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Abstract In malaria-endemic areas of Sub-Saharan Africa, overlap of clinical symptoms between malarial and non-malarial febrile illnesses can lead to empiric use of antibiotics among children. Our study aimed to illustrate the potential impact of decreasing malaria prevalence from malaria control efforts on antibiotic use. We constructed a probabilistic decision tree model representing antibiotic prescription in febrile children

In malaria-endemic areas of Sub-Saharan Africa, overlap of clinical symptoms between malarial and non-malarial febrile illnesses can lead to empiric use of antibiotics among children. Our study aimed to illustrate the potential impact of decreasing malaria prevalence from malaria control efforts on antibiotic use. We constructed a probabilistic decision tree model representing antibiotic prescription in febrile children < 5 years. This model was used to predict change in absolute antibiotic use compared to baseline under levels of decreasing malaria prevalence. Model parameters were based on data from a hospital study in Ghana and validated via literature review. The baseline prevalence of malaria diagnoses was 52% among all hospitalized children. For our main results, we reported outcomes for a scenario representing a 50% decrease in malaria prevalence. Compared to baseline, absolute antibiotic prescription decreased from a baseline of 639 doses (95% CI 574–694) to 575 (95% CI 502–638). This reflected a 10% (95% CI 7%–13%) decrease in absolute antibiotic use. Our findings demonstrate that effective malaria control can reduce pediatric antibiotic use. However, until substantial progress is made in developing accurate diagnostics for non-malarial febrile illnesses, further reductions in antibiotic use will remain a challenge. [ABSTRACT FROM AUTHOR]

Malaria and typhoid fevers are twin diseases that plague many Sub-Saharan African and Asian countries at epidemic proportions with almost a third of all deaths occurring in Nigeria in the last decade. Diagnosis of malaria in Nigeria relies heavily on the simple and inexpensive microscopy and the Widal agglutination test is commonly used in resource-poor settings where cultures fail or unavailable for typhoid fever diagnosis. The study was conceived to determine the relevance of the Widal agglutination test in a malaria endemic region. Patients who had previously received artemisinin combination therapy (ACT) with unremitting febrile illness who gave consent were enlisted into the study. Blood samples were collected for blood films, examined microscopically for the presence of malaria parasites. Widal agglutination test was carried out on each separated serum with the rapid slide agglutination test and titre was determined for sera showing agglutination with tube dilution assay. Malaria parasites were present in 236/429(55.0%) of the blood samples of which 41.7% had parasitemia density of =5000/mL of blood. Parasitemia density higher than 5000/μL of blood accounted for 13.4%. Widal agglutination titres as high as 320 were recorded in patients with malaria parasites as wells as those without malaria parasitemia. Malaria is a major cause of febrile illness in the study population which can be carefully excluded with the inexpensive blood film microcopy to enable proper evaluation for typhoid fever to be undertaken. [ABSTRACT FROM AUTHOR]

This research examines the causal impact of institutional quality on economic development from a novel perspective. At the country level, we exploit variation in the natural malaria prevalence in 1900, just before vector-control methods were developed, to instrument for institutional quality using a two-stage least squares instrumental variables framework. Our instrument is a population-weighted average of malaria endemicity estimates for the year 1900 developed by the World Health Organization scientists in the 1960s. We argue that this measure of historical malaria offers more expansive geographic information about the disease environment, and our baseline IV estimates reveal that greater institutional quality causes greater contemporaneous economic growth. Next, we investigate the robustness of these baseline results to alternative explanations, including the role of geography and the role of early colonizers' experiences, as the causal link between the early disease environmental, institutional quality, and contemporary growth. As an additional test of the explanatory power of malaria endemicity in 1900 as an instrumental variable, we replace our instrument for settler mortality and replicate the core results from the seminal study on colonial origins of comparative development by Acemoglu et al. (2001). In summary, we propose that malaria endemicity estimated for 1900 holistically explains the legacy of early disease on institutional quality development and contemporary economic development, thus significantly contributing to the resolution of the geography versus institutions debate. [ABSTRACT FROM AUTHOR]

Purpose: Coronavirus disease 2019 (COVID-19) has become a serious public health problem worldwide. This study sought to examine the associations of daily average temperature (AT) and relative humidity (ARH) with the percent increase in COVID-19 cases. Methods: Daily confirmed cases and meteorological factors in 38 districts of India were collected between 1st April 2020 to 30th April 2020. Taking a 5-day time lag of average values of the variables and multiple days-samples, we ran multiple models and performed appropriate hypothesis tests to decide the single preferred model for each sample data. Suitable fixed effects (FE) and random effects (RE) models with cluster-robust standard errors were applied to quantify the district-specific associations of meteorological and other variables with COVID-19 cases. Results: All FE models revealed that every one-degree rise in AT led to a decrease in 3.909 points (on average) in percent increase in COVID-19 cases. All RE models showed that with one unit increase in the malaria annual parasite index, there was a significant increase in 10.835 points (on average) in percent increase in COVID-19 cases. In both FE and RE models, ARH was found to be negatively associated with a percent increase in COVID-19 cases, although in half of these models the association was statistically insignificant. Conclusion: Our results indicate that mean temperature, mean relative humidity, and malaria endemicity might have an essential role in the stability and transmissibility of the 2019 novel coronavirus. [ABSTRACT FROM AUTHOR]

Abstract Background Health workers' compliance with outpatient malaria case-management guidelines has been improving, specifically regarding the universal testing of suspected cases and the use of artemisinin-based combination therapy (ACT) only for positive results (i.e., ‘test and treat’). Whether the improvements in compliance with ‘test and treat’ guidelines are consistent across different malaria endemicity areas has not been examined. Methods Data from 11 national, cross-sectional, outpatient malaria case-management surveys undertaken in Kenya from 2010 to 2016 were analysed. Four primary indicators (i.e., ‘test and treat’) and eight secondary indicators of artemether-lumefantrine (AL) dosing, dispensing, and counselling were measured. Mixed logistic regression models were used to analyse the annual trends in compliance with the indicators across the different malaria endemicity areas (i.e., from highest to lowest risk being lake endemic, coast endemic, highland epidemic, semi-arid seasonal transmission, and low risk). Results Compliance with all four ‘test and treat’ indicators significantly increased in the area with the highest malaria risk (i.e., lake endemic) as follows: testing of febrile patients (OR = 1.71 annually; 95% CI = 1.51–1.93), AL treatment for test-positive patients (OR = 1.56; 95% CI = 1.26–1.92), no anti-malarial for test-negative patients (OR = 2.04; 95% CI = 1.65–2.54), and composite ‘test and treat’ compliance (OR = 1.80; 95% CI = 1.61–2.01). In the low risk areas, only compliance with test-negative results significantly increased (OR = 2.27; 95% CI = 1.61–3.19) while testing of febrile patients showed declining trends (OR = 0.89; 95% CI = 0.79–1.01). Administration of the first AL dose at the facility significantly increased in the areas of lake endemic (OR = 2.33; 95% CI = 1.76–3.10), coast endemic (OR = 5.02; 95% CI = 2.77–9.09) and semi-arid seasonal transmission (OR = 1.44; 95% CI = 1.02–2.04). In areas of the lowest risk of transmission and highland epidemic zone, none of the AL dosing, dispensing, and counselling tasks significantly changed over time. Conclusions There is variability in health workers' compliance with outpatient malaria case-management guidelines across different malaria-risk areas in Kenya. Major improvements in areas of the highest risk have not been seen in low-risk areas. Interventions to improve practices should be targeted geographically.

The COVID-19 pandemic is creating a panic all over the world. By this time it has reached almost all countries causing variable morbidity and mortality in different countries. The mapping of COVID-19 pandemic shows a great difference in the spread of virus, morbidity and mortality. Several studies have shown that in middle high and high-income countries, its spread is very rapid and very high, and is associated with higher rates of morbidity and mortality. However, in developing countries and in most of the lower income countries, the spread of infection is comparatively very slow and is associated with comparatively lower morbidity and mortality. BCG vaccination policy, presence of more natural killer (NK) cells, killer immunoglobulin receptor (KIR) genes, repeated microbial infections, environmental factors, and malaria endemicity appear to be important contributing factors. Looking at these contributing factors, which are in favor of developing and lower income countries, the COVID-19 pandemic may not be very dreadful like affluent countries.

The COVID-19 pandemic is creating a panic all over the world. By this time it has reached almost all countries causing variable morbidity and mortality in different countries. The mapping of COVID-19 pandemic shows a great difference in the spread of virus, morbidity and mortality. Several studies have shown that in middle high and high-income countries, its spread is very rapid and very high, and is associated with higher rates of morbidity and mortality. However, in developing countries and in most of the lower income countries, the spread of infection is comparatively very slow and is associated with comparatively lower morbidity and mortality. BCG vaccination policy, presence of more natural killer (NK) cells, killer immunoglobulin receptor (KIR) genes, repeated microbial infections, environmental factors, and malaria endemicity appear to be important contributing factors. Looking at these contributing factors, which are in favor of developing and lower income countries, the COVID-19 pandemic may not be very dreadful like affluent countries.

Background: Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). Methods: This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. Results: A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. Conclusions: Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps, improving sustainable supply chain management of malaria drugs and diagnostics, and addressing regulatory challenges in the local contexts. [ABSTRACT FROM AUTHOR]