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Amaral PST, Garcia KKS, Suárez-Mutis MC, Coelho RR, Galardo AK, Murta F, Moresco GG, Siqueira AM, Gurgel-Gonçalves R. Malaria in areas under mining activity in the Amazon: A review. Rev Soc Bras Med Trop 2024; 57:e002002024. [PMID: 38922216 PMCID: PMC11210384 DOI: 10.1590/0037-8682-0551-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/09/2024] [Indexed: 06/27/2024] Open
Abstract
Deforestation and high human mobility due to mining activities have been key to the increase in malaria cases in the Americas. Here, we review the epidemiological and control aspects of malaria in the Amazon mining areas. Epidemiological evidence shows: 1) a positive correlation between illegal mining activity and malaria incidence, mostly in the Amazon region; 2) most Brazilian miners are males aged 15-29 years who move between states and even countries; 3) miners do not fear the disease and rely on medical care, diagnosis, and medication when they become ill; 4) illegal mining has emerged as the most reported anthropogenic activity within indigenous lands and is identified as a major cause of malaria outbreaks among indigenous people in the Amazon; and 5) because mining is largely illegal, most areas are not covered by any healthcare facilities or activities, leading to little assistance in the diagnosis and treatment of malaria. Our review identified five strategies for reducing the malaria incidence in areas with mining activities: 1) reviewing legislation to control deforestation and mining expansion, particularly in indigenous lands; 2) strengthening malaria surveillance by expanding the network of community health agents to support rapid diagnosis and treatment; 3) reinforcing vector control strategies, such as the use of insecticide-treated nets; 4) integrating deforestation alerts into the national malaria control program; and 5) implementing multi-sectoral activities and providing prompt assistance to indigenous populations. With this roadmap, we can expect a decrease in malaria incidence in the Amazonian mining areas in the future.
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Affiliation(s)
- Pablo Sebastian Tavares Amaral
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-graduação em Medicina Tropical, Brasília, DF, Brasil
- Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Klauss Kleydmann Sabino Garcia
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-graduação em Medicina Tropical, Brasília, DF, Brasil
- Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
- Universidade de Brasília, Faculdade de Ciências da Saúde, Brasília, DF, Brasil
| | | | - Ronan Rocha Coelho
- Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Allan Kardec Galardo
- Laboratório de Entomologia Médica, Instituto de Pesquisas Científicas e Tecnológicas do Estado do Amapá, Macapá, AP, Brasil
| | - Felipe Murta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Departamento de Ensino e Pesquisa, Manaus, AM, Brasil
| | - Gilberto Gilmar Moresco
- Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
- Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - André Machado Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Gurgel-Gonçalves
- Universidade de Brasília, Faculdade de Medicina, Laboratório de Parasitologia Médica e Biologia Vetores, Brasília, DF, Brasil
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Cassidy CA, Kabugho L, Kibaba G, Lin B, Hollingsworth B, Baguma E, Juliano JJ, Mulogo EM, Boyce RM, Ciccone EJ. Comparison of commercially available, rapid, point-of-care C-reactive protein assays among children with febrile illness in southwestern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002727. [PMID: 38241274 PMCID: PMC10798459 DOI: 10.1371/journal.pgph.0002727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/21/2023] [Indexed: 01/21/2024]
Abstract
In Uganda, children with febrile illness are often treated with antibiotics even though most have self-limiting, likely viral, infections. C-reactive protein (CRP) measurement can help identify those who are more likely to have a bacterial infection and therefore need antibiotic treatment. Implementation of a CRP rapid diagnostic test (RDT) at the point-of-care in resource-constrained settings with minimal laboratory infrastructure could reduce unnecessary antibiotic use. In this study, we evaluated the performance of three semi-quantitative CRP RDTs (Actim, BTNX, Duo) against a reference CRP assay requiring an electrically powered analyzer (Afinion). While both tests demonstrated substantial agreement with Afinion, Actim had slightly higher agreement than BTNX. The sensitivity was higher for the BTNX test, whereas the Actim test had a higher specificity, at cut-offs of 40 mg/L and 80 mg/L. At a cut-off of 20 mg/L, Duo demonstrated substantial agreement with the Afinion test as well. Our results demonstrate the reliability of CRP RDTs when compared to a reference standard. CRP RDTs without the need for a laboratory-based analyzer are promising tools for optimizing antibiotic use in low-resource settings.
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Affiliation(s)
- Caitlin A. Cassidy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lydiah Kabugho
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Georget Kibaba
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bradley Lin
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Brandon Hollingsworth
- Department of Entomology, Cornell University, Ithaca, New York, United States of America
| | - Emmanuel Baguma
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan J. Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Edgar M. Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M. Boyce
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Emily J. Ciccone
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Shelus V, Mumbere N, Mulogo EM, Barrington C, Baguma E, Muhindo R, Herrington JE, Emch M, Maman S, Boyce RM. Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda. Front Public Health 2023; 11:1140405. [PMID: 37056663 PMCID: PMC10089286 DOI: 10.3389/fpubh.2023.1140405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundThe World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing.MethodsThe purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria.ResultsMost drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative.ConclusionsDespite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.
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Affiliation(s)
- Victoria Shelus
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nobert Mumbere
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar M. Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - James E. Herrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Emch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ross M. Boyce
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Ross M. Boyce
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Gebreegziabher E, Dah C, Coulibaly B, Sie A, Bountogo M, Ouattara M, Compaoré A, Nikiema M, Tiansi J, Dembélé N, Lebas E, Roh M, Glidden DV, Arnold BF, Lietman TM, Oldenburg CE. The Association between Malnutrition and Malaria Infection in Children under 5 Years in Burkina Faso: A Longitudinal Study. Am J Trop Med Hyg 2023; 108:561-568. [PMID: 36623486 PMCID: PMC9978547 DOI: 10.4269/ajtmh.22-0573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/25/2022] [Indexed: 01/11/2023] Open
Abstract
The relationship between malaria infection and malnutrition is complex. Using data from a randomized controlled trial of 450 children 0-5 years of age in Burkina Faso, we examined the effect of malaria infection on short-term changes in anthropometric measures, the effect of malnutrition on malaria infection, and whether age modified the effect of baseline anthropometric measures on malaria infection. Malaria infection, assessed by blood smear microscopy and weight, height, mid-upper arm circumference, height-for-age z-score, weight-for-age z-score, and weight-for-height z-score were measured at three time points: baseline, 2 weeks, and 6 months. We used generalized estimating equations adjusted for sex, age, breastfeeding, maternal education, and study treatment (azithromycin versus placebo) for all analyses. Interaction terms were used to assess effect modification by age. Among the 366 children with no malaria infection at baseline, 43 (11.6%) had malaria infection within 6 months. There were no important differences in anthropometric measures at 2 weeks and 6 months between those with and without malaria infection at baseline. There were no significant differences in prevalence of malaria infection by baseline anthropometric measures. Age (0-30 months versus 30-60 months) modified the effect of baseline weight and height on malaria infection. Among those aged 0-30 months, for each kilogram increase in weight, malaria infection increased by 27% (95% CI: 6-53%), and for each centimeter increase in height, it increased by 9% (95% CI: 1-17%), but there were no differences for those aged 30-60 months.
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Affiliation(s)
- Elisabeth Gebreegziabher
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Clarisse Dah
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | | | - Adama Compaoré
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Jérôme Tiansi
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Nestor Dembélé
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Michelle Roh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
- Address correspondence to Catherine Oldenburg, Francis I. Proctor Foundation, University of California San Francisco, 490 Illinois St., Second Floor, San Francisco, CA 94158. E-mail:
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Boyce RM, Muhindo E, Baguma E, Muhindo R, Shem B, François R, Hawke S, Shook-Sa BE, Ntaro M, Nalusaji A, Nyehangane D, Reyes R, Juliano JJ, Siedner MJ, Staedke SG, Mulogo EM. Permethrin-treated baby wraps for the prevention of malaria: results of a randomized controlled pilot study in rural Uganda. Malar J 2022; 21:63. [PMID: 35197060 PMCID: PMC8864600 DOI: 10.1186/s12936-022-04086-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Progress against malaria has stalled and may even be slipping backwards in high-burden countries. This is due to a range of factors including insecticide resistance and mosquito feeding behaviours that limit contact with widely-employed interventions including long-lasting insecticidal nets and indoor-residual spraying. Thus, further innovations in malaria control are urgently needed. Methods The pilot was a randomized, placebo-controlled pilot study of permethrin-treated baby wraps—known locally as lesus—in children 6–18 months of age at a single site in rural western Uganda. Fifty mother–infant pairs were assigned to permethrin-treated or untreated lesus in a 1:1 allocation. Participants and clinical staff were blinded to group assignments through use of sham treatment and re-treatment of lesus. Participants attended scheduled clinic visits every 2 weeks for a total 12 weeks. The primary outcome of interest was the safety of the intervention, assessed as changes in the frequency of use, rates of discontinuation, and incidence of adverse events, such as skin rash. Secondary outcomes included acceptability and feasibility of the intervention as measured through participant satisfaction and completion of study activities, respectively. Results Overall, rates of retention and participation were relatively high with 86.0% (43 of 50) of participants completing all scheduled visits, including 18 (75.0%) and 25 (96.2%) in the intervention and control arms respectively. By the conclusion of the 12-week follow-up period, one adverse event (0.35 events per 100 person-weeks, one-sided 95% CI 0.0–1.65) was reported. Satisfaction with the lesu was high in both groups. In each study arm, there were five incident RDT positive results, but the only PCR-positive results were observed in the control group (n = 2). Conclusions Permethrin-treated baby wraps were well-tolerated and broadly acceptable. Adverse events were infrequent and mild. These findings support future trials seeking to determine the efficacy of treated wraps to prevent P. falciparum malaria infection in young children as a complementary tool to existing household-based interventions. Trial registration: ClinicalTrials.gov Identifier: NCT04102592, Registered 25 September 2019. Available at: https://clinicaltrials.gov/ct2/show/NCT04102592 Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04086-w.
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Affiliation(s)
- Ross M Boyce
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 230, RM 2151, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Enid Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bwambale Shem
- Bugoye Level III Health Center, Uganda Ministry of Health, Kasese, Uganda
| | - Ruthly François
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sam Hawke
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Dan Nyehangane
- Epicentre Mbarara Research Centre, Mbarara, Uganda.,Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raquel Reyes
- Division of Hospital Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jonathan J Juliano
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 230, RM 2151, Chapel Hill, NC, 27599, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Sarah G Staedke
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Muir RK, Guerra M, Bogyo MM. Activity-Based Diagnostics: Recent Advances in the Development of Probes for Use with Diverse Detection Modalities. ACS Chem Biol 2022; 17:281-291. [PMID: 35026106 DOI: 10.1021/acschembio.1c00753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abnormal enzyme expression and activity is a hallmark of many diseases. Activity-based diagnostics are a class of chemical probes that aim to leverage this dysregulated metabolic signature to produce a detectable signal specific to diseased tissue. In this Review, we highlight recent methodologies employed in activity-based diagnostics that provide exquisite signal sensitivity and specificity in complex biological systems for multiple disease states. We divide these examples based upon their unique signal readout modalities and highlight those that have advanced into clinical trials.
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Affiliation(s)
- Ryan K. Muir
- Department of Pathology and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Matteo Guerra
- Department of Pathology and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Matthew M. Bogyo
- Department of Pathology and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305, United States
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7
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Shelus V, Mumbere N, Masereka A, Masika B, Kiitha J, Nyangoma G, Mulogo EM, Barrington C, Baguma E, Muhindo R, Herrington JE, Emch M, Maman S, Boyce RM. "Testing for malaria does not cure any pain" A qualitative study exploring low use of malaria rapid diagnostic tests at drug shops in rural Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001235. [PMID: 36962844 PMCID: PMC10021593 DOI: 10.1371/journal.pgph.0001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
The World Health Organization recommends all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment. Despite recommendations, many fevers presenting at private drug shops are treated presumptively as malaria without diagnostic testing. The purpose of this qualitative study was to describe community perceptions of RDTs and explore ways to improve malaria case management at drug shops in Bugoye, western Uganda. A total of 63 in-depth interviews were conducted between September and December 2021 with 24 drug shop clients, 19 drug shop vendors, 12 community health workers, and 8 health and community officials. Data was analyzed using thematic content analysis and narrative techniques. While drug shop clients valued RDTs, the cost of the test limited their use. Further, mistrust in negative results and fear about treatment options for conditions other than malaria led to nonadherence to negative RDTs. Improvement with antimalarials after a negative RDT, or no RDT at all, was seen as proof an individual had malaria, reinforcing the acceptability of liberal antimalarial use. Drug shop vendors were knowledgeable about malaria case management but financially conflicted between recommending best practices and losing business. While clients viewed drug shop vendors as trusted health professionals, health officials distrusted them as business owners focused on maximizing profits. Study results suggest public-private partnerships that recognize the essential role of drug shops, better incorporate them into the healthcare system, and leverage the high levels of community trust in vendors, could provide greater opportunities for oversight and training to improve private-sector malaria case management. Interventions that address financial barriers to RDT use, emphasize the financial benefits of malaria testing, increase vendor knowledge about illnesses confused with malaria, and improve the quality of vendor-client counseling could increase RDT uptake and improve adherence to RDT results.
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Affiliation(s)
- Victoria Shelus
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Nobert Mumbere
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amos Masereka
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bonita Masika
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joackim Kiitha
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Nyangoma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - James E Herrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael Emch
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ross M Boyce
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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8
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Kassam NA, Kaaya RD, Damian DJ, Schmiegelow C, Kavishe RA, Alifrangis M, Wang CW. Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi. Malar J 2021; 20:193. [PMID: 33879164 PMCID: PMC8056660 DOI: 10.1186/s12936-021-03730-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background High altitude settings in Eastern Africa have been reported to experience increased malaria burden due to vector habitat expansion. This study explored possible associations between malaria test positivity rates and its predictors including malaria control measures and meteorological factors at a high-altitude, low malaria transmission setting, south of Mount Kilimanjaro. Methods Malaria cases reported at the Tanganyika Plantation Company (TPC) hospital’s malaria registers, meteorological data recorded at TPC sugar factory and data on bed nets distributed in Lower Moshi from 2009 to 2018 were studied. Correlation between bed nets distributed and malaria test positivity rates were explored by using Pearson correlation analysis and the associations between malaria test positivity rates and demographic and meteorological variables were determined by logistic regression and negative binomial regression analyses, respectively. Results Malaria cases reported at TPC hospital ranged between 0.48 and 2.26% per year and increased slightly at the introduction of malaria rapid diagnostic tests. The risk of testing positive for malaria were significantly highest among individuals aged between 6 and 15 years (OR = 1.65; 1.65 CI = 1.28–2.13; p = 0.001) and 16–30 years (OR = 1.49; CI = 1.17–1.89; p = 0.001) and when adjusted for age, the risk were significantly higher among male individuals when compared to female individuals (OR = 1.54; 1.00–1.31; p = 0.044). Malaria test positivity rates were positively associated with average monthly minimum temperatures and negatively associated with average monthly maximum temperatures (incidence rate ratio (IRR) = 1.37, 95% confidence interval (CI) = 1.05–1.78, p = 0.019 and IRR = 0.72, 95% CI = 0.58–0.91, p = 0.005, respectively). When analysed with one month lag for predictor variables, malaria test positivity rates were still significantly associated with average monthly minimum and maximum temperatures (IRR = 1.67, 95% CI = 1.28–2.19, p = 0.001 and IRR = 0.68, 95% CI = 0.54–0.85, p = 0.001, respectively). Average monthly rainfall and relative humidity with or without a one month lag was not associated with malaria test positivity rates in the adjusted models. Explopring possible associations between distribution of long-lasting insecticidal nets, (LLINs) and malaria test positivity rates showed no apparent correlation between numbers of LLINs distributed in a particular year and malaria test positivity rates. Conclusion In Lower Moshi, the risk of being tested positive for malaria was highest for older children and male individuals. Higher minimum and lower maximum temperatures were the strongest climatic predictors for malaria test positivity rates. In areas with extensive irrigation activity as in Lower Moshi, vector abundance and thus malaria transmission may be less dependent on rainfall patterns and humidity. Mass distribution of LLINs did not have an effect in this area with already very low malaria transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03730-1.
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Affiliation(s)
- Nancy A Kassam
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania.
| | - Robert D Kaaya
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Damian J Damian
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Reginald A Kavishe
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Christian W Wang
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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9
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Kassaza K, Long AC, McDaniels JM, Andre M, Fredrickson W, Nyehangane D, Orikiriza P, Operario DJ, Bazira J, Mwanga-Amumpaire JA, Moore CC, Guler JL, Boum Y. Surveillance of Plasmodium falciparum pfcrt haplotypes in southwestern uganda by high-resolution melt analysis. Malar J 2021; 20:114. [PMID: 33632242 PMCID: PMC7908690 DOI: 10.1186/s12936-021-03657-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chloroquine (CQ) resistance is conferred by mutations in the Plasmodium falciparum CQ resistance transporter (pfcrt). Following CQ withdrawal for anti-malarial treatment, studies across malaria-endemic countries have shown a range of responses. In some areas, CQ sensitive parasites re-emerge, and in others, mutant haplotypes persist. Active surveillance of resistance mutations in clinical parasites is essential to inform treatment regimens; this effort requires fast, reliable, and cost-effective methods that work on a variety of sample types with reagents accessible in malaria-endemic countries. METHODS Quantitative PCR followed by High-Resolution Melt (HRM) analysis was performed in a field setting to assess pfcrt mutations in two groups of clinical samples from Southwestern Uganda. Group 1 samples (119 in total) were collected in 2010 as predominantly Giemsa-stained slides; Group 2 samples (125 in total) were collected in 2015 as blood spots on filter paper. The Rotor-Gene Q instrument was utilized to assess the impact of different PCR-HRM reagent mixes and the detection of mixed haplotypes present in the clinical samples. Finally, the prevalence of the wild type (CVMNK) and resistant pfcrt haplotypes (CVIET and SVMNT) was evaluated in this understudied Southwestern region of Uganda. RESULTS The sample source (i.e. Giemsa-stained slides or blood spots) and type of LCGreen-based reagent mixes did not impact the success of PCR-HRM. The detection limit of 10- 5 ng and the ability to identify mixed haplotypes as low as 10 % was similar to other HRM platforms. The CVIET haplotype predominated in the clinical samples (66 %, 162/244); however, there was a large regional variation between the sample groups (94 % CVIET in Group 1 and 44 % CVIET in Group 2). CONCLUSIONS The HRM-based method exhibits the flexibility required to conduct reliable assessment of resistance alleles from various sample types generated during the clinical management of malaria. Large regional variations in CQ resistance haplotypes across Southwestern Uganda emphasizes the need for continued local parasite genotype assessment to inform anti-malarial treatment policies.
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Affiliation(s)
- Kennedy Kassaza
- Epicentre Mbarara Research Centre, Mbarara, Uganda
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anna C Long
- Department of Biology, University of Virginia, Box 400328, 22904, Charlottesville, VA, USA
| | - Jennifer M McDaniels
- Department of Biology, University of Virginia, Box 400328, 22904, Charlottesville, VA, USA
| | - Mharlove Andre
- Department of Biology, University of Virginia, Box 400328, 22904, Charlottesville, VA, USA
| | - Wasswa Fredrickson
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22904, USA
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet A Mwanga-Amumpaire
- Epicentre Mbarara Research Centre, Mbarara, Uganda
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christopher C Moore
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22904, USA
| | - Jennifer L Guler
- Department of Biology, University of Virginia, Box 400328, 22904, Charlottesville, VA, USA.
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22904, USA.
| | - Yap Boum
- Epicentre Mbarara Research Centre, Mbarara, Uganda.
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda.
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10
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Chang JL, Reyes R, Matte M, Ntaro M, Mulogo E, Wiens MO, Meshnick SR, Siedner MJ, Boyce RM. Who Stays and Who Goes: Predictors of Admission among Patients Presenting with Febrile Illness and a Positive Malaria Rapid Diagnostic Test in a Rural Ugandan Health Center. Am J Trop Med Hyg 2019; 99:1080-1088. [PMID: 30062988 DOI: 10.4269/ajtmh.18-0338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Not much is known about clinical decision-making in rural, low-resource settings regarding fever, a common reason for presentation to care. In this prospective cohort study of patients presenting with febrile illness to a rural Ugandan health center, we examined demographic and clinical factors predictive of an initial disposition of inpatient admission after clinical evaluation, but before laboratory testing. We then assessed the association of laboratory results and system factors with a change between initial and final disposition plans. Four thousand nine hundred twenty-four patients with suspected febrile illness were included in the primary analysis. The strongest predictors for an initial disposition of admission after clinical examination were impaired consciousness (adjusted risk ratio [aRR], 3.21; 95% confidence interval [CI]: 2.44-4.21) and fever on examination (aRR, 2.27; 95% CI: 1.79-2.87). Providers initially planned to discharge patients with significant vital sign abnormalities, including tachypnea (3.6%) and hypotension (1.3%). Anemia strongly predicted a final disposition of admission after an initial disposition of discharge (aRR, 48.34; 95% CI: 24.22-96.49); other laboratory abnormalities, including hypoglycemia and acidosis, did not change disposition planning. In those with an initial disposition of admission, living farther than the two neighboring villages was associated with a final disposition of discharge (aRR, 2.12; 95% CI: 1.10-4.12). A concerning number of patients with abnormal vital signs and laboratory results were not admitted for inpatient care. Geographic factors may influence a patient's final disposition contrary to a provider's initial disposition plan. Future work should assess longer term outcomes after discharge and a broader study population.
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Affiliation(s)
- Jonathan L Chang
- Duke University School of Medicine, Durham, North Carolina.,School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raquel Reyes
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Matte
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ntaro
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Matthew O Wiens
- Center for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Steven R Meshnick
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark J Siedner
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Mbarara University of Science and Technology, Mbarara, Uganda
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11
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Tello-Cajiao ME, Osorio L. Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia. Am J Trop Med Hyg 2019; 101:696-704. [PMID: 31333163 PMCID: PMC6726934 DOI: 10.4269/ajtmh.19-0222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
Abstract
There is insufficient evidence on whether dengue rapid diagnostic tests (dRDTs) influence clinical decisions in endemic areas. Therefore, our objective was to evaluate the impact of dRDTs on the prescription of antibiotics and anti-inflammatory drugs by physicians in a dengue-endemic area in Colombia. A retrospective cohort study was conducted with 330 patients in Cali, Colombia, between January 2012 and December 2017. The exposure was defined by the result of the dRDT. The outcomes were prescription of antibiotics and anti-inflammatory drugs after results of dRDT. Incidence and RR with 95% CIs were estimated. Multivariate logistic regression models were fitted separately for each outcome. Antibiotics were prescribed in 3% exposed and 14% unexposed. Anti-inflammatory drugs were prescribed in 1.2% exposed and 7.9% unexposed. A positive dRDT reduced the prescription of anti-inflammatories (AdjOR: 0.06, 95% CI: 0.008-0.5) but, by itself, had no effect on antibiotics (AdjOR: 1.1, 95% CI: 0.2-6); however, in hospitalized patients, a positive result reduced the probability of antibiotic prescription (AdjOR: 0.02, 95% CI: 0.00-0.8). Despite limitations of current dRDTs, they influence treatment decisions. Further studies are needed to assess the effect of dRDTs in patient outcomes and health-care costs.
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Affiliation(s)
- María Elena Tello-Cajiao
- Grupo de Epidemiología y Salud Poblacional (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | - Lyda Osorio
- Grupo de Epidemiología y Salud Poblacional (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
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12
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Ogwang R, Akena G, Yeka A, Osier F, Idro R. The 2015-2016 malaria epidemic in Northern Uganda; What are the implications for malaria control interventions? Acta Trop 2018; 188:27-33. [PMID: 30145260 PMCID: PMC7116666 DOI: 10.1016/j.actatropica.2018.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 02/03/2023]
Abstract
Vector control and effective case management are currently the backbone strategies of malaria control. Kitgum district, an area of perennial holoendemic malaria transmission intensity in Northern Uganda, appears to have experienced a malaria epidemic in 2015. This study aimed to describe the malaria trends in Kitgum General Hospital from 2011 to 2017 in relation to climatic factors and the application of population-based malaria control interventions. Hospital records were examined retrospectively to calculate malaria normal channels, malaria cases per 1000 population, test positivity rates (TPR) and to enumerate pregnancy malaria, hospitalizations and deaths. Climatic factors (humidity, temperature and rainfall) and population-based malaria control interventions that had been applied during this period were described. Kitgum district experienced an epidemic between the years 2015 and 2016; the malaria burden rose above the established normal channels. At its peak the number of malaria cases attending KGH was over 20 times above the normal channels. The total number of cases per 1000 population increased from 7 in 2014 to 113 in 2015 and 114 in 2016 (p value for trend <0.0001). Similarly, TPR increased from 10.5% to 54.6% between 2014 and 2016 (p value for trend <0.0001). This trend was also observed for malaria attributable hospitalizations, and malaria in pregnancy. There were no significant changes in any of the climatic factors assessed (p value = 0.92, 0.99, 0.52 for relative humidity, max temperature, and rainfall, respectively). The malaria upsurge occurred in conjunction with a general decline in the use and application of malaria control interventions. Specifically, indoor residual spraying was interrupted in 2014. In response to the epidemic, IRS was reapplied together with mass distribution of long-lasting insecticide treated nets (LLINs) in 2017. Subsequently, there was a decline in all malaria indicators. The epidemic in Kitgum occurred in association with the interruption of IRS and appears to have abated following its re-introduction alongside LLINs. The study suggests that to enable malaria elimination in areas of high malaria transmission intensity, effective control measures may need to be sustained for the long-term.
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Affiliation(s)
- Rodney Ogwang
- Makerere University College of Health Sciences, Kampala, Uganda; Centre of Tropical Neuroscience, Kitgum Site, Uganda
| | | | - Adoke Yeka
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Faith Osier
- Centre for Infectious Diseases, Parasitology Heidelberg University Hospital, Heidelberg, Germany; KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda; Centre of Tropical Neuroscience, Kitgum Site, Uganda; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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13
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Tsukahara T, Sugahara T, Furusawa T, Hombhanje FW. Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea. Front Public Health 2018; 6:75. [PMID: 29594096 PMCID: PMC5859013 DOI: 10.3389/fpubh.2018.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Methods Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Results Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval −0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. Conclusion The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers’ preferences toward girls.
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Affiliation(s)
- Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuma Sugahara
- Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | - Francis Wanak Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
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14
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Improving the Specificity of Plasmodium falciparum Malaria Diagnosis in High-Transmission Settings with a Two-Step Rapid Diagnostic Test and Microscopy Algorithm. J Clin Microbiol 2017; 55:1540-1549. [PMID: 28275077 DOI: 10.1128/jcm.00130-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/02/2017] [Indexed: 11/20/2022] Open
Abstract
Poor specificity may negatively impact rapid diagnostic test (RDT)-based diagnostic strategies for malaria. We performed real-time PCR on a subset of subjects who had undergone diagnostic testing with a multiple-antigen (histidine-rich protein 2 and pan-lactate dehydrogenase pLDH [HRP2/pLDH]) RDT and microscopy. We determined the sensitivity and specificity of the RDT in comparison to results of PCR for the detection of Plasmodium falciparum malaria. We developed and evaluated a two-step algorithm utilizing the multiple-antigen RDT to screen patients, followed by confirmatory microscopy for those individuals with HRP2-positive (HRP2+)/pLDH-negative (pLDH-) results. In total, dried blood spots (DBS) were collected from 276 individuals. There were 124 (44.9%) individuals with an HRP2+/pLDH+ result, 94 (34.1%) with an HRP2+/pLDH- result, and 58 (21%) with a negative RDT result. The sensitivity and specificity of the RDT compared to results with real-time PCR were 99.4% (95% confidence interval [CI], 95.9 to 100.0%) and 46.7% (95% CI, 37.7 to 55.9%), respectively. Of the 94 HRP2+/pLDH- results, only 32 (34.0%) and 35 (37.2%) were positive by microscopy and PCR, respectively. The sensitivity and specificity of the two-step algorithm compared to results with real-time PCR were 95.5% (95% CI, 90.5 to 98.0%) and 91.0% (95% CI, 84.1 to 95.2), respectively. HRP2 antigen bands demonstrated poor specificity for the diagnosis of malaria compared to that of real-time PCR in a high-transmission setting. The most likely explanation for this finding is the persistence of HRP2 antigenemia following treatment of an acute infection. The two-step diagnostic algorithm utilizing microscopy as a confirmatory test for indeterminate HRP2+/pLDH- results showed significantly improved specificity with little loss of sensitivity in a high-transmission setting.
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15
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Yegorov S, Galiwango RM, Ssemaganda A, Muwanga M, Wesonga I, Miiro G, Drajole DA, Kain KC, Kiwanuka N, Bagaya BS, Kaul R. Low prevalence of laboratory-confirmed malaria in clinically diagnosed adult women from the Wakiso district of Uganda. Malar J 2016; 15:555. [PMID: 27842555 PMCID: PMC5109652 DOI: 10.1186/s12936-016-1604-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022] Open
Abstract
Background The malaria burden in sub-Saharan Africa (SSA) has fallen substantially. Nevertheless, malaria remains a serious health concern, and Uganda ranks third in SSA in total malaria burden. Epidemiological studies of adult malaria in Uganda are scarce and little is known about rates of malaria in non-pregnant adult women. This pilot study assessed malaria prevalence among adult women from Wakiso district, historically a highly malaria endemic region. Methods Adult women using public health services were screened for malaria, HIV and pregnancy. A physician-selected subset of women presenting to the Outpatient Department of Entebbe General Hospital (EGH) with current fever (axillary temperature ≥37.5 °C) or self-reporting fever during the previous 24 h, and a positive thick smear for malaria in the EGH laboratory were enrolled (n = 86). Women who self-identified as pregnant or HIV-positive were excluded from screening. Malaria infection was then assessed using HRP2/pLDH rapid diagnostic tests (RDTs) in all participants. Repeat microscopy and PCR were performed at a research laboratory for a subset of participants. In addition, 104 women without a history of fever were assessed for asymptomatic parasitaemia using RDT, and a subset of these women screened for parasitaemia using microscopy (40 women) and PCR (40 women). Results Of 86 women diagnosed with malaria by EGH, only two (2.3%) had malaria confirmed using RDT, subsequently identified as a Plasmodium falciparum infection by research microscopy and PCR. Subset analysis of hospital diagnosed RDT-negative participants detected one sub-microscopic infection with Plasmodium ovale. Compared to RDT, sensitivity, specificity and PPV of hospital microscopy were 100% (CI 19.8–100), 0% (CI 0–5.32) and 2.33% (CI 0.403–8.94) respectively. Compared to PCR, sensitivity, specificity and PPV of hospital microscopy were 100% (CI 31.0–100), 0% (CI 0–34.5) and 23.1% (CI 6.16–54.0), respectively. No malaria was detected among asymptomatic women using RDT, research microscopy or PCR. Conclusions Malaria prevalence among adult women appears to be low in Wakiso, but is masked by high rates of malaria overdiagnosis. More accurate malaria testing is urgently needed in public hospitals in this region to identify true causes of febrile illness and reduce unnecessary provision of anti-malarial therapy.
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Affiliation(s)
- Sergey Yegorov
- Departments of Medicine and Immunology, University of Toronto, 1 King's College Circle, 6356, Toronto, ON, M5S1A8, Canada.
| | - Ronald M Galiwango
- Departments of Medicine and Immunology, University of Toronto, 1 King's College Circle, 6356, Toronto, ON, M5S1A8, Canada
| | - Aloysious Ssemaganda
- UVRI-IAVI HIV Vaccine Program, Plot 50-55 Nakiwogo Road, Entebbe, Uganda.,Institute for Glycomics, Griffith University, Gold Coast, Parklands Drive, Southport, QLD, 4215, Australia
| | - Moses Muwanga
- Entebbe General Hospital, P.O. Box 29, Entebbe, Uganda
| | - Irene Wesonga
- Entebbe General Hospital, P.O. Box 29, Entebbe, Uganda
| | - George Miiro
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - David A Drajole
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Kevin C Kain
- Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, MaRS Centre, University Health Network, 101 College St. TMDT 10-360A, Toronto, ON, M5G1L7, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Plot 50-55 Nakiwogo Road, Entebbe, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Bernard S Bagaya
- UVRI-IAVI HIV Vaccine Program, Plot 50-55 Nakiwogo Road, Entebbe, Uganda.,Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rupert Kaul
- Departments of Medicine and Immunology, University of Toronto, 1 King's College Circle, 6356, Toronto, ON, M5S1A8, Canada
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16
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Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Metlay JP, Band L, Siedner MJ. Severe Flooding and Malaria Transmission in the Western Ugandan Highlands: Implications for Disease Control in an Era of Global Climate Change. J Infect Dis 2016; 214:1403-1410. [PMID: 27534686 DOI: 10.1093/infdis/jiw363] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/28/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There are several mechanisms by which global climate change may impact malaria transmission. We sought to assess how the increased frequency of extreme precipitation events associated with global climate change will influence malaria transmission in highland areas of East Africa. METHODS We used a differences-in-differences, quasi-experimental design to examine spatial variability in the incidence rate of laboratory-confirmed malaria cases and malaria-related hospitalizations between villages (1) at high versus low elevations, (2) with versus without rivers, and (3) upstream versus downstream before and after severe flooding that occurred in Kasese District, Western Region, Uganda, in May 2013. RESULTS During the study period, 7596 diagnostic tests were performed, and 1285 patients were admitted with a diagnosis of malaria. We observed that extreme flooding resulted in an increase of approximately 30% in the risk of an individual having a positive result of a malaria diagnostic test in the postflood period in villages bordering a flood-affected river, compared with villages farther from a river, with a larger relative impact on upstream versus downstream villages (adjusted rate ratio, 1.91 vs 1.33). CONCLUSIONS Extreme precipitation such as the flooding described here may pose significant challenges to malaria control programs and will demand timely responses to mitigate deleterious impacts on human health.
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Affiliation(s)
| | - Raquel Reyes
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine
| | - Michael Matte
- Department of Community Health, Mbarara University of Science and Technology, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Uganda
| | - Joshua P Metlay
- Division of General Internal Medicine, Massachusetts General Hospital
| | - Lawrence Band
- Department of Geography, University of North Carolina, Chapel Hill
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston
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Audu R, Anto BP, Koffuor GA, Abruquah AA, Buabeng KO. Malaria rapid diagnostic test evaluation at private retail pharmacies in Kumasi, Ghana. J Res Pharm Pract 2016; 5:175-80. [PMID: 27512708 PMCID: PMC4966236 DOI: 10.4103/2279-042x.185723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management. Methods: In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated. Findings: While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43. Conclusion: Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation.
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Affiliation(s)
- Rauf Audu
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kama Health Service, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Berko Panyin Anto
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asumeng Koffuor
- Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kwame Ohene Buabeng
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kasetsirikul S, Buranapong J, Srituravanich W, Kaewthamasorn M, Pimpin A. The development of malaria diagnostic techniques: a review of the approaches with focus on dielectrophoretic and magnetophoretic methods. Malar J 2016; 15:358. [PMID: 27405995 PMCID: PMC4942956 DOI: 10.1186/s12936-016-1400-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
The large number of deaths caused by malaria each year has increased interest in the development of effective malaria diagnoses. At the early-stage of infection, patients show non-specific symptoms or are asymptomatic, which makes it difficult for clinical diagnosis, especially in non-endemic areas. Alternative diagnostic methods that are timely and effective are required to identify infections, particularly in field settings. This article reviews conventional malaria diagnostic methods together with recently developed techniques for both malaria detection and infected erythrocyte separation. Although many alternative techniques have recently been proposed and studied, dielectrophoretic and magnetophoretic approaches are among the promising new techniques due to their high specificity for malaria parasite-infected red blood cells. The two approaches are discussed in detail, including their principles, types, applications and limitations. In addition, other recently developed techniques, such as cell deformability and morphology, are also overviewed in this article.
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Affiliation(s)
- Surasak Kasetsirikul
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Jirayut Buranapong
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Werayut Srituravanich
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Morakot Kaewthamasorn
- Animal Vector-Borne Diseases Research Group, The Veterinary Parasitology Unit, Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Alongkorn Pimpin
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand.
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Boyce RM, Reyes R, Matte M, Ntaro M, Mulogo E, Lin FC, Siedner MJ. Practical Implications of the Non-Linear Relationship between the Test Positivity Rate and Malaria Incidence. PLoS One 2016; 11:e0152410. [PMID: 27018990 PMCID: PMC4809590 DOI: 10.1371/journal.pone.0152410] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/14/2016] [Indexed: 11/29/2022] Open
Abstract
Background The test positivity rate (TPR), defined as the number of laboratory-confirmed malaria tests per 100 suspected cases examined, is widely used by malaria surveillance programs as one of several key indicators of temporal trends in malaria incidence. However, there have been few studies using empiric data to examine the quantitative nature of this relationship. Methods To characterize the relationship between the test positivity rate and the incidence of malaria, we fit regression models using the confirmed malaria case rate as the outcome of interest and TPR as the predictor of interest. We varied the relationship between the two by alternating linear and polynomial terms for TPR, and compared the goodness of fit of each model. Results A total of 7,668 encounters for malaria diagnostic testing were recorded over the study period within a catchment area of 25,617 persons. The semi-annual TPR ranged from 4.5% to 59% and the case rates ranged from 0.5 to 560 per 1,000 persons. The best fitting model was an exponential growth model (R2 = 0.80, AIC = 637). At low transmission levels (TPR<10%), the correlation between TPR and CMCR was poor, with large reductions in the TPR, for example from 10% to 1%, was associated with a minimal change in the CMCR (3.9 to 1.7 cases per 1,000 persons). At higher transmission levels, the exponential relationship made relatively small changes in TPR suggestive of sizeable change in estimated malaria incidence, suggesting that TPR remains a valuable surveillance indicator in such settings. Conclusions The TPR and the confirmed malaria case rate have a non-linear relationship, which is likely to have important implications for malaria surveillance programs, especially at the extremes of transmission.
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Affiliation(s)
- Ross M. Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
- * E-mail:
| | - Raquel Reyes
- Division of General Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Mark J. Siedner
- Department of Medicine, Harvard Medical School, and Massachusetts General Hospital, Boston, United States of America
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20
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Boyce RM, Reyes R, Shem B. The Health Centre Community. Int J Epidemiol 2016; 45:29-32. [PMID: 26971320 DOI: 10.1093/ije/dyv371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Raquel Reyes
- Division of General Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA and
| | - Bwambale Shem
- Bugoye Health Centre Level III, Uganda Ministry of Health, Kasese District, Western Region Uganda
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Brembilla A, Mauny F, Garcia A, Koura KG, Deloron P, Faucher JF. Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study. Eur J Clin Microbiol Infect Dis 2016; 35:681-9. [PMID: 26864042 DOI: 10.1007/s10096-016-2587-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023]
Abstract
Data centered on antibiotics usage and their determinants in African pediatric populations are limited. In order to define the determinants of antibiotics prescriptions (ABPr), we analyzed the data of a birth cohort in Benin. From 2007 to 2009, 538 infants were followed from birth to 18 months in three different health centers. The following determinants were assessed: infants' clinical findings at consultations, mothers' and children's characteristics at birth, and health parameters recorded at scheduled follow-up of general health parameters. Multilevel logistic models were performed for analysis. Among the 4394 consultations, fever represented 53.7 % of consultations, 64.1 % of which were non-malarial fevers. Antibiotics were prescribed during 44.2 % of the consultations and the proportion of ABPr differed significantly among health centers (p < 10(-3)). Nearly 40 % of ABPr were related to children without fever. During the first semester of life, the percentage of ABPr was twice lower than after (27.4 vs. 54.7, p < 10(-3)). Respiratory and enteric symptoms were positively associated with ABPr (p < 10(-3)). Malaria was significantly associated with a lower ABPr after the first semester [odds ratio (OR) = 0.55, 95 % confidence interval (CI) = 0.44-0.67, p < 10(-3)]. No maternal and child at-birth characteristics were associated with ABPr. ABPr was positively associated with a low breastfeeding score (p < 10(-3)). Studies on the rational use of antibiotics in this population should give priority to children more than 6 months of age, without malaria, and with respiratory and/or enteric symptoms. Our data also advocate for studies specifically designed to assess and improve healthcare providers' compliance to guidelines on antibiotics usage.
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Affiliation(s)
- A Brembilla
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France. .,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France.
| | - F Mauny
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France
| | - A Garcia
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - K G Koura
- Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France
| | - P Deloron
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - J-F Faucher
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
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