Declining Burden of Malaria Over two Decades in a Rural Community of Muheza District, North-Eastern Tanzania.

The recently reported declining burden of malaria in some African countries has been attributed to scaling-up of different interventions although in some areas, these changes started before implementation of major interventions. This study assessed the long-term trends of malaria burden for 20 years (1992--2012) in Magoda and for 15 years in Mpapayu village of Muheza district, north-eastern Tanzania, in relation to different interventions as well as changing national malaria control policies.\ud Repeated cross-sectional surveys recruited individuals aged 0 -- 19 years from the two villages whereby blood smears were collected for detection of malaria parasites by microscopy. Prevalence of Plasmodium falciparum infections and other indices of malaria burden (prevalence of anaemia, splenomegaly and gametocytes) were compared across the years and between the study villages. Major interventions deployed including mobile clinic, bed nets and other research activities, and changes in national malaria control policies were also marked. In Magoda, the prevalence of P. falciparum infections initially decreased between 1992 and 1996 (from 83.5 to 62.0%), stabilized between 1996 and 1997, and further declined to 34.4% in 2004. A temporary increase between 2004 and 2008 was followed by a progressive decline to 7.2% in 2012, which is more than 10-fold decrease since 1992. In Mpapayu (from 1998), the highest prevalence was 81.5% in 1999 and it decreased to 25% in 2004. After a slight increase in 2008, a steady decline followed, reaching <5% from 2011 onwards. Bed net usage was high in both villages from 1999 to 2004 (>=88%) but it decreased between 2008 and 2012 (range, 28% - 68%). After adjusting for the effects of bed nets, age, fever and year of study, the risk of P. falciparum infections decreased significantly by >=97% in both villages between 1999 and 2012 (p < 0.001). The prevalence of splenomegaly (>40% to <1%) and gametocytes (23% to <1%) also decreased in both villages.Discussion and conclusionsA remarkable decline in the burden of malaria occurred between 1992 and 2012 and the initial decline (1992 -- 2004) was most likely due to deployment of interventions, such as bed nets, and better services through research activities. Apart from changes of drug policies, the steady decline observed from 2008 occurred when bed net coverage was low suggesting that other factors contributed to the most recent pattern. These results suggest that continued monitoring is required to determine causes of the changing malaria epidemiology and also to monitor the progress towards maintaining low malaria transmission and reaching related millennium development goals

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed

US food allergy patients’ experiences, priorities, and needs: A qualitative study

Background: Understanding patient experiences with food allergies (FAs) is essential for developing treatments that meet patients’ needs and aiding clinicians in optimizing care. Objective: We sought to provide clinicians and researchers with an inclusive view of IgE-mediated FA patients’ experiences, including (1) FA’s natural history, including signs, symptoms, health system experiences, and diagnosis pathways; (2) the disease’s burden and psychosocial impacts on individuals and families; (3) perspectives on treatment attributes, benefits, and clinical trial participation; and (4) topics and resources patients and caregivers seek regarding FAs. Enhanced understanding of these challenges and opportunities can improve personalized care and patient outcomes. Methods: We conducted virtual interviews with 81 US residents with at least 1 physician-confirmed IgE-mediated FA. Interviews lasted up to 60 minutes. All participants were required to self-report a history of severe allergic reactions. Recruitment was via social media, health care providers, and patient advocacy organizations. Results: Most participants had multiple FAs, with peanuts and/or tree nuts (86%) being the most common. Common reaction types were skin/mouth (91%), respiratory (65%), and gastrointestinal (53%). Key diagnosis pathways included seeking urgent/emergency care after severe reactions and discussing moderate symptoms with primary care doctors. Barriers to diagnosis included long allergist wait times, travel, and other commitments. Most participants with epinephrine autoinjectors felt confident using them due to prior training. FA impacts varied, from minor daily disruptions to significant emotional, social, educational, and career challenges, mainly due to allergen avoidance efforts. Most participants (59%) showed an interest in clinical trials, influenced by potential risks and benefits, trial type, location, accessibility, and child willingness. Despite valuing epinephrine autoinjectors, participants noted unmet needs such as inconvenience, high costs, short expiration dates, and shortages. Desired treatment benefits included proactive treatments enabling allergen ingestion without symptoms and more information on FA management. Conclusions: This study offers insights into the diverse needs of IgE-mediated FA patients, highlighting the importance of comprehensive clinician awareness to enhance personalized care, optimize patient experiences, and improve outcomes. Addressing financial barriers and unmet needs through a team approach, clear communication, psychosocial support, and accessible resources is essential