Risk associated with asymptomatic parasitaemia occurring post-antimalarial treatment

OBJECTIVE: Parasites may recur asymptomatically after initial clearance by antimalarial treatment. Current guidelines recommend treatment only when patients develop symptoms or at the end of follow-up. We wanted to assess prospectively the probability of becoming symptomatic and the risks of this practice. METHODS: We analysed data collected in 13 trials of uncomplicated paediatric malaria conducted in eight sub-Saharan African countries. These studies followed all cases of post-treatment asymptomatic parasitaemia until they developed symptoms or to the end of the 28-day follow-up period, at which time parasite genotypes were compared to pre-treatment isolates to distinguish between recrudescences and new infections. RESULTS: There were 425 asymptomatic recurrences after 2576 treatments with either chloroquine, sulfadoxine/pyrimethamine or amodiaquine, of which 225 occurred by day 14 and 200 between day 15 and day 28. By day 28, 42% developed fever (median time to fever = 5 days) and 30% remained parasitaemic but afebrile, while 23% cleared their parasites (outcome unknown in 4%). Young age, parasitaemia >/=500 parasites/microl; onset of parasitaemia after day 14, and treatment with amodiaquine were the main variables associated with higher risk of developing fever. CONCLUSION: In areas of moderate to intense transmission, asymptomatic recurrences of malaria after treatment carry a substantial risk of becoming ill within a few days and should be treated as discovered. Young children are at higher risk. The higher risk carried by cases occurring in the second half of follow-up may be explained by falling residual drug levels

Treatment of malaria restricted to laboratory-confirmed cases: a prospective cohort study in Ugandan children.

BACKGROUND: Presumptive treatment of malaria in febrile children is widely advocated in Africa. This may occur in the absence of diagnostic testing or even when diagnostic testing is performed but fails to detect malaria parasites. Such over-treatment of malaria has been tolerated in the era of inexpensive and safe monotherapy. However, with the introduction of new artemisinin-based combination therapy (ACT), presumptive treatment becomes economically and clinically less acceptable. METHODS: The risks and benefits of only treating children with microscopy confirmed malaria using a prospective cohort design were investigated. A representative sample of 601 children between one and 10 years of age were recruited from a census population in Kampala, Uganda and were followed for all of their health care needs in a study clinic. Standard microscopy was performed each time a child presented with a new episode of fever and antimalarial therapy given only if the blood smear was positive. RESULTS: Of 5,895 visits for new medical problems 40% were for febrile illnesses. Of the 2,359 episodes of new febrile illnesses, blood smears were initially reported as negative in 1,608 (68%) and no antimalarial therapy was given. Six of these initially negative smears were reported to be positive following quality control reading of all blood smears: four of these patients were subsequently diagnosed with uncomplicated malaria and two cleared their parasites without antimalarial treatment. Of the 1,602 new febrile illnesses in which the final blood smear reading was classified as negative, only 13 episodes (0.8%) were diagnosed with malaria in the subsequent 7 days. All 13 of these episodes of malaria were uncomplicated and were successfully treated. CONCLUSION: In this urban setting, malaria was responsible for only 32% of febrile episodes. Withholding antimalarial therapy in febrile children with negative blood smears was safe and saved over 1,600 antimalarial treatments in 601 children over an 18-month period. In the era of expensive ACT, directing resources towards improving diagnostic and treatment practices may provide a cost-effective measure for promoting rational use of antimalarial therapy

Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial

OBJECTIVES: To assess if the clinical outcome of patients treated after performing a Rapid Diagnostic Test for malaria (RDT) is at least equivalent to that of controls (treated presumptively without test) and to determine the impact of the introduction of a malaria RDT on clinical decisions. METHODS: Randomized, multi-centre, open clinical trial in two arms in 2006 at the end of the dry and of the rainy season in 10 peripheral health centres in Burkina Faso: one arm with use of RDT before treatment decision, one arm managed clinically. Primary endpoint: persistence of fever at day 4. Secondary endpoints: frequency of malaria treatment and of antibiotic treatment. RESULTS: A total of 852 febrile patients were recruited in the dry season and 1317 febrile patients in the rainy season, and randomized either to be submitted to RDT (P_RTD) or to be managed presumptively (P_CLIN). In both seasons, no significant difference was found between the two randomized groups in the frequency of antimalarial treatment, nor of antibiotic prescription. In the dry season, 80.8% and 79.8% of patients with a negative RDT were nevertheless diagnosed and treated for malaria, and so were 85.0% and 82.6% negative patients in the rainy season. In the rainy season only, both diagnosis and treatment of other conditions were significantly less frequent in RDT positive vs. negative patients (48.3% vs. 61.4% and 46.2% vs. 59.9%, P = 0.00 and 0.00, respectively). CONCLUSION: Our study was inconclusive on RDT safety (clinical outcome in the two randomized groups), because of an exceedingly and unexpectedly low compliance with the negative test result. Further research is needed on best strategies to promote adherence and on the safety of a test based strategy compared with the current, presumptive treatment strategy

The place of giftedness in the Nigerian education system

This paper had made serious effort in defining the concept “giftedness”. It went further to discuss the place of giftedness in Nigerian education system in the light of the recommendation of the national policy on education, disregard for merit in our society, the menace of our quota system syndrome, and tribal sentiments in the country. Consequently, in conclusion among other things the paper suggested that merit should not be compromised with, for any reason. The school system, educators, planners, administrators, counsellors, psychologists and government should play their parts in identifying and developing the gifted persons early enough, as doing this would mean developing the nation technologically and otherwise, for self-reliance and nation building

Clinical Performance of an Automated Reader in Interpreting Malaria Rapid Diagnostic Tests in Tanzania.

Parasitological confirmation of malaria is now recommended in all febrile patients by the World Health Organization (WHO) to reduce inappropriate use of anti-malarial drugs. Widespread implementation of rapid diagnostic tests (RDTs) is regarded as an effective strategy to achieve this goal. However, the quality of diagnosis provided by RDTs in remote rural dispensaries and health centres is not ideal. Feasible RDT quality control programmes in these settings are challenging. Collection of information regarding diagnostic events is also very deficient in low-resource countries. A prospective cohort of consecutive patients aged more than one year from both genders, seeking routine care for febrile episodes at dispensaries located in the Bagamoyo district of Tanzania, were enrolled into the study after signing an informed consent form. Blood samples were taken for thick blood smear (TBS) microscopic examination and malaria RDT (SD Bioline Malaria Antigen Pf/PanTM (SD RDT)). RDT results were interpreted by both visual interpretation and DekiReaderTM device. Results of visual interpretation were used for case management purposes. Microscopy was considered the "gold standard test" to assess the sensitivity and specificity of the DekiReader interpretation and to compare it to visual interpretation. In total, 1,346 febrile subjects were included in the final analysis. The SD RDT, when used in conjunction with the DekiReader and upon visual interpretation, had sensitivities of 95.3% (95% CI, 90.6-97.7) and 94.7% (95% CI, 89.8--97.3) respectively, and specificities of 94.6% (95% CI, 93.5--96.1) and 95.6% (95% CI, 94.2--96.6), respectively to gold standard. There was a high percentage of overall agreement between the two methods of interpretation. The sensitivity and specificity of the DekiReader in interpretation of SD RDTs were comparable to previous reports and showed high agreement to visual interpretation (>98%). The results of the study reflect the situation in real practice and show good performance characteristics of DekiReader on interpreting malaria RDTs in the hands of local laboratory technicians. They also suggest that a system like this could provide great benefits to the health care system. Further studies to look at ease of use by community health workers, and cost benefit of the system are warranted

Information Technology as a Mechanism for Educational Transformations in a Changing Society

Education is a definite and ground-breaking channel for a high standard of living, an opportunity for intellectual interactions, social networking amongst current academic professionals, college and university graduates, at local, state, and community. The primary purpose of life-long education is to promote personal and professional development, and advancement of the national and world economy. Ancient times support the premise that after continued self-regulating attempts, the time has come for current and future graduates, professionals, and the entire education community to focus on the primacy of computer information technology, which has widened human access to vital data, video, and information transmission and communication, also created an irreversible phenomenon in instruction and learning endeavors, and continues to serve as the best medium for multiple sources of information and communication. The emergence of computer information technology has equally created a wide range of opportunities for greater production; doing away with the lingering global language barriers, and creating a working podium in the academic and political world. It is a proven tenet that the continued use of computer information technology and associated devices such as the Internet, mobile telephones, and electronic mail for data, information transmission, and communication has improved the standard of living and enhanced the exchange of ideas, effective method of learning endeavours, a decrease in alarming attrition rate of students dropping out of the degree programmes and improvement in academic performance

Exploring preparedness of social workers to address the environmental justice issue in communities: the case of selected dumping sites in King Sabata Dalindyebo (KSD) municipality, Eastern Cape

Social workers are mandated to address environmental justice issues as part of working towards promoting community and environmental sustainability within and between communities. This thesis reports from a research study that was aimed at exploring the preparedness of social workers to address pollution in King Sabata Dalindyebo communities with the objective to: understand the social work intervention strategies social workers use to address pollution in KSD communities; identify the challenges if any social workers face when addressing pollution in KSD communities; and explore the confidence of social workers when addressing pollution in KSD communities. To achieve its aim and objectives, this study was exclusively informed by a qualitative research approach and thus utilised an explorative case study design to obtain in-depth qualitative data. Semi-structured interviews were conducted with twelve social workers using a semi-structured interview guide. The interviewed social workers were sampled utilizing convenience and snowball sampling techniques. Mass collected data was analysed thematically and thus presented according to themes and subthemes. Findings indicated that social workers are not sufficiently prepared to address pollution in KSD communities because of lack of environmental education and training, coupled with lack of enabling resources. Therefore, this study recommended environmental social work education and training through organisational workshops as well as improved support and resourcing. This study also recommended a future study that will explore the progress of social work towards promoting environmental sustainability in communities.Thesis (MSW) -- Faculty of Social Sciences and Humanities, 202

Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa.

Guido Bastiaens and colleagues describe barriers to achieving scale-up and appropriate use of rapid diagnostic tests and artemisinin-based combination therapy for malaria in sub-Saharan Africa. Please see later in the article for the Editors' Summary

Exploring preparedness of social workers to address the environmental justice issue in communities: the case of selected dumping sites in King Sabata Dalindyebo (KSD) municipality, Eastern Cape

Social workers are mandated to address environmental justice issues as part of working towards promoting community and environmental sustainability within and between communities. This thesis reports from a research study that was aimed at exploring the preparedness of social workers to address pollution in King Sabata Dalindyebo communities with the objective to: understand the social work intervention strategies social workers use to address pollution in KSD communities; identify the challenges if any social workers face when addressing pollution in KSD communities; and explore the confidence of social workers when addressing pollution in KSD communities. To achieve its aim and objectives, this study was exclusively informed by a qualitative research approach and thus utilised an explorative case study design to obtain in-depth qualitative data. Semi-structured interviews were conducted with twelve social workers using a semi-structured interview guide. The interviewed social workers were sampled utilizing convenience and snowball sampling techniques. Mass collected data was analysed thematically and thus presented according to themes and subthemes. Findings indicated that social workers are not sufficiently prepared to address pollution in KSD communities because of lack of environmental education and training, coupled with lack of enabling resources. Therefore, this study recommended environmental social work education and training through organisational workshops as well as improved support and resourcing. This study also recommended a future study that will explore the progress of social work towards promoting environmental sustainability in communities.Thesis (MSW) -- Faculty of Social Sciences and Humanities, 202

Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment

BACKGROUND: Studies of malaria in well-defined cohorts offer important data about the epidemiology of this complex disease, but few have been done in urban African populations. To generate a sampling frame for a longitudinal study of malaria incidence and treatment in Kampala, Uganda, a census, mapping and survey project was conducted. METHODS: All households in a geographically defined area were enumerated and mapped. Probability sampling was used to recruit a representative sample of children and collect baseline descriptive data for future longitudinal studies. RESULTS: 16,172 residents living in 4931 households in a densely-populated community (18,824 persons/km(2)) were enumerated. A total of 582 households were approached with at least one child less than 10 years of age in order to recruit 601 children living in 322 households. At enrollment, 19% were parasitaemic, 24% were anaemic, 43% used bednets, and 6% used insecticide-treated nets. Low G6PD activity (OR = 0.33, P = 0.009) and bednet use (OR = 0.64, P = 0.045) were associated with a decreased risk of parasitaemia. Increasing age (OR = 0.62 for each year, P < 0.001) and bednet use (OR = 0.58, P = 0.02) were associated with a decreased risk of anaemia CONCLUSION: Detailed surveys of target populations in urban Africa can provide valuable descriptive data and provide a sampling frame for recruitment of representative cohorts for longitudinal studies. Plans to use a multi-disciplinary approach to improve the understanding of the distribution and determinants of malaria incidence and response to therapy in this population are discussed