Artemisinin derivatives versus quinine in treating severe malaria in children: a systematic review

<p>Abstract</p> <p>Background</p> <p>The efficacy of intravenous quinine, which is the mainstay for treating severe malaria in children, is decreasing in South East Asia and Africa. Artemisinin derivatives are a potential alternative to quinine. However, their efficacy compared to quinine in treating severe malaria in children is not clearly understood. The objective of this review was to assess the efficacy of parenteral artemisinin derivatives versus parenteral quinine in treating severe malaria in children.</p> <p>Methods</p> <p>All randomized controlled studies comparing parenteral artemisinin derivatives with parenteral quinine in treating severe malaria in children were included in the review. Data bases searched were: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to February 2008), EMBASE (1980 to February 2008), and LILACS (1982 to February 2008). Dichotomous variables were compared using risk ratios (RR) and the continuous data using weighted mean difference (WMD).</p> <p>Results</p> <p>Twelve trials were included (1,524 subjects). There was no difference in mortality between artemisinin derivatives and quinine (RR = 0.90, 95% CI 0.73 to 1.12). The artemisinin derivatives resolved coma faster than quinine (WMD = -4.61, 95% CI: -7.21 to -2.00, fixed effect model), but when trials with adequate concealment only were considered this differences disappeared. There was no statistically significant difference between the two groups in parasite clearance time, fever clearance time, incidence of neurological sequelae and 28^thday cure rate. One trial reported significantly more local reactions at the injection site with intramuscular quinine compared to artemether. None of the trials was adequately powered to demonstrate equivalence.</p> <p>Conclusion</p> <p>There was no evidence that treatment of children with severe malaria with parenteral artemisinin derivatives was associated with lower mortality or long-term morbidity compared to parenteral quinine. Future studies require adequately powered equivalence trial design to decide whether both drugs are equally effective.</p

Effect of meteorological factors on clinical malaria risk among children: an assessment using village-based meteorological stations and community-based parasitological survey

<p>Abstract</p> <p>Background</p> <p>Temperature, rainfall and humidity have been widely associated with the dynamics of malaria vector population and, therefore, with spread of the disease. However, at the local scale, there is a lack of a systematic quantification of the effect of these factors on malaria transmission. Further, most attempts to quantify this effect are based on proxy meteorological data acquired from satellites or interpolated from a different scale. This has led to controversies about the contribution of climate change to malaria transmission risk among others. Our study addresses the original question of relating meteorological factors measured at the local scale with malaria infection, using data collected at the same time and scale.</p> <p>Methods</p> <p>676 children (6–59 months) were selected randomly from three ecologically different sites (urban and rural). During weekly home visits between December 1, 2003, and November 30, 2004, fieldworkers tested children with fever for clinical malaria. They also collected data on possible confounders monthly. Digital meteorological stations measured ambient temperature, humidity, and rainfall in each site. Logistic regression was used to estimate the risk of clinical malaria given the previous month's meteorological conditions.</p> <p>Results</p> <p>The overall incidence of clinical malaria over the study period was 1.07 episodes per child. Meteorological factors were associated with clinical malaria with mean temperature having the largest effect.</p> <p>Conclusion</p> <p>Temperature was the best predictor for clinical malaria among children under five. A systematic measurement of local temperature through ground stations and integration of such data in the routine health information system could support assessment of malaria transmission risk at the district level for well-targeted control efforts.</p

Coquillettidia (Culicidae, Diptera) mosquitoes are natural vectors of avian malaria in Africa

<p>Abstract</p> <p>Background</p> <p>The mosquito vectors of <it>Plasmodium </it>spp. have largely been overlooked in studies of ecology and evolution of avian malaria and other vertebrates in wildlife.</p> <p>Methods</p> <p><it>Plasmodium </it>DNA from wild-caught <it>Coquillettidia </it>spp. collected from lowland forests in Cameroon was isolated and sequenced using nested PCR. Female <it>Coquillettidia aurites </it>were also dissected and salivary glands were isolated and microscopically examined for the presence of sporozoites.</p> <p>Results</p> <p>In total, 33% (85/256) of mosquito pools tested positive for avian <it>Plasmodium </it>spp., harbouring at least eight distinct parasite lineages. Sporozoites of <it>Plasmodium </it>spp. were recorded in salivary glands of <it>C. aurites </it>supporting the PCR data that the parasites complete development in these mosquitoes. Results suggest <it>C. aurites</it>, <it>Coquillettidia pseudoconopas </it>and <it>Coquillettidia metallica </it>as new and important vectors of avian malaria in Africa. All parasite lineages recovered clustered with parasites formerly identified from several bird species and suggest the vectors capability of infecting birds from different families.</p> <p>Conclusion</p> <p>Identifying the major vectors of avian <it>Plasmodium </it>spp. will assist in understanding the epizootiology of avian malaria, including differences in this disease distribution between pristine and disturbed landscapes.</p

Geographic Distribution, Habitat, Reproduction, and Conservation Status of Crocodilians in the Americas

The chapter gives an introductory overview on the biology of the 11 species of crocodilians inhabiting the Americas. Geographical distribution is broadly discussed in the light of biogeographical and evolutionary origins. As a broad generalization, crocodilians are morphologically, genetically, and ecologically conservative and show a high dispersal ability, which together complicate the delimitation of species boundaries. Furthermore, distinct clades of crocodilians are a result of environmental selection for different adaptive characteristics. Gene flow occurs between clades, but distinct morphological varieties are sometimes a result of environmental filters. Thus, many taxa of crocodilians can be considered ecological species. Reproductive characteristics, such as nest-site choice and female reproductive output, influence reproductive success and thus population trends, so we discuss reproductive and habitat characteristics in the light of conservation genetics. Finally, the status of crocodilians is discussed both in terms of past hunting pressure and current conservation and management initiatives. In general, crocodilians can look after themselves if they have sufficient habitat, but some species are critically endangered by hunting, even though much of their original habitat remains intact. Conservation actions must be applied locally, taking into account threats and dispersal between source and sink populations. Given the difficulty of studying the dispersal of crocodilians by direct observation in most places in Latin America, the definition of effective management units will depend on genetic studies that can be linked to economic or conservation goals