schistosoma haematobium is endemic in 43 of the 52 African states in the African, European, and Eastern Mediterranean Regions of WHO [1]. Only 11 of these countries have so [...]

Prerequisites for effective interventions against severe anaemia and malaria among infants are economic evaluations to aid the setting of priorities and the making of health policy. In the present study we analysed the cost and effectiveness of three control strategies hypothetically delivered through the Expanded Programme on Immunization (EPI). For the prevention of severe anaemia and from the perspective of the health provider, the cost-effectiveness ratios were, respectively, US$ 8, US$ 9, and US$ 21 per disability-adjusted life year (DALY) for malaria chemoprophylaxis with Deltaprim (a combination of 3.125 mg pyrimethamine and 25 mg dapsone) + iron, Deltaprim alone, or iron supplementation alone. For malaria prevention, Deltaprim + iron cost US$ 9.7 per DALY and Deltaprim alone cost US$ 10.2 per DALY. From a sociocultural perspective the cost-effectiveness ratios ranged from US$ 9 to US$ 26 for severe anaemia prevention and from US$ 11 to US$ 12 for the prevention of clinical malaria. These ratios were highly cost-effective, as defined by the World Bank&apos;s proposed threshold of less than US$ 25 per DALY for comparative assessments. Furthermore, all the preventive interventions were less costly than the current malaria and anaemia control strategies that rely on clinical case management. This economic analysis supports the inclusion of both malaria chemoprophylaxis and iron supplementation delivered through EPI as part of the control strategies for these major killers of infants in parts of sub-Saharan Africa. Keywords: anaemia; antimalarials; cost-benefit analysis; health care costs; iron-deficiency; malaria; United Republic of Tanzania., Voir page 105 le resume en francais. En la pagina 105 figura un resumen en espanol. Introduction Malaria is responsible for 4% of global deaths (1). Sub-Saharan Africa suffers most [...]