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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]

Abstract: Objective: To investigate resistance and safety of HHPG–19K in treating non–small cell lung cancer patients. Methods: A total of 30 cases were selected and randomly divided into 5 groups: three HHPG–19K groups of different dosage (60 μg/kg/day, 100 μg/kg/day, 200 μg/kg/day), positive control group (Filgrastim, namely G–CSF5 μg/kg/day) and negative control group. Safety indexes of 5 groups were observed and compared. Results: All patients had adverse event (100%) in three HHPG–19K groups, and increased ALP, ALT and AST were main events. The degree was mild to moderate. There was no significant difference in the incidence of adverse event between dosage groups and positive control group no difference. But the incidence of negative control group was 13%, which was significantly lower than dosage groups and positive control group. Conclusions: non–small cell lung cancer patients have satisfactory tolerance to HHPG–19K, and have no resistance. Besides, dosage at 100 μ g/kg is the most safe. [Copyright &y& Elsevier]

Abstract: Objective: To assess the prevalence of malaria parasitemia in north–east Nigeria and to evaluate the measures for the prevention of malaria. Methods: A village in north–eastern Nigeria was selected for the cross sectional study at the height of the rainy season in October 2011. A total of 550 inhabitants of a hamlet were recruited for this study. After obtaining the consent individuals received a structured interview and were tested for malaria parasites in their blood films. Recruits testing positive for malaria were given a course of artemesinin–based combination therapy (ACT). Results: A total of 497 inhabitants representing approximately 90 percent of the population participated: a quarter of the study group carried malaria parasitesexclusively Plasmodium falciparum (P. falciparum)–representing a P. falciparum parasite rate (PfPR) of 24.5%. Besides, 53/138 in the age group of 2 to < 10 years old children tested positive for P. falciparum representing a PfPR2–10 value of 38.4%. Malaria control measures were used in just under a third (157/497) of this cohort. Despite these measures 28/157 (17.8%) still tested positive for P. falciparum. Conclusions: The malaria burden is overestimated for this region in north–east Nigeria. The findings support an intermediate pattern of malaria endemicity. The 30% bed nets coverage for malaria control is well below the WHO estimates for 2011. [Copyright &y& Elsevier]

Abstract: APOBEC3B, a gene involved in innate response, exhibits insertion–deletion polymorphism across world populations. We observed the insertion allele to be nearly fixed in malaria endemic regions of sub-Saharan Africa as well as populations with high malaria incidence in the past. This prompted us to investigate the possible association of the polymorphism with falciparum malaria. We studied the distribution of APOBEC3B, in 25 diverse Indian populations comprising of 500 samples and 176 severe or non-severe Plasmodium falciparum patients and 174 ethnically-matched uninfected individuals from a P. falciparum endemic and a non-endemic region of India. The deletion frequencies ranged from 0% to 43% in the Indian populations. The frequency of the insertion allele strikingly correlated with the endemicity map of P. falciparum malaria in India. A strong association of the deletion allele with susceptibility to falciparum malaria in the endemic region (non-severe vs. control, Odds ratio=4.96, P value=9.5E−06; severe vs. control, OR=4.36, P value=5.76E−05) was observed. Although the frequency of deletion allele was higher in the non-endemic region, there was a significant association of the homozygous deletion genotype with malaria (OR=3.17, 95% CI=1.10–10.32, P value=0.0177). Our study also presents a case for malaria as a positive selection force for the APOBEC3B insertion and suggests a major role for this gene in innate immunity against malaria. [Copyright &y& Elsevier]

The sickle cell (HbS) gene occurs at a variable frequency in the Middle Eastern Arab countries, with characteristic distribution patterns and representing an overall picture of blood genetic disorders in the region. The origin of the gene has been debated, but studies using β-globin gene haplotypes have ascertained that there were multiple origins for HbS. In some regions the HbS gene is common and exhibits polymorphism, while the reverse is true in others. A common causative factor for the high prevalence and maintenance of HbS and thalassaemia genes is malaria endemicity. The HbS gene also co-exists with other haemoglobin variants and thalassaemia genes and the resulting clinical state is referred to as sickle cell disease (SCD). In the Middle Eastern Arab countries, the clinical picture of SCD expresses two distinct forms, the benign and the severe forms, which are related to two distinct β-globin gene haplotypes. These are referred to as the Saudi-Indian and the Benin haplotypes, respectively. In a majority of the Middle Eastern Arab countries the HbS is linked to the Saudi-Indian haplotype, while in others it is linked to the Benin haplotype. This review outlines the frequency, distribution, clinical feature, management and prevention as well as gene interactions of the HbS genes with other haemoglobin disorders in the Middle Eastern Arab countries. [ABSTRACT FROM AUTHOR]

Hemoglobin profile studies have been carried out in four samples from different districts of Porto Velho (Rondônia State) in the western Amazonian region of Brazil: Candelária, Bate Estaca, Hemeron (at the State Blood Bank), and São Carlos. Samples from 337 unrelated individuals were collected during medical and paramedical team visits by professionals from the Instituto de Pesquisa em Patologia Tropical and the Centro de Pesquisa em Patologias Tropicais (both research institutes in tropical diseases). The aim of this study is to assess the frequency of alleles in the hemoglobin system, mainly alleles HB*A, *S, and *E. The overall phenotype frequencies were HB A,S = 0.025, HB A,E = 0.006, and HB A,A = 0.969. Samples from the blood bank subjects and samples from the homogeneous areas of São Carlos and Candelária plus Bate Estaca have a chi-square of heterogeneity of 6.383 (p = 0.041) and 8.406 (p = 0.015), respectively. The allele frequencies (HB*A = 0.984, HB*S = 0.012, and HB*E = 0.003) do not significantly differ from frequencies found in other Brazilian regions. [ABSTRACT FROM AUTHOR]