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1. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya

Author

Sayed, Shahin, Ngugi, Anthony K, Mahoney, Megan R, Kurji, Jaameeta, Talib, Zohray M, Macfarlane, Sarah B, Wynn, Theresa A, Saleh, Mansoor, Lakhani, Amyn, Nderitu, Esther, Agoi, Felix, Premji, Zul, Zujewski, Jo Anne, and Moloo, Zahir

Subjects
Health Services and Systems, Health Sciences, Rural Health, Cancer, Health Services, Clinical Research, Behavioral and Social Science, Breast Cancer, Good Health and Well Being, Adolescent, Adult, Breast Neoplasms, Cross-Sectional Studies, Family Characteristics, Female, Focus Groups, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Humans, Kenya, Male, Middle Aged, Patient Acceptance of Health Care, Role, Rural Population, Surveys and Questionnaires, Young Adult, Breast health care, Breast cancer, Knowledge, Attitudes, Barriers, Male heads of households, Public Health and Health Services, Public Health, Epidemiology, Health services and systems, Public health
Abstract

BackgroundData on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman's breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman's breast health seeking behavior.MethodsThis was a mixed method cross-sectional study, conducted between Sept 1st 2015 Sept 30th 2016. We administered surveys to women and male heads of households. Outcomes of interest were analysed in Stata ver 13 and tabulated against gender. We conducted six focus group discussions (FGDs) and 22 key informant interviews (KIIs) with opinion leaders and health care providers, respectively. Elements of the Rapid Assessment Process (RAP) were used to guide analysis of the FGDs and the KIIs.ResultsA total of 442 women and 237 male heads of households participated in the survey. Although more than 80% of respondents had heard of breast cancer, fewer than 10% of women and male heads of households had knowledge of 2 or more of its risk factors. More than 85% of both men and women perceived breast cancer as a very serious illness. Over 90% of respondents would visit a health facility for a breast lump. Variable recognition of signs of breast cancer, limited decision- autonomy for women, a preference for traditional healers, lack of trust in the health care system, inadequate access to services, limited early-detection services were the six themes that emerged from the FGDs and the KIIs. There were discrepancies between the qualitative and quantitative data for the perceived role of the male head of household as a barrier to seeking breast health care.ConclusionsDetermining level of breast cancer knowledge, the characteristics of breast health seeking behavior and the perceived barriers to accessing breast health are the first steps in establishing locally relevant intervention programs.

Published
2019

4. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Author

Mansoor, Rashid, Commons, Robert J, Douglas, Nicholas M, Abuaku, Benjamin, Achan, Jane, Adam, Ishag, Adjei, George O, Adjuik, Martin, Alemayehu, Bereket H, Allan, Richard, Allen, Elizabeth N, Anvikar, Anupkumar R, Arinaitwe, Emmanuel, Ashley, Elizabeth A, Ashurst, Hazel, Asih, Puji BS, Bakyaita, Nathan, Barennes, Hubert, Barnes, Karen I, Basco, Leonardo, Bassat, Quique, Baudin, Elisabeth, Bell, David J, Bethell, Delia, Bjorkman, Anders, Boulton, Caroline, Bousema, Teun, Brasseur, Philippe, Bukirwa, Hasifa, Burrow, Rebekah, Carrara, Verena I, Cot, Michel, D'Alessandro, Umberto, Das, Debashish, Das, Sabyasachi, Davis, Timothy ME, Desai, Meghna, Djimde, Abdoulaye A, Dondorp, Arjen M, Dorsey, Grant, Drakeley, Chris J, Duparc, Stephan, Espie, Emmanuelle, Etard, Jean-Francois, Falade, Catherine, Faucher, Jean Francois, Filler, Scott, Fogg, Carole, Fukuda, Mark, Gaye, Oumar, Genton, Blaise, Rahim, Awab Ghulam, Gilayeneh, Julius, Gonzalez, Raquel, Grais, Rebecca F, Grandesso, Francesco, Greenwood, Brian, Grivoyannis, Anastasia, Hatz, Christoph, Hodel, Eva Maria, Humphreys, Georgina S, Hwang, Jimee, Ishengoma, Deus, Juma, Elizabeth, Kachur, S Patrick, Kager, Piet A, Kamugisha, Erasmus, Kamya, Moses R, Karema, Corine, Kayentao, Kassoum, Kazienga, Adama, Kiechel, Jean-Rene, Kofoed, Poul-Erik, Koram, Kwadwo, Kremsner, Peter G, Lalloo, David G, Laman, Moses, Lee, Sue J, Lell, Bertrand, Maiga, Amelia W, Martensson, Andreas, Mayxay, Mayfong, Mbacham, Wilfred, McGready, Rose, Menan, Herve, Menard, Didier, Mockenhaupt, Frank, Moore, Brioni R, Muller, Olaf, Nahum, Alain, Ndiaye, Jean-Louis, Newton, Paul N, Ngasala, Billy E, Nikiema, Frederic, Nji, Akindeh M, Noedl, Harald, Nosten, Francois, Ogutu, Bernhards R, Ojurongbe, Olusola, Osorio, Lyda, Ouedraogo, Jean-Bosco, Owusu-Agyei, Seth, Pareek, Anil, Penali, Louis K, Piola, Patrice, Plucinski, Mateusz, Premji, Zul, Ramharter, Michael, Richmond, Caitlin L, Rombo, Lars, Rosenthal, Philip J, Salman, Sam, Same-Ekobo, Albert, Sibley, Carol, Sirima, Sodiomon B, Smithuis, Frank M, Some, Fabrice A, Staedke, Sarah G, Starzengruber, Peter, Strub-Wourgaft, Nathalie, Sutanto, Inge, Swarthout, Todd D, Syafruddin, Din, Talisuna, Ambrose O, Taylor, Walter R, Temu, Emmanuel A, Thwing, Julie I, Tinto, Halidou, Tjitra, Emiliana, Toure, Offianan A, Tran, T Hien, Ursing, Johan, Valea, Innocent, Valentini, Giovanni, van Vugt, Michele, von Seidlein, Lorenz, Ward, Stephen A, Were, Vincent, White, Nicholas J, Woodrow, Charles J, Yavo, William, Yeka, Adoke, Zongo, Issaka, Simpson, Julie A, Guerin, Philippe J, Stepniewska, Kasia, Price, Ric N, Roper, Cally, Resistance, WorldWide Antimalarial, WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group, Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), Epidémiologie des Maladies Chroniques en zone tropicale (EpiMaCT), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-OmégaHealth (ΩHealth), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Group, WorldWide Antimalarial Resistance Network Falciparum Haematology Study, Mansoor, R, Ashley, EA, Ashurst, H, Burrow, R, Carrara, VI, Das, D, Dondorp, AM, Humphreys, GS, Lee, SJ, Mayxay, M, McGready, R, Newton, PN, Nosten, F, Richmond, CL, Sibley, C, Smithuis, FM, Taylor, WR, Tran, TH, von Seidlein, L, White, NJ, Woodrow, CJ, Guerin, PJ, Stepniewska, K, Price, RN, AII - Infectious diseases, Intensive Care Medicine, Infectious diseases, APH - Global Health, and APH - Quality of Care

Subjects
Infectious Medicine, Plasmodium falciparum, wh_120, Infektionsmedicin, Severe anaemia, Parasitemia, wa_530, Antimalarials, Non-artemisinin-based therapy, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, parasitic diseases, qv_256, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Malaria, Falciparum, Child, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Pooled analysis of individual patient data, Anemia, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Artemisinin-based therapy, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Malaria, wc_750, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Haemoglobin
Abstract

Background Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.

Published
2022

9. Averting a malaria disaster in Africa: where does the buck stop?

Author

Whitty Christopher J.M., Allan Richard, Wiseman Virginia, Ochola Sam, Nakyanzi-Mugisha Maria Veronicah, Vonhm Benjamin, Mwita Mahemba, Miaka Constantin, Oloo Aggrey, Premji Zul, Burgess Craig, and Mutabingwa Theonest K.

Subjects
Malaria, Falciparum/drug therapy, Antimalarials/economics, Drug therapy, Combination, Artemisinins/economics, Drug costs, Patient acceptance of health care, Financing, Organized, Africa, Public aspects of medicine, RA1-1270
Abstract

The serious threat posed by the spread of drug-resistant malaria in Africa has been widely acknowledged. Chloroquine resistance is now almost universal, and resistance to the successor drug, sulfadoxine-pyrimethamine (SP), is growing rapidly. Combination therapy has been suggested as being an available and potentially lasting solution to this impending crisis. However, the current cost of combination therapy, and especially that of artemisinin combination therapy (ACT), is potentially a serious drawback, even if a significant part of its cost is passed on to the end-user. If the question of cost is not successfully addressed this could lead to adverse results from the deployment of combination therapy as first-line treatment. These adverse effects range from an increase in potentially fatal delays in infected individuals presenting to medical services, to exclusion of the poorest malaria sufferers from receiving treatment altogether. Urgent steps are needed to reduce the cost of combination therapy to the end-user in a sustainable way if it is to be usable, and some possible approaches are discussed.

Published
2004

10. Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials

Author

Aponte, John J, Schellenberg, David, Egan, Andrea, Breckenridge, Alasdair, Carneiro, Ilona, Critchley, Julia, Danquah, Ina, Dodoo, Alexander, Kobbe, Robin, Lell, Bertrand, May, Jürgen, Premji, Zul, Sanz, Sergi, Sevene, Esperanza, Soulaymani-Becheikh, Rachida, Winstanley, Peter, Adjei, Samuel, Anemana, Sylvester, Chandramohan, Daniel, Issifou, Saadou, Mockenhaupt, Frank, Owusu-Agyei, Seth, Greenwood, Brian, Grobusch, Martin P, Kremsner, Peter G, Macete, Eusebio, Mshinda, Hassan, Newman, Robert D, Slutsker, Laurence, Tanner, Marcel, Alonso, Pedro, and Menendez, Clara

Published
2009
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11. Placental pathology associated with household air pollution in a cohort of pregnant women from Dar es Salaam, Tanzania

Author

Wylie, Blair J., Matechi, Emmanuel, Kishashu, Yahya, Fawzi, Wafaie, Premji, Zul, Coull, Brent A., Hauser, Russ, Ezzati, Majid, and Roberts, Drucilla J.

Subjects
Histochemistry -- Research, Pregnant women -- Health aspects -- Research, Air pollution -- Health aspects -- Research, Environmental issues, Health
Abstract

BACKGROUND: Smoke from the burning of biomass fuels has been linked with adverse pregnancy outcomes such as low birth weight, stillbirth, and prematurity. OBJECTIVE: To identify potential underlying mechanisms of adverse perinatal outcomes, we explored the association of placental pathology with household air pollution in pregnant women from urban/periurban Tanzania who cook predominantly with charcoal. METHODS: Between 2011 and 2013, we measured personal exposures to fine particulate matter ([PM.sub.2.5]) and carbon monoxide (CO) over 72 hr among a cohort of Tanzanian pregnant women. Placentas were collected after delivery for examination. Placental pathologies of inflammatory, hypoxic, ischemic/hypertensive, infectious and thrombotic etiologies were diagnosed, blinded to exposure levels. Using multiple logistic regression, we explored the association of [PM.sub.2.5] and CO exposure with placental pathology. RESULTS: One hundred sixteen women had personal air exposure measurements and placental histopathology available for analysis. [PM.sub.2.5] and CO exposures were moderate [geometric means (GSD) were 40.5 µg/[m.sup.3] (17.3) and 2.21 ppm (1.47) respectively]; 88.6% of [PM.sub.2.5] measurements exceeded World Health Organization air quality guidelines. We observed an increase in the odds (per 1-unit increase in exposure on the ln-scale) of fetal thrombotic vasculopathy (FTV) both with increasing [PM.sub.2.5] [adjusted odds ratio (aOR) = 5.5; 95% CI: 1.1, 26.8] and CO measurements (aOR = 2.5; 95% CI: 1.0, 6.4) in adjusted models only. FTV also was more common among pregnancies complicated by stillbirth or low birth weight. CONCLUSIONS: Fetal thrombosis may contribute to the adverse outcomes associated with household air pollution from cook stoves during pregnancy. Larger studies are necessary for confirmation. http://dx.doi.org/ 10.1289/EHP256., Introduction An estimated 40% of the world's population relies on solid biomass fuels (wood, charcoal, crop residues) for cooking or heating (Bonjour et al. 2013). The smoke generated from the [...]

Published
2017
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12. Plasma zinc concentrations are depressed during the acute phase response in children with falciparum malaria

Author

Duggan, Christopher, MacLeod, William B., Krebs, Nancy F., Westcott, Jamie L., Fawzi, Wafaie W., Premji, Zul G., Mwanakasale, Victor, Simon, Jonathon L., Yeboah-Antwi, Kojo, and Hamer, Davidson H.

Subjects
C-reactive protein -- Research, Trace elements in nutrition -- Research, Zinc in the body -- Research, Malaria -- Care and treatment, Food/cooking/nutrition
Abstract

Plasma concentrations of some micronutrients are altered in the setting of acute infectious or inflammatory stress. Previous studies have provided conflicting evidence concerning the extent and direction of changes in plasma zinc concentrations during the acute phase response. We carried out an observational cohort study in 689 children enrolled in a randomized trial of zinc supplementation during acute falciparum malaria in order to evaluate the relation between plasma zinc concentration and the acute phase response. Plasma zinc was measured by atomic absorption spectrophotometry. On admission, 70% of all subjects had low plasma zinc ( KEY WORDS: * malaria * zinc * Plasmodium falciparum * child * acute phase response * C-reactive protein

Published
2005

13. Determination of reference intervals for common chemistry and immunoassay tests for Kenyan adults based on an internationally harmonized protocol and up-to-date statistical methods

Author

Omuse, Geoffrey, primary, Ichihara, Kiyoshi, additional, Maina, Daniel, additional, Hoffman, Mariza, additional, Kagotho, Elizabeth, additional, Kanyua, Alice, additional, Mwangi, Jane, additional, Wambua, Caroline, additional, Amayo, Angela, additional, Ojwang, Peter, additional, Premji, Zul, additional, and Erasmus, Rajiv, additional

Published
2020
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14. A rapid triage test for active pulmonary tuberculosis in adult patients with persistent cough

Author

Ahmad, Rushdy, primary, Xie, Liangxia, additional, Pyle, Margaret, additional, Suarez, Marta F., additional, Broger, Tobias, additional, Steinberg, Dan, additional, Ame, Shaali M., additional, Lucero, Marilla G., additional, Szucs, Matthew J., additional, MacMullan, Melanie, additional, Berven, Frode S., additional, Dutta, Arup, additional, Sanvictores, Diozele M., additional, Tallo, Veronica L., additional, Bencher, Robert, additional, Eisinger, Dominic P., additional, Dhingra, Usha, additional, Deb, Saikat, additional, Ali, Said M., additional, Mehta, Saurabh, additional, Fawzi, Wafaie W., additional, Riley, Ian D., additional, Sazawal, Sunil, additional, Premji, Zul, additional, Black, Robert, additional, Murray, Christopher J. L., additional, Rodriguez, Bill, additional, Carr, Steven A., additional, Walt, David R., additional, and Gillette, Michael A., additional

Published
2019
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16. PS-003: EVIDENCE-INFORMED POLICY MAKING: CHALLENGES AND OPPORTUNITIES

Author

Makanga, Michael, Beattie, Pauline, Breugelmans, Gabrielle, Nyirenda, Thomas, Bockarie, Moses, Tanner, Marcel, Volmink, Jimmy, Hankins, Catherine, Walzl, Gerhard, Chegou, Novel, Malherbe, Stephanus, Hatherill, Mark, Scriba, Thomas J., Zak, Daniel E., Barry, Clifton E., Kaufmann, Stefan H.E., Noor, Abdisalan, Strub-Wourgaft, Nathalie, Phillips, Patrick, Munguambe, Khátia, Ravinetto, Raffaella, Tinto, Halidou, Diro, Ermias, Mahendrahata, Yodi, Okebe, Joseph, Rijal, Suman, Garcia, Coralith, Sundar, Shyam, Ndayisaba, Gilles, Sopheak, Thai, Ngoduc, Thang, Loen, Harry Van, Jacobs, Jan, D'Alessandro, Umberto, Boelaert, Marleen, Buvé, Anne, Kamalo, Patrick, Manda-Taylor, Lucinda, Rennie, Stuart, Mokgatla, Boitumelo, Bahati, Prince, Ijsselmuiden, Carel, Afolabi, Muhammed, Mcgrath, Nuala, Kampmann, Beate, Imoukhuede, Egeruan, Alexander, Neal, Larson, Heidi, Chandramohan, Daniel, Bojang, Kalifa, Kasaro, Margaret Phiri, Muluka, Brenda, Kaunda, Kaunda, Morse, Jill, Westfall, Andrew, Kapata, Nathan, Kruuner, Annika, Henostroza, German, Reid, Stewart, Alabi, Abraham, Foguim, Francis, Sankarganesh, Jeyaraj, Bruske, Ellen, Mfoumbi, Arnault, Mevyann, Chester, Adegnika, Ayola, Lell, Bertrand, Kranzer, Katharina, Kremsner, Peter, Grobusch, Martin, Sabiiti, Wilber, Ntinginya, Nyanda, Kuchaka, Davis, Azam, Khalide, Kampira, Elizabeth, Mtafya, Bariki, Bowness, Ruth, Bhatt, Nilesh, Davies, Gerry, Kibiki, Gibson, Gillespie, Stephen, Lejon, Veerle, Ilboudo, Hamidou, Mumba, Dieudonné, Camara, Mamady, Kaba, Dramane, Lumbala, Crispin, Fèvre, Eric, Jamonneau, Vincent, Bucheton, Bruno, Büscher, Philippe, Chisenga, Caroline, Sinkala, Edford, Chilengi, Roma, Chitundu, Hellen, Zyambo, Zude, Wandeler, Gilles, Vinikoor, Michael, Emilie, Dama, Camara, Oumou, Mathurin, Koffi, Guiguigbaza-Kossigan, Dayo, Philippe, Büscher, Regassa, Fikru, Hassane, Sakande, Bienvenu, Somda Martin, Fabrice, Courtin, Ouédraogo, Elie, Kouakou, Lingue, Owusu, Michael, Mensah, Eric, Enimil, Anthony, Mutocheluh, Mohamed, Ndongo, Francis Ateba, Tejiokem, Mathurin Cyrille, Texier, Gaetan, Penda, Calixte, Ndiang, Suzie, Ndongo, Jean-Audrey, Guemkam, Georgette, Sofeu, Casimir Ledoux, Afumbom, Kfutwa, Faye, Albert, Msellati, Philippe, Warszawski, Josiane, Vos, Alinda, Devillé, Walter, Barth, Roos, Klipstein-Grobusch, Kerstin, Tempelman, Hugo, Venter, François, Coutinho, Roel, Grobbee, Diederick, Ssemwanga, Deogratius, Lyagoba, Frederick, Magambo, Brian, Kapaata, Anne, Kirangwa, Joseph, Nannyonjo, Maria, Nassolo, Faridah, Nsubuga, Rebecca, Yebra, Gonzalo, Brown, Andrew, Kaleebu, Pontiano, Nylén, Hanna, Habtewold, Abiy, Makonnen, Eyasu, Yimer, Getnet, Burhenne, Jürgen, Diczfalusy, Ulf, Aklillu, Eleni, Steele, Duncan, Walker, Richard, Simuyandi, Michelo, Beres, Laura, Bosomprah, Samuel, Ansumana, Rashid, Taitt, C., Lamin, J.M., Jacobsen, K.H., Mulvaney, S.P., Leski, T., Bangura, U., Stenger, D., Vries, Sophie De, Zinsou, Frejus Jeannot, Honkpehedji, J, Dejon, Jean Claude, Loembe, Marguerite Massinga, Bache, Bache, Pakker, Nadine, Leeuwen, Remko Van, Hounkpatin, Aurore Bouyoukou, Yazdanbakhsh, Maria, Bethony, Jeffrey, Hotez, Peter, Diemert, David, Bache, Bache Emmanuel, Fernandes, José F., Mba, Régis M Obiang, Kabwende, Anita L., Grobusch, Martin P., Krishna, Sanjeev, Kremsner, Peter G., Todagbe, Agnandji Selidji, Nambozi, Michael, Kabuya, Jean-Bertin, Hachizovu, Sebastian, Mwakazanga, David, Kasongo, Webster, Buyze, Jozefien, Mulenga, Modest, Geertruyden, Jean-Pierre, Gitaka, Jesse, Chan, Chim, Kongere, James, Kagaya, Wataru, Kaneko, Akira, Kabore, Naomie, Barry, Nouhoun, Kabre, Zachari, Werme, Karidia, Fofana, Aminata, Compaore, Daniel, Nikiema, Frederic, Some, Fabrice, Djimde, Abdoulaye, Zongo, Issaka, Ouedraogo, Bosco, Kone, Aminatou, Sagara, Issaka, Björkman, Anders, Gil, Jose Pedro, Nchinda, Godwin, Bopda, Alain, Nji, Nadesh, Ambada, Georgia, Ngu, Loveline, Tchadji, Jules, Sake, Carol, Magagoum, Suzanne, Njambe, Ghislain D., Lisom, Abel, Park, Chae Gyu, Tait, Dereck, Sibusiso, Hlatjwako, Manda, Olga, Croucher, Kristin, Westhuizen, Anja Van Der, Mshanga, Isaac, Levin, Jonathan, Nanvubya, Annet, Kibengo, Freddie, Jaoko, Walter, Pala, Pietro, Perreau, Matthieu, Namuniina, Annemarie, Kitandwe, Paul, Tapia, Gonzalo, Serwanga, Jennifer, Yates, Nicole, Fast, Pat, Mayer, Bryan, Montefiori, David, Tomaras, Georgia, Robb, Merlin, Lee, Carter, Wagner, Ralf, Sanders, Edward, Kilembe, William, Kiwanuka, Noah, Gilmour, Jill, Kuipers, Hester, Vooij, Dani, Chinyenze, Kundai, Priddy, Frances, Ding, Song, Hanke, Tom, Pantaleo, Giuseppe, Ngasala, Billy, Jovel, Irina, Malmberg, Maja, Mmbando, Bruno, Premji, Zul, Mårtensson, Andreas, Mwaiswelo, Richard, Agbor, Lenshina, Apinjoh, Tobias, Mwanza, Sydney, Chileshe, Justin, Joshi, Sudhaunshu, Malunga, Phidelis, Manyando, Christine, Laufer, Miriam, Dara, Antoine, Niangaly, Amadou, Sinha, Indranil, Brodin, David, Fofana, Bakary, Dama, Souleymane, Dembele, Demba, Sidibe, Bakary, Diallo, Nouhoum, Thera, Mahamadou, Wright, Karin, Gil, Jose, Doumbo, Ogobara, Baraka, Vito, Nabasumba, Carolyn, Francis, Filbert, Lutumba, Pascal, Mavoko, Hypolite, Alifrangis, Michael, Geertruyden, Jean-Pierre Van, Sissoko, Sekou, Sangaré, Cheick, Toure, Sekou, Sanogo, Kassim, Diakite, Hamadoun, Toure, Siaka, Doumbia, Diagassan, Haidara, Kadiatou, Julé, Amélie, Ashurst, Hazel, Merson, Laura, Olliaro, Piero, Marsh, Vicki, Lang, Trudie, Guérin, Philippe, Awuondo, Kennedy, Njenga, Daniel, Nyakarungu, Elizabeth, Titus, Pauline, Sutamihardja, Awalludin, Lowe, Brett, Ogutu, Bernhards, Billingsley, Peter, Soulama, Issiaka, Kaboré, Moïse, Coulibaly, Aboubacar, Ouattara, Maurice, Sanon, Souleymane, Diarra, Amidou, Bougouma, Edith, Ouedraogo, Alphonse, Sombie, Benjamin, Ouedraogo, Amidou, Kargougou, Désiré, Ouattara, Daouda, Issa, Nebie, Tiono, Alfred, Sirima, Sodiomon, Chaponda, Mike, Dabira, Edgard, Dao, François, Dara, Nianwalou, Sidibe, Bouran, Coulibaly, Moctar, Tolo, Allaye, Maiga, Hamma, Ouologuem, Nouhoum, Niangaly, Hamidou, Botchway, Felix, Wilson, Nana, Dickinson-Copeland, Carmen M, Adjei, Andrew A., Wilson, Michael, Stiles, Jonathan K., Hamid, Muzamil Abdel, Awad-Elgeid, Mona, Nasr, Awad, Netongo, Palmer, Kamdem, Séverin, Velavan, Thirumalaisamy, Lasry, Estrella, Diarra, Modibo, Bamadio, Amadou, Traore, Aliou, Coumare, Samba, Soma, Bahonan, Dicko, Yeyia, Sangare, Boubou, Tembely, Aly, Traore, Djibril, Haidara, Aboubecrin, Dicko, Alassane, Diawara, Elisabeth, Beavogui, Abdoul, Camara, Daouda, Sylla, Malick, Yattara, Mohamed, Sow, Amadou, Camara, Gnèpou Camara, Diallo, Saliou, Mombo-Ngoma, Ghyslain, Remppis, Jonathan, Sievers, Moritz, Manego, Rella Zoleko, Endamne, Lilian, Hutchinson, David, Held, Jana, Supan, Christian, Salazar, Carmen L. Ospina, Bonkian, Léa Nadège, Nahum, Alain, Sié, Ali, Abdulla, Salim, Cantalloube, Cathy, Djeriou, Elhadj, Bouyou-Akotet, Marielle, Mordmüller, Benjamin, Siribie, Mohamadou, Sirima, Sodiomon B., Ouattara, San Maurice, Coulibaly, Sam, Kabore, Jean Moïse, Amidou, Diarra, Tekete, Mamadou, Burhenne, Juergen, Traore, Oumar, Haefeli, Walter, Borrmann, Steffen, Kaboré, Naomie, Kabré, Zachari, Nikèma, Fréderic, Compaoré, Daniel, Somé, Fabrice, Djimdé, Abdoulaye, Ouédraogo, Jean, Chalwe, Victor, Miller, John, Diakité, Hamadoun, Greco, Beatrice, Spangenberg, Thomas, Kourany-Lefoll, Elly, Oeuvray, Claude, Mulry, Jim, Tyagarajan, Kamala, Magsaam, Bettina, Barnes, Karen, Hodel, Eva Maria, Humphreys, Georgina, Pace, Cheryl, Banda, C.G, Denti, Paulo, Allen, Elizabeth, Lalloo, David, Mwapasa, Victor, Terlouw, Anja, Mwesigwa, Julia, Achan, Jane, Jawara, Musa, Ditanna, Gian, Worwui, Archibald, Affara, Muna, Koukouikila-Koussounda, Félix, Kombo, Michael, Vouvoungui, Christevy, Ntoumi, Francine, Etoka-Beka, Mandingha Kosso, Deibert, Julia, Poulain, Pierre, Kobawila, Simon, Gueye, Nerly Gampio, Koukouikila-Koussounda, Felix, Seda, Brian, Kwambai, Titus, Jangu, Phelix, Samuels, Aaron, ter Kuile, Feike, Kariuki, Simon, Barry, Aissata, Bousema, Teun, Okech, Brenda, Egwang, Thomas, Corran, Patrick, Riley, Eleanor, Ezennia, Ifeoma, Ekwunife, Obinna, Muleba, Mbanga, Stevenson, Jennifer, Mbata, Keith, Coetzee, Maureen, Norris, Douglas, Moneke-Anyanwoke, Ngozi, Momodou, Jasseh, Clarke, Ed, Scott, Susana, Tijani, Adelani, Djimde, Moussa, Vaillant, Michel, Samouda, Hanen, Mensah, Victorine, Roetynck, Sophie, Kanteh, Ebrima, Bowyer, Georgina, Ndaw, Amy, Oko, Francis, Bliss, Carly, Jagne, Ya Jankey, Cortese, Riccardo, Nicosia, Alfredo, Roberts, Rachel, D'Alessio, Flavia, Leroy, Odile, Faye, Babacar, Cisse, Badara, Gerry, Stephen, Viebig, Nicola, Lawrie, Alison, Ewer, Katie, Hill, Adrian, Nebie, Issa, Tiono, Alfred B, Sanou, Guillaume, Konate, Amadou T, Yaro, Baptiste J, Sodiomon, Sirima, Honkpehedji, Yabo, Agobe, Jean Claude Dejon, Zinsou, Frejus, Mengue, Juliana, Richie, Thomas, Hoffman, Stephen, Nouatin, Odilon, Ngoa, Ulysse Ateba, Edoa, Jean R, Homoet, Andreas, Engelhon, Julie Englhon, Massinga-Louembe, Marguerite, Esen, Meral, Theisen, Michael, Sim, Kim Lee, Luty, Adrian Jf, Moutairou, Kabirou, Dinko, Bismarck, King, Elizabeth, Targett, Geoffrey, Sutherland, Colin, Likhovole, Clement, Ouma, Collins, Vulule, John, Musau, Susan, Khayumbi, Jeremiah, Okumu, Albert, Murithi, Wilfred, Otu, Jacob, Gehre, Florian, Zingue, Dezemon, Kudzawu, Samuel, Forson, Audrey, Mane, Morto, Rabna, Paulo, Diarra, Bassirou, Kayede, Salako, Adebiyi, Emmanuel, Kehinde, Aderemi, Onyejepu, Nneka, Onubogu, Catherine, Idigbe, Emmanuel, Ba, Awa, Diallo, Aissatou, Mboup, Souleymane, Disse, Kodjo, Kadanga, Gerard, Dagnra, Yaotse, Baldeh, Ignatius, Corrah, Tumani, Jong, Bouke De, Antonio, Martin, Musanabaganwa, Clarisse, Musabyimana, Jean Pierre, Karita, Etienne, Diop, Blondin, Nambajimana, Abidan, Dushimiyimana, Valentine, Karame, Prosper, Russell, Jim, Ndoli, Jules, Hategekimana, Theobald, Sendegeya, Augustin, Condo, Jeannine, Binagwaho, Agnes, Okonko, Iheanyi, Okerentugba, Phillip, Opaleye, Oluyinka, Awujo, Ezinwanne, Frank-Peterside, Nnenna, Moyo, Sikhulile, Kotokwe, Kenanao, Mohammed, Terence, Boleo, Coretah, Mupfumi, Lucy, Chishala, Samuel, Gaseitsiwe, Simani, Tsalaile, Lesedi, Bussmann, Herman, Makhema, Joseph, Baum, Marianna, Marlink, Richard, Engelbretch, Susan, Essex, Max, Novitsky, Vladimir, Saka, Emmanuel, Kalipalire, Zex, Bhairavabhotla, Ravikiran, Midiani, Dalitso, Sherman, Judith, Mgode, Georgies, Cox, Christophe, Bwana, Dickens, Mtui, Leah, Magesa, Daniel, Kahwa, Amos, Mfinanga, Godfrey, Mulder, Christiaan, Borain, Nick, Petersen, Lizette, Plessis, Julianne Du, Theron, Grant, Holm-Hansen, Carol, Tekwu, Emmanuel Mouafo, Sidze, Larissa Kamgue, Assam, Jean Paul Assam, Eyangoh, Sarah, Niemann, Stefan, Beng, Veronique Penlap, Frank, Matthias, Atiadeve, Samuel, Hilmann, Doris, Awoniyi, Dolapo, Baumann, Ralf, Kriel, Belinda, Jacobs, Ruschca, Kidd, Martin, Loxton, Andre, Kaempfer, Susanne, Singh, Mahavir, Mwanza, Winnie, Milimo, Deborah, Moyo, Maureen, Kasese, Nkatya, Cheeba-Lengwe, Maina, Munkondya, Stembiso, Ayles, Helen, Haas, Petra De, Muyoyeta, Monde, Namuganga, Anna Ritah, Kizza, Harriet Mayanja, Mendy, Alieu, Tientcheu, Leopold, Ayorinde, Abigail, Coker, Edward, Egere, Uzochukwu, Coussens, Anna, Naude, Celeste, Chaplin, George, Noursadeghi, Mahdad, Martineau, Adrian, Jablonski, Nina, Wilkinson, Robert, Ouedraogo, Henri Gautier, Matteelli, Alberto, Regazzi, Mario, Tarnagda, Grissoum, Villani, Paola, Sulis, Giorgia, Diagbouga, Serge, Roggi, Alberto, Giorgetti, Francesco, Kouanda, Seni, Bidias, Amel, Ndjonka, Dieudonné, Olemba, Clémence, Souleymanou, Arabo, Mukonzo, Jackson, Kuteesa, Ronald, Ogwal-Okeng, Jasper, Gustafsson, Lars L., Owen, Joel, Bassi, Peter, Gashau, Wadzani, Olaf, Klungel, Dodoo, Alexander, Okonkwo, Prosper, Kanki, Phyllis, Maruapula, Dorcas, Seraise, Boitumelo, Einkauf, Kevin, Reilly, Amanda, Rowley, Christopher, Musonda, Rosemary, Framhein, Anna, Mpagama, Stella, Semvua, Hadija, Maboko, Leonard, Hoelscher, Michael, Heinrich, Norbert, Mulenga, Lloyd, Kaayunga, Callistus, Davies, Mary-Ann, Egger, Matthias, Musukuma, Kalo, Dambe, Rosalia, Usadi, Benjamin, Ngari, Moses, Thitiri, Johnstone, Mwalekwa, Laura, Fegan, Greg, Berkley, James, Nsagha, Dickson, Munamunungu, Virginia, Bolton, Carolyn, Siyunda, Alice, Shilimi, Jacinta, Bucciardini, Raffaella, Fragola, Vincenzo, Abegaz, Teshome, Lucattini, Stefano, Halifom, Atakilt, Tadesse, Eskedar, Berhe, Micheal, Pugliese, Katherina, Castro, Paola De, Terlizzi, Roberta, Fucili, Luca, Gregorio, Massimiliano Di, Mirra, Marco, Zegeye, Teame, Binelli, Andrea, Vella, Stefano, Abraham, Loko, Godefay, Hagos, Rakotoarivelo, Rivo, Raberahona, Mihaja, Randriamampionona, Njary, Andriamihaja, Rabezanahary, Rasamoelina, Tahinamandranto, Cornet, Muriel, Randria, Mamy Jean De Dieu, Benet, Thomas, Vanhems, Philippe, Andrianarivelo, Mala Rakoto, Chirwa, Uchizi, Michelo, Charles, Hamoonga, Raymond, Wandiga, Steve, Oduor, Patience, Agaya, Janet, Sharma, Aditya, Cavanaugh, Sean, Cain, Kevin, Mukisa, John, Mupere, Ezekiel, Worodria, William, Ngom, Justice Trésor, Koro, Francioli, Godwe, Celestin, Adande, Clemence, Ateugieu, Romaric, Onana, Tatiana, Ngono, Annie, Kamdem, Yannick, Ngo-Niobe, Sara, Etoa, François-Xavier, Kanengoni, Muchineripi, Ruzario, Sithembile, Ndebele, Paul, Shana, Melody, Tarumbiswa, Fadzai, Musesengwa, Rosemary, Gutsire, Rutendo, Fisher, Kevin, Thyagarajan, Bargavi, Akanbi, Olusola, Binuyo, Michael, Ssengooba, Willy, Respeito, Durval, Mambuque, Edson, Blanco, Silvia, Mandomando, Inacio, Cobelens, Frank, Garcia-Basteiro, Alberto, Tamene, Ayele, Topp, Stephanie, Mwamba, Chanda, Padian, Nancy, Sikazwe, Izukanji, Geng, Elvin, Holmes, Charles, Sikombe, Kombatende, Hantuba, Cardinal, Czaicki, Nancy, Simbeza, Sandra, Somwe, Paul, Umulisa, Michele, Ilo, Jennifer, Kestelyn, Evelyne, Uwineza, Mireille, Agaba, Stephen, Delvaux, Therese, Wijgert, Janneke, Gethi, Dickson, Odeny, Lazarus, Tamandjou, Cynthia, Kaindjee-Tjituka, Francina, Brandt, Laura, Cotton, Mark, Nel, Etienne, Preiser, Wolfgang, Andersson, Monique, Adepoju, Abiola, Magana, Musa, Etsetowaghan, Andrew, Chilikwazi, Mutinta, Sutcliffe, Catherine, Thuma, Philip, Sinywimaanzi, Kathy, Matakala, Hellen, Munachoonga, Passwell, Moss, William, Masenza, Issa Sabi, Geisenberger, Otto, Agrea, Peter, Rwegoshora, France, Mahiga, Hellen, Olomi, Willyhelmina, Kroidl, Arne, Kayode, Gbenga, Amoakoh-Coleman, Mary, Ansah, Evelyn, Uthman, Olalekan, Fokam, Joseph, Santoro, Maria-Mercedes, Musolo, Chrissie, Chimbiri, Isabel, Chikwenga, Gloria, Deula, Ruth, Massari, Riccardo, Lungu, Agness, Perno, Carlo-Federico, Ndzengue, Georgia, Loveline, Ngu, Lissom, Abel, Flaurent, Tchouangueu, Sosso, Samuel, Essomba, Claudine, Kpeli, Grace, Otchere, Isaac, Lamelas, Araceli, Buultjens, Andrew, Bulach, Dieter, Baines, Sarah, Seemann, Torsten, Giulieri, Stefano, Nakobu, Zuliehatu, Aboagye, Samuel, Owusu-Mireku, Evelyn, Danso, Emelia, Hauser, Julia, Hinic, Vladimira, Pluschke, Gerd, Stinear, Timothy, Yeboah-Manu, Dorothy, Elshayeb, Ayman, Siddig, Marmar El, Ahmed, Abdel Azim, Hussien, Adil El, Kabwe, Mwila, Tembo, John, Chilukutu, Lophina, Chilufya, Moses, Ngulube, Francis, Lukwesa, Chileshe, Enne, Virve, Wexner, Hannah, Mwananyanda, Lawrence, Hamer, Davidson, Sinyangwe, Sylvester, Ahmed, Yusuf, Klein, Nigel, Maeurer, Markus, Zumla, Ali, Bates, Matthew, Beyala, Landry, Etienne, Guenou, Anthony, Njimbia, Benjamin, Azike, Ateudjieu, Jerome, Chibwe, Bertha, Ojok, David, Tarr, Christine Attia, Perez, Guillermo Martinez, Omeonga, Senga, Kibungu, Fanta, Meyer, Ana, Lansana, Peter, Mayor, Alfredo, Onyango, Peter, Loggerenberg, François Van, Furtado, Tamzin, Boggs, Liam, Segrt, Alexis, Dochez, Carine, Burnett, Rosemary, Mphahlele, M. Jeffrey, Miiro, George, Mbidde, Edward, Peshu, Norbert, Kivaya, Esther, Ngowi, Bernard, Kavishe, Reginald, Maowia, Mukhtar, Sandstrom, Eric, Ayuo, Elizabeth, Mmbaga, Blandina, Leisegang, Cordelia, Thorpe, Marie, Batchilly, Elizabeth, N'Guessan, Jean-Pierre, Kanteh, Dembo, Søfteland, Solrun, Sebitloane, Motshedisi, Vwalika, Bellington, Taylor, Myra, Galappaththi-Arachchige, Hashini, Holmen, Sigve, Gundersen, Svein Gunnar, Ndhlovu, Patricia, Kjetland, Eyrun Floerecke, Kombe, Francis, Toohey, Jacintha, Pienaar, Elizabeth, Kredo, Tamara, Cham, Pa Modou, Abubakar, Ismaela, Dondeh, Bai Lamin, Vischer, Nerina, Pfeiffer, Constanze, Burri, Christian, Musukwa, Kalo, Zürcher, Samuel, Mwandu, Temwani, Bauer, Sophie, Adriko, Moses, Mwaura, Peter, Omolloh, Kevin, Jones, Clarer, Malecela, Mwelecele, Hamidu, Buhari Adamu, Jenner, Tettevi Edward, Asiedu, Larbi John, Osei-Atweneboana, Mike, Afeke, Innocent, Addo, Phyllis, Newman, Mercy, Durnez, Lies, Eddyani, Miriam, Ammisah, Nana, Abas, Mona, Quartey, Maxwell, Ablordey, Anthony, Akinwale, Olaoluwa, Adeneye, Adeniyi, Ezeugwu, Sylvanus, Olukosi, Yetunde, Adewale, Babatunde, Sulyman, Medinat, Mafe, Margaret, Okwuzu, Jane, Gyang, Pam, Nwafor, Timothy, Henry, Uzoma, Musa, Bilkisu, Ujah, Innocent, Agobé, Jean Claude Dejon, Grau-Pujol, Berta, Sacoor, Charfudin, Nhabomba, Augusto, Casellas, Aina, Quintó, Llorenç, Subirà, Carme, Giné, Ricard, Valentín, Antònia, Muñoz, Jose, Nikiema, Marguerite, Ky-Ba, Absatou, Comapore, Kiswendsida Abdou Muller, Traore, Alfred, Sangare, Lassana, Oluremi, Adeolu, Michel, Mandro, Camara, Yaya, Sanneh, Bakary, Cuamba, Inocencia, Gutiérrez, Jose, Lázaro, Carlota, Mejia, Rojelio, Adedeji, Abimbola, Folorunsho, Sola, Demehin, Pelumi, Akinsanya, Bamidele, Cowley, Giovanna, Silva, Eunice Teixeira Da, Nabicassa, Meno, Barros, Pedrozinho Duarte Pereira De, Blif, Milena Mbote, Bailey, Robin, Last, Anna, Mahendradhata, Yodi, Gotuzzo, Eduardo, Nys, Kateljine De, Casteels, Minnes, Nona, Sylvie Kwedi, Lumeka, Kabwende, Todagbe, Agnandji, Djima, Mariam Mama, Ukpong, Morenike, Sagay, Atiene, Khamofu, Hadiza, Torpey, Kwasi, Afiadigwe, Evaristus, Anenih, James, Ezechi, Oliver, Nweneka, Chidi, Idoko, John, Muhumuza, Simon, Katahoire, Anne, Nuwaha, Fred, Olsen, Annette, Okeyo, Seth, Omollo, Raymond, Kimutai, Robert, Ochieng, Michael, Egondi, Thaddaeus, Moonga, Clement, Chileshe, Chisele, Magwende, George, Anumudu, Chiaka, Onile, Olugbenga, Oladele, Victoria, Adebayo, Adewale, Awobode, Henrietta, Oyeyemi, Oyetunde, Odaibo, Alexander, Kabuye, Emily, Lutalo, Tom, Njua-Yafi, Clarisse, Nkuo-Akenji, Theresa, Anchang-Kimbi, Judith, Mugri, Regina, Chi, Hanesh, Tata, Rolland, Njumkeng, Charles, Dodoo, Daniel, Achidi, Eric, Fernandes, José, Bache, Emmanuel B., Matakala, Kalumbu, Searle, Kelly, Greenman, Michelle, and Rainwater-Lovett, Kaitlin

Subjects
Abstracts of Poster Presentations, Abstracts of Oral Presentations, Author Index, Abstracts of Presentations in Plenary Sessions, Article, Abstracts of the Eighth Edctp Forum, 6–9 November 2016
Published
2017

18. Prevalence of and Risk Factors Associated with Polymerase Chain Reaction-Determined Plasmodium falciparum Positivity on Day 3 after Initiation of Artemether–Lumefantrine Treatment for Uncomplicated Malaria in Bagamoyo District, Tanzania

Author

Mwaiswelo, Richard, primary, Ngasala, Billy, additional, Jovel, Irina, additional, Xu, Weiping, additional, Larsson, Erik, additional, Malmberg, Maja, additional, Gil, Jose Pedro, additional, Premji, Zul, additional, Mmbando, Bruno P., additional, and Mårtensson, Andreas, additional

Published
2019
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19. Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment in Tanzanian children with acute uncomplicated malaria

Author

Carlsson Anja M, Ngasala Billy E, Dahlström Sabina, Membi Christopher, Veiga Isabel M, Rombo Lars, Abdulla Salim, Premji Zul, Gil J, Björkman Anders, and Mårtensson Andreas

Subjects
Plasmodium falciparum, Malaria, PCR, Parasite population dynamics, Artemether-lumefantrine, Anti-malarial drug trials, Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa. Methods A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 h after initiation of treatment. Parasite population dynamics were assessed using nested polymerase chain reaction (PCR)-genotyping of merozoite surface protein (msp) 1 and 2. Results PCR-analyses from nine sequential blood samples collected after initiation of treatment identified 20 and 21 additional genotypes in 15/50 (30%) and 14/50 (28%) children with msp1 and msp2, respectively, non-detectable in the pre-treatment samples (-2 and 0 h combined). Some 15/20 (75%) and 14/21 (67%) of these genotypes were identified within 24 h, whereas 17/20 (85%) and 19/21 (90%) within 48 h for msp1 and msp2, respectively. The genotype profile was diverse, and varied considerably over time both within and between patients, molecular markers and their respective families. Conclusion PCR analyses from multiple blood samples collected during the early treatment phase revealed a complex picture of parasite sub-populations. This underlines the importance of interpreting PCR-outcomes with caution and suggests that the present use of PCR-adjustment from paired blood samples in anti-malarial drug trials may overestimate assessment of drug efficacy in high transmission areas in Africa. The study is registered at http://www.clinicaltrials.gov with identifier NCT00336375.

Published
2011
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20. Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets

Author

Ohno Summer, Neal Bruce, Mehta Saurabh, Lucero Marilla, Lozano Rafael, Kumar Vishwajeet, Kumar Aarti, Kalter Henry, Joshi Rohina, Hernández Bernardo, Gómez Sara, Flaxman Abraham D, Fawzi Wafaie, Dutta Arup, Dhingra Usha, Das Vinita, Dantzer Emily, Dandona Lalit, Ali Said, Baqui Abdullah, Ahuja Ramesh, Black Robert, Lopez Alan D, Murray Christopher JL, Prasad Rajendra, Praveen Devarsetty, Premji Zul, Ramírez-Villalobos Dolores, Remolador Hazel, Riley Ian, Romero Minerva, Said Mwanaidi, Sanvictores Diozele, Sazawal Sunil, and Tallo Veronica

Subjects
Verbal autopsy, VA, validation, Philippines, Tanzania, India, Mexico, gold standard, cause of death, Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment. Methods Data collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths. Results Over 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions. Conclusions This unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.

Published
2011
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21. Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study

Author

Blessborn Daniel, Petzold Max G, Ferreira Pedro E, Carlsson Anja M, Malmberg Maja, Ngasala Billy E, Bergqvist Yngve, Gil José P, Premji Zul, and Mårtensson Andreas

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p ≤ 0.046). Conclusions Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.

Published
2011
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22. Understanding caretakers' dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate

Author

Gomes Melba F, Premji Zul, Warsame Marian, Kakoko Deodatus C, Simba Daudi O, Tomson Goran, and Johansson Eva

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Malaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate. Methods Four focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis. Results The theme "Caretakers dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate" depicts the challenge they face. Caretakers' understanding of the rationale for going to hospital after treatment - when and why they should adhere - influenced adherence. Caretakers, whose children did not improve, usually adhered to referral advice. If a child had noticeably improved with pre-referral treatment however, caretakers weighed whether they should proceed to the facility, balancing the child's improved condition against other competing priorities, difficulties in reaching the health facilities, and the perceived quality of care at the health facility. Some misinterpretation were found regarding the urgency and rationale for adherence among some caretakers of children who improved which were attributed to be possibly due to their prior understanding. Conclusion Some caretakers did not adhere when their children improved and some who adhered did so without understanding why they should proceed to the facility. Successful implementation of the rectal artesunate strategy depends upon effective communication regarding referral to clinic.

Published
2010
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24. Impact of training in clinical and microscopy diagnosis of childhood malaria on antimalarial drug prescription and health outcome at primary health care level in Tanzania: A randomized controlled trial

Author

Massele Amos Y, Petzold Max G, Warsame Marian, Mubi Marycelina, Ngasala Billy, Gustafsson Lars L, Tomson Goran, Premji Zul, and Bjorkman Anders

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Prescribing antimalarial medicines based on parasite confirmed diagnosis of malaria is critical to rational drug use and optimal outcome of febrile illness. The impact of microscopy-based versus clinical-based diagnosis of childhood malaria was assessed at primary health care (PHC) facilities using a cluster randomized controlled training intervention trial. Methods Sixteen PHC facilities in rural Tanzania were randomly allocated to training of health staff in clinical algorithm plus microscopy (Arm-I, n = 5) or clinical algorithm only (Arm-II, n = 5) or no training (Arm-III, n = 6). Febrile under-five children presenting at these facilities were assessed, treated and scheduled for follow up visit after 7 days. Blood smears on day 0 were only done in Arm-I but on Day 7 in all arms. Primary outcome was antimalarial drug prescription. Other outcomes included antibiotic prescription and health outcome. Multilevel regression models were applied with PHC as level of clustering to compare outcomes in the three study arms. Results A total of 973, 1,058 and 1,100 children were enrolled in arms I, II and III, respectively, during the study period. Antimalarial prescriptions were significantly reduced in Arm-I (61.3%) compared to Arms-II (95.3%) and III (99.5%) (both P < 0.001), whereas antibiotic prescriptions did not vary significantly between the arms (49.9%, 54.8% and 34.2%, respectively). In Arm-I, 99.1% of children with positive blood smear readings received antimalarial prescriptions and so did 11.3% of children with negative readings. Those with positive readings were less likely to be prescribed antibiotics than those with negative (relative risk = 0.66, 95% confidence interval: 0.55, 0.72). On day 7 follow-up, more children reported symptoms in Arm-I compared to Arm-III, but fewer children had malaria parasitaemia (p = 0.049). The overall sensitivity of microscopy reading at PHC compared to reference level was 74.5% and the specificity was 59.0% but both varied widely between PHCs. Conclusion Microscopy based diagnosis of malaria at PHC facilities reduces prescription of antimalarial drugs, and appears to improve appropriate management of non-malaria fevers, but major variation in accuracy of the microscopy readings was found. Lack of qualified laboratory technicians at PHC facilities and the relatively short training period may have contributed to the shortcomings. Trial registration This study is registered at Clinicaltrials.gov with the identifier NCT00687895.

Published
2008
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25. Willingness and ability to pay for artemisinin-based combination therapy in rural Tanzania

Author

Montgomery Scott M, Premji Zul, Forsberg Birger C, Saulo Eleonor C, and Björkman Anders

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background The aim of this study was to analyse willingness to pay (WTP) and ability to pay (ATP) for ACT for children below five years of age in a rural setting in Tanzania before the introduction of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. Socio-economic factors associated with WTP and expectations on anti-malaria drugs, including ACT, were also explored. Methods Structured interviews and focus group discussions were held with mothers, household heads, health-care workers and village leaders in Ishozi, Gera and Ishunju wards in north-west Tanzania in 2004. Contingent valuation method (CVM) was used with "take-it-or-leave-it" as the eliciting method, expressed as WTP for a full course of ACT for a child and households' opportunity cost of ACT was used to assess ATP. The study included descriptive analyses with multivariate adjustment for potential confounding factors. Results Among 265 mothers and household heads, 244 (92%, CI = 88%–95%) were willing to pay Tanzanian Shillings (TSh) 500 (US$ 0.46) for a child's dose of ACT, but only 55% (49%–61%) were willing to pay more than TSh 500. Mothers were more often willing to pay than male household heads (adjusted odds ratio = 2.1, CI = 1.2–3.6). Socio-economic status had no significant effect on WTP. The median annual non-subsidized ACT cost for clinical malaria episodes in an average household was calculated as US$ 6.0, which would represent 0.9% of the average total consumption expenditures as estimated from official data in 2001. The cost of non-subsidized ACT represented 7.0% of reported total annual expenditure on food and 33.0% of total annual expenditure on health care. "Rapid effect," "no adverse effect" and "inexpensive" were the most desired features of an anti-malarial drug. Conclusion WTP for ACT in this study was less than its real cost and a subsidy is, therefore, needed to enable its equitable affordability. The decision taken in Tanzania to subsidize Coartem® fully at governmental health care facilities and at a consumer price of TSh 300–500 (US$ 0.28–0.46) at special designated shops through the programme of Accredited Drug Dispensing Outlets (ADDOs) appears to be well founded.

Published
2008
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27. Habitat characterization and spatial distribution of Anopheles sp. mosquito larvae in Dar es Salaam (Tanzania) during an extended dry period

Author

Tanner Marcel, Premji Zul, Kiama Michael, Mtasiwa Deo, Sattler Michael A, Killeen Gerry F, and Lengeler Christian

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Introduction By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions. Methods In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. Ecologic parameters, mosquito larvae density and geographic location were recorded for each site. Logistic regression analysis was used to determine the key ecological factors explaining the different densities of mosquito larvae. Results A total of 405 potential open breeding sites were examined. Large drains, swamps and puddles were associated with no or low Anopheles sp. larvae density. The probability of Anopheles sp. larvae to be present was reduced when water was identified as "turbid". Small breeding sites were more commonly colonized by Anopheles sp. larvae. Further, Anopheles gambiae s.l. larvae were found in highly organically polluted habitats. Conclusions Clear ecological characteristics of the breeding requirements of Anopheles sp. larvae could not be identified in this setting. Hence, every stagnant open water body, including very polluted ones, have to be considered as potential malaria vector breeding sites.

Published
2005
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29. Iron Supplementation among Iron-Replete and Non-Anemic Pregnant Women: A Randomized Placebo-Controlled Trial in Tanzania

Author

Etheredge, Analee J, Premji, Zul, Gunaratna, Nilupa S, Abioye, Ajibola Ibraheem, Aboud, Said, Duggan, Christopher, Mongi, Robert, Meloney, Laura, Speigleman, Donna, Roberts, Drucilla, Hamer, Davidson H, and Fawzi, Wafaie W

Subjects
Adult, Placenta Diseases, Anemia, Iron-Deficiency, Iron, Prenatal Care, Tanzania, Article, Malaria, Trace Elements, Hemoglobins, Young Adult, Treatment Outcome, Double-Blind Method, Pregnancy, Dietary Supplements, Birth Weight, Humans, Female
Abstract

Anemia is common in pregnancy and increases the risk of adverse outcomes. Iron deficiency is a leading cause of anemia in sub-Saharan Africa, and iron supplementation is the standard of care during pregnancy; however, recent trials among children have raised concerns regarding the safety of iron supplementation in malaria-endemic regions. There is limited evidence on the safety of iron supplementation during pregnancy in these areas.To evaluate the safety and efficacy of iron supplementation during pregnancy in a malaria-endemic region.We conducted a randomized, double-blind, placebo-controlled clinical trial among pregnant women presenting for antenatal care in Dar es Salaam, Tanzania, from September 28, 2010, through October 4, 2012. Iron-replete, nonanemic women were eligible if they were uninfected with human immunodeficiency virus, primigravidae or secundigravidae, and at or before 27 weeks of gestation. Screening of 21,316 women continued until the target enrollment of 1500 was reached. Analyses followed the intent-to-treat principle and included all randomized participants.Participants were randomized to receive 60 mg of iron or placebo, returning every 4 weeks for standard prenatal care, including malaria screening, prophylaxis with the combination of sulfadoxine and pyrimethamine, and treatment, as needed.The primary outcomes were placental malaria, maternal hemoglobin level at delivery, and birth weight.Among 1500 study participants (750 randomized for each group), 731 in iron group and 738 in placebo group had known birth outcomes and 493 in iron group and 510 in placebo group had placental samples included in the analysis. Maternal characteristics were similar at baseline in the iron and placebo groups, and 1354 (91.7%) used malaria control measures. The risk of placental malaria was not increased by maternal iron supplementation (relative risk [RR], 1.03; 95% CI, 0.65-1.65), and iron supplementation did not significantly affect birth weight (3155 vs 3137 g, P = .89). Compared with placebo, iron supplementation significantly improved the mean increase from baseline to delivery for hemoglobin (0.1 vs -0.7 g/dL, P .001) and serum ferritin (41.3 vs 11.3 µg/L, P .001). Iron supplementation significantly decreased the risk of anemia at delivery by 40% (RR, 0.60; 95% CI, 0.51-0.71) but not severe anemia (RR, 0.68; 95% CI, 0.41-1.14). Iron supplementation significantly reduced the risk of maternal iron deficiency at delivery by 52% (RR, 0.48; 95% CI, 0.32-0.70) and the risk of iron deficiency anemia by 66% (RR, 0.34; 95% CI, 0.19-0.62).Prenatal iron supplementation among iron-replete, nonanemic women was not associated with an increased risk of placental malaria or other adverse events in the context of good malaria control. Participants receiving supplementation had improved hematologic and iron status at delivery compared with the placebo group. These findings provide support for continued administration of iron during pregnancy in malaria-endemic regions.clinicaltrials.gov Identifier: NCT01119612.

Published
2015

31. Sustained High Cure Rate of Artemether–Lumefantrine against Uncomplicated Plasmodium falciparum Malaria after 8 Years of Its Wide-Scale Use in Bagamoyo District, Tanzania

Author

Mwaiswelo, Richard, primary, Malmberg, Maja, additional, Mmbando, Bruno P., additional, Gil, J. Pedro, additional, Premji, Zul, additional, Mårtensson, Andreas, additional, Xu, Weiping, additional, Jovel, Irina, additional, Björkman, Anders, additional, and Ngasala, Billy, additional

Published
2017
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33. High resolution melting: a useful field-deployable method to measure dhfr and dhps drug resistance in both highly and lowly endemic Plasmodium populations

Author

Ndiaye, Yaye Dié, primary, Diédhiou, Cyrille K., additional, Bei, Amy K., additional, Dieye, Baba, additional, Mbaye, Aminata, additional, Mze, Nasserdine Papa, additional, Daniels, Rachel F., additional, Ndiaye, Ibrahima M., additional, Déme, Awa B., additional, Gaye, Amy, additional, Sy, Mouhamad, additional, Ndiaye, Tolla, additional, Badiane, Aida S., additional, Ndiaye, Mouhamadou, additional, Premji, Zul, additional, Wirth, Dyann F., additional, Mboup, Souleymane, additional, Krogstad, Donald, additional, Volkman, Sarah K., additional, Ahouidi, Ambroise D., additional, and Ndiaye, Daouda, additional

Published
2017
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34. Evaluation of the Parasight Platform for Malaria Diagnosis

Author

Eshel, Yochay, primary, Houri-Yafin, Arnon, additional, Benkuzari, Hagai, additional, Lezmy, Natalie, additional, Soni, Mamta, additional, Charles, Malini, additional, Swaminathan, Jayanthi, additional, Solomon, Hilda, additional, Sampathkumar, Pavithra, additional, Premji, Zul, additional, Mbithi, Caroline, additional, Nneka, Zaitun, additional, Onsongo, Simon, additional, Maina, Daniel, additional, Levy-Schreier, Sarah, additional, Cohen, Caitlin Lee, additional, Gluck, Dan, additional, Pollak, Joseph Joel, additional, and Salpeter, Seth J., additional

Published
2017
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37. Baseline data of parasite clearance in patients with falciparum malaria treated with an artemisinin derivative : an individual patient data meta-analysis

Author

WWARN Parasite Clearance Study Group, Abdulla, Salim, Ashley, Elizabeth A, Bassat, Quique, Bethell, Delia, Björkman, Anders, Borrmann, Steffen, D'Alessandro, Umberto, Dahal, Prabin, Day, Nicholas P, Diakite, Mahamadou, Djimde, Abdoulaye A, Dondorp, Arjen M, Duong, Socheat, Edstein, Michael D, Fairhurst, Rick M, Faiz, M Abul, Falade, Catherine, Flegg, Jennifer A, Fogg, Carole, Gonzalez, Raquel, Greenwood, Brian, Guérin, Philippe J, Guthmann, Jean-Paul, Hamed, Kamal, Hien, Tran Tinh, Htut, Ye, Juma, Elizabeth, Lim, Pharath, Mårtensson, Andreas, Mayxay, Mayfong, Mokuolu, Olugbenga A, Moreira, Clarissa, Newton, Paul, Noedl, Harald, Nosten, Francois, Ogutu, Bernhards R, Onyamboko, Marie A, Owusu-Agyei, Seth, Phyo, Aung Pyae, Premji, Zul, Price, Ric N, Pukrittayakamee, Sasithon, Ramharter, Michael, Sagara, Issaka, Se, Youry, Suon, Seila, Stepniewska, Kasia, Ward, Stephen A, White, Nicholas J, and Winstanley, Peter A

Subjects
Male, Artemether/lumefantrine, Social and Clinical Pharmacy, Drug Resistance, Physiology, Parasitemia, Drug resistance, chemistry.chemical_compound, Medicine, Parasite hosting, Artemisinin, Malaria, Falciparum, Child, Diagnosis & treatment, Clinical Trials as Topic, Surveillance, monitoring, evaluation, biology, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, Artemisinins, 3. Good health, Infectious Diseases, Blood, Artemisinin resistance, Child, Preschool, Female, medicine.drug, Adult, endocrine system, Adolescent, Plasmodium falciparum, Antimalarials, Young Adult, Health Sciences, parasitic diseases, Animals, Humans, Aged, Parasite clearance, business.industry, Research, Samhällsfarmaci och klinisk farmaci, Infant, medicine.disease, biology.organism_classification, Malaria, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, chemistry, Artesunate, Immunology, Parasitology, business
Abstract

Background Artemisinin resistance in Plasmodium falciparum manifests as slow parasite clearance but this measure is also influenced by host immunity, initial parasite biomass and partner drug efficacy. This study collated data from clinical trials of artemisinin derivatives in falciparum malaria with frequent parasite counts to provide reference parasite clearance estimates stratified by location, treatment and time, to examine host factors affecting parasite clearance, and to assess the relationships between parasite clearance and risk of recrudescence during follow-up. Methods Data from 24 studies, conducted from 1996 to 2013, with frequent parasite counts were pooled. Parasite clearance half-life (PC1/2) was estimated using the WWARN Parasite Clearance Estimator. Random effects regression models accounting for study and site heterogeneity were used to explore factors affecting PC1/2 and risk of recrudescence within areas with reported delayed parasite clearance (western Cambodia, western Thailand after 2000, southern Vietnam, southern Myanmar) and in all other areas where parasite populations are artemisinin sensitive. Results PC1/2 was estimated in 6975 patients, 3288 of whom also had treatment outcomes evaluate d during 28–63 days follow-up, with 93 (2.8 %) PCR-confirmed recrudescences. In areas with artemisinin-sensitive parasites, the median PC1/2 following three-day artesunate treatment (4 mg/kg/day) ranged from 1.8 to 3.0 h and the proportion of patients with PC1/2 >5 h from 0 to 10 %. Artesunate doses of 4 mg/kg/day decreased PC1/2 by 8.1 % (95 % CI 3.2–12.6) compared to 2 mg/kg/day, except in populations with delayed parasite clearance. PC1/2 was longer in children and in patients with fever or anaemia at enrolment. Long PC1/2 (HR = 2.91, 95 % CI 1.95–4.34 for twofold increase, p

Published
2015

38. Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data

Author

Abdulla, Salim, Adam, Ishag, Adjei, George O., Adjuik, Martin A., Alemayehu, Bereket, Allan, Richard, Arinaitwe, Emmanuel, Ashley, Elizabeth A., Ba, Mamadou S., Barennes, Hubert, Barnes, Karen I., Bassat, Quique, Baudin, Elisabeth, Berens-Riha, Nicole, Bjoerkman, Anders, Bompart, Francois, Bonnet, Maryline, Borrmann, Steffen, Bousema, Teun, Brasseur, Philippe, Bukirwa, Hasifa, Checchi, Francesco, Dahal, Prabin, D'Alessandro, Umberto, Desai, Meghna, Dicko, Alassane, Djimde, Abdoulaye A., Dorsey, Grant, Doumbo, Ogobara K., Drakeley, Chris J., Duparc, Stephan, Eshetu, Teferi, Espie, Emmanuelle, Etard, Jean-Francois, Faiz, Abul M., Falade, Catherine O., Fanello, Caterina I., Faucher, Jean-Francois, Faye, Babacar, Faye, Oumar, Filler, Scott, Flegg, Jennifer A., Fofana, Bakary, Fogg, Carole, Gadalla, Nahla B., Gaye, Oumar, Genton, Blaise, Gething, Peter W., Gil, Jose P., Gonzalez, Raquel, Grandesso, Francesco, Greenhouse, Bryan, Greenwood, Brian, Grivoyannis, Anastasia, Guerin, Philippe J., Guthmann, Jean-Paul, Hamed, Kamal, Hamour, Sally, Hay, Simon I., Hodel, Eva Maria, Humphreys, Georgina S., Hwang, Jimee, Ibrahim, Maman L., Jima, Daddi, Jones, Joel J., Jullien, Vincent, Juma, Elizabeth, Kachur, Patrick S., Kager, Piet A., Kamugisha, Erasmus, Kamya, Moses R., Karema, Corine, Kayentao, Kassoum, Kiechel, Jean-Rene, Kironde, Fred, Kofoed, Poul-Erik, Kremsner, Peter G., Krishna, Sanjeev, Lameyre, Valerie, Lell, Bertrand, Lima, Angeles, Makanga, Michael, Malik, ElFatih M., Marsh, Kevin, Martensson, Andreas, Massougbodji, Achille, Menan, Herve, Menard, Didier, Menendez, Clara, Mens, Petra F., Meremikwu, Martin, Moreira, Clarissa, Nabasumba, Carolyn, Nambozi, Michael, Ndiaye, Jean-Louis, Ngasala, Billy E., Nikiema, Frederic, Nsanzabana, Christian, Ntoumi, Francine, Oguike, Mary, Ogutu, Bernhards R., Olliaro, Piero, Omar, Sabah A., Ouedraogo, Jean-Bosco, Owusu-Agyei, Seth, Penali, Louis K., Pene, Mbaye, Peshu, Judy, Piola, Patrice, Plowe, Christopher V., Premji, Zul, Price, Ric N., Randrianarivelojosia, Milijaona, Rombo, Lars, Roper, Cally, Rosenthal, Philip J., Sagara, Issaka, Same-Ekobo, Albert, Sawa, Patrick, Schallig, Henk D. F. H., Schramm, Birgit, Seck, Amadou, Shekalaghe, Seif A., Sibley, Carol H., Sinou, Vronique, Sirima, Sodiomon B., Som, Fabrice A., Sow, Doudou, Staedke, Sarah G., Stepniewska, Kasia, Sutherland, Colin J., Swarthout, Todd D., Sylla, Khadime, Talisuna, Ambrose O., Taylor, Walter R. J., Temu, Emmanuel A., Thwing, Julie I., Tine, Roger C. K., Tinto, Halidou, Tommasini, Silva, Toure, Offianan A., Ursing, Johan, Vaillant, Michel T., Valentini, Giovanni, Van den Broek, Ingrid, Van Vugt, Michele, Ward, Stephen A., Winstanley, Peter A., Yavo, William, Yeka, Adoke, Zolia, Yah M., Zongo, Issaka, and WWARN Artemisinin based Combination Therapy (ACT) Africa Baseline Study Group

Subjects
parasitic diseases
Abstract

BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P 37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Published
2015

39. Adding a single low-dose of primaquine (0.25 mg/kg) to artemether-lumefantrine did not compromise treatment outcome of uncomplicated Plasmodium falciparum malaria in Tanzania: a randomized, single-blinded clinical trial

Author

Mwaiswelo, Richard, primary, Ngasala, Billy, additional, Jovel, Irina, additional, Aydin-Schmidt, Berit, additional, Gosling, Roland, additional, Premji, Zul, additional, Mmbando, Bruno, additional, Björkman, Anders, additional, and Mårtensson, Andreas, additional

Published
2016
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43. A shortened verbal autopsy instrument for use in routine mortality surveillance systems

Author

Serina, Peter, primary, Riley, Ian, additional, Stewart, Andrea, additional, Flaxman, Abraham D., additional, Lozano, Rafael, additional, Mooney, Meghan D, additional, Luning, Richard, additional, Hernandez, Bernardo, additional, Black, Robert, additional, Ahuja, Ramesh, additional, Alam, Nurul, additional, Alam, Sayed Saidul, additional, Ali, Said Mohammed, additional, Atkinson, Charles, additional, Baqui, Abdulla H., additional, Chowdhury, Hafizur R., additional, Dandona, Lalit, additional, Dandona, Rakhi, additional, Dantzer, Emily, additional, Darmstadt, Gary L, additional, Das, Vinita, additional, Dhingra, Usha, additional, Dutta, Arup, additional, Fawzi, Wafaie, additional, Freeman, Michael, additional, Gamage, Saman, additional, Gomez, Sara, additional, Hensman, Dilip, additional, James, Spencer L., additional, Joshi, Rohina, additional, Kalter, Henry D., additional, Kumar, Aarti, additional, Kumar, Vishwajeet, additional, Lucero, Marilla, additional, Mehta, Saurabh, additional, Neal, Bruce, additional, Ohno, Summer Lockett, additional, Phillips, David, additional, Pierce, Kelsey, additional, Prasad, Rajendra, additional, Praveen, Devarsetty, additional, Premji, Zul, additional, Ramirez-Villalobos, Dolores, additional, Rampatige, Rasika, additional, Remolador, Hazel, additional, Romero, Minerva, additional, Said, Mwanaidi, additional, Sanvictores, Diozele, additional, Sazawal, Sunil, additional, Streatfield, Peter K., additional, Tallo, Veronica, additional, Vadhatpour, Alireza, additional, Wijesekara, Nandalal, additional, Murray, Christopher J. L., additional, and Lopez, Alan D., additional

Published
2015
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44. Improving performance of the Tariff Method for assigning causes of death to verbal autopsies

Author

Serina, Peter, primary, Riley, Ian, additional, Stewart, Andrea, additional, James, Spencer L., additional, Flaxman, Abraham D., additional, Lozano, Rafael, additional, Hernandez, Bernardo, additional, Mooney, Meghan D., additional, Luning, Richard, additional, Black, Robert, additional, Ahuja, Ramesh, additional, Alam, Nurul, additional, Alam, Sayed Saidul, additional, Ali, Said Mohammed, additional, Atkinson, Charles, additional, Baqui, Abdulla H., additional, Chowdhury, Hafizur R., additional, Dandona, Lalit, additional, Dandona, Rakhi, additional, Dantzer, Emily, additional, Darmstadt, Gary L., additional, Das, Vinita, additional, Dhingra, Usha, additional, Dutta, Arup, additional, Fawzi, Wafaie, additional, Freeman, Michael, additional, Gomez, Sara, additional, Gouda, Hebe N., additional, Joshi, Rohina, additional, Kalter, Henry D., additional, Kumar, Aarti, additional, Kumar, Vishwajeet, additional, Lucero, Marilla, additional, Maraga, Seri, additional, Mehta, Saurabh, additional, Neal, Bruce, additional, Ohno, Summer Lockett, additional, Phillips, David, additional, Pierce, Kelsey, additional, Prasad, Rajendra, additional, Praveen, Devarsatee, additional, Premji, Zul, additional, Ramirez-Villalobos, Dolores, additional, Rarau, Patricia, additional, Remolador, Hazel, additional, Romero, Minerva, additional, Said, Mwanaidi, additional, Sanvictores, Diozele, additional, Sazawal, Sunil, additional, Streatfield, Peter K., additional, Tallo, Veronica, additional, Vadhatpour, Alireza, additional, Vano, Miriam, additional, Murray, Christopher J. L., additional, and Lopez, Alan D., additional

Published
2015
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45. Iron Supplementation in Iron-Replete and Nonanemic Pregnant Women in Tanzania

Author

Etheredge, Analee J., primary, Premji, Zul, additional, Gunaratna, Nilupa S., additional, Abioye, Ajibola Ibraheem, additional, Aboud, Said, additional, Duggan, Christopher, additional, Mongi, Robert, additional, Meloney, Laura, additional, Spiegelman, Donna, additional, Roberts, Drucilla, additional, Hamer, Davidson H., additional, and Fawzi, Wafaie W., additional

Published
2015
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48. The pervasive triad of food security, gender inequity and women's health: Exploratory research from sub-Saharan Africa

Author

Hyder, Adnan A, Maman, Suzanne, Nyoni, Joyce E, Khasiani, Shaniysa A, Teoh, Noreen, Premji, Zul, and Sohani, Salim

Subjects
Gender Identity, Agriculture, Original Articles, Workload, Focus Groups, Kenya, Tanzania, Food Supply, Interviews as Topic, Household Work, Humans, Women's Health, Female, Interpersonal Relations, Cooking, Prejudice
Abstract

This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues-food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad.In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania.A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions.The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity.The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health.

Published
2005

49. Habitat characterization and spatial distribution of Anopheles sp. mosquito larvae in Dar es Salaam (Tanzania) during an extended dry period

Author

Sattler, Michael A, Mtasiwa, Deo, Kiama, Michael, Premji, Zul, Tanner, Marcel, Killeen, Gerry F, and Lengeler, Christian

Subjects
Population Density, Mosquito Control, lcsh:Arctic medicine. Tropical medicine, lcsh:RC955-962, Research, fungi, Urban Health, Fresh Water, Tanzania, Vector control, Insect Vectors, Malaria, lcsh:Infectious and parasitic diseases, Disasters, Logistic Models, Larva, Anopheles, parasitic diseases, Animals, Humans, lcsh:RC109-216
Abstract

Introduction By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions. Methods In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. Ecologic parameters, mosquito larvae density and geographic location were recorded for each site. Logistic regression analysis was used to determine the key ecological factors explaining the different densities of mosquito larvae. Results A total of 405 potential open breeding sites were examined. Large drains, swamps and puddles were associated with no or low Anopheles sp. larvae density. The probability of Anopheles sp. larvae to be present was reduced when water was identified as "turbid". Small breeding sites were more commonly colonized by Anopheles sp. larvae. Further, Anopheles gambiae s.l. larvae were found in highly organically polluted habitats. Conclusions Clear ecological characteristics of the breeding requirements of Anopheles sp. larvae could not be identified in this setting. Hence, every stagnant open water body, including very polluted ones, have to be considered as potential malaria vector breeding sites.

Published
2005

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